FAMILY CLINIC INC COLLEGES

Manila
Nursing Program

A CASE STUDY

ON

CESAREAN DELIVERY

TONDO MEDICAL CENTER

(OB Ward)
July 18, 2009 – July 19, 2009

In partial fulfillment
of the requirements for
Related Learning Experience

Submitted by:

Level III Group E8 - A

Cuevas, Reynaldo
Parungao, April Dianne
Rabe, Reyna
Raz, Jerickson
Resumadero, Mary Ross
Revilla, Byron
Submitted to:
Mrs. Maribelle Paglinawan RN -
MAN
Clinical Instructor

INTRODUCTION
A C-section delivery is performed when a vaginal birth is not possible or is
not safe for the mother or child. Cesarean deliveries were initially performed
to separate the mother and the fetus in an attempt to save the fetus of a
moribund patient. This operation subsequently developed into a surgical
procedure to resolve maternal or fetal complications not amenable to vaginal
delivery, either for mechanical limitations or to temporize delivery for
maternal or fetal benefit.
Surgery is usually done while the woman is awake but numbed from the
chest to the feet. This is done by giving her epidural or spinal anesthesia.
The surgeon make a cut across the belly just above the pubic area. The
uterus and amniotic sac are opened, and the baby is delivered.The health
care team clears the baby's mouth and nose of fluids, and the umbilical cord
is clamped and cut. The pediatrician or nurse makes sure that the infant's
breathing is normal and that the baby is stable.
The mother is awake and she can hear and see her baby. The father or
another support person is often able to be with the mother during the
delivery. The decision to have a C-section delivery can depend on the
obstetrician, the delivery location, and the woman's past deliveries or
medical history.
Some reasons for having C-section instead of vaginal delivery are:
Reasons related to the baby: Abnormal heart rate in the baby, abnormal
position of the baby in the uterus such as crosswise (transverse) or feet-first
(breech), developmental problems such as hydrocephalus or spina bifida,
multiple babies in the uterus (triplet and some twin pregnancies)
Reasons related to the mother: Active genital herpes infection, large uterine
fibroids low in the uterus near the cervix, HIV infection in the mother,
previous uterine surgery, including myomectomy and previous C-sections,
severe illness in the mother, including heart disease, toxemia, preeclampsia
or eclampsia
Problems with labor or delivery: Baby's head is too large to pass through
mother's pelvis (cephalopelvic disproportion), prolonged or arrested labor,
very large baby (macrosomia)
Problems with the placenta or umbilical cord: placenta attaches in abnormal
location (placenta previa), placenta prematurely separated from uterine wall
(placenta abruptio), umbilical cord comes through the cervix before the baby
(umbilical cord prolapse).
Typically the recovery time depends on the patient and their pain/
inflammation levels. Doctors do recommend no strenuous work i.e. lifting
objects over 10 lbs., running, walking up stairs, or athletics for up to two
weeks.
NURSING HEALTH HISTORY

Patient’s Profile:

Name: Vicky M. Cabael

Address: P-2 Blk 9D Lot 13 A-3 Malabon City
Birthday: June 6, 1972
Age: 36 yrs old
Birthplace: Pampanga
Nationality: Filipino

Husband: Arnulfo Cabael

Occupation: Jeep Driver

Father: Avelino Martin

Mother: Vilma Calaguas
Admission Date/ Time: July 13,2009 (10:10PM)

This the case of Mrs, Vicky Cabael, a 36 yrs old mother with an OB
score of G6P5 and a TPAL of 5005. The age of gestation is 39 weeks by LMP.
Her LMP was 2nd week of October 2008, exact date unrecalled. Her EDC was
supposed to be July 21 2009. She mentioned having all 5 elderly children
delivered in a lying-in near close to their neighborhood. She was brought
there and was assessed by a midwife and went through the course of labor.
Unfortunately even with a fully dilated cervix, the fetus won’t descend. She
was on second stage of labor when admitted to Tondo Medical Hospital OB
Ward. Mrs. Cabael was also examined for vulvar edema and the amniotic
discharge was thickly meconium stained which is an indication of fetal
distress. Upon admission, she had the following VS:

 T = 37.2°C
 P = 96 bpm
 R = 20 bpm
 BP=130/100 mmHg
Dr. N. Ramos, her surgeon gave her the following orders: July 13, 2009
o > NPO
o IVF: D5LRS 1L x 20 gtts/min
PN55 1L x 20 gtts/min
o For CBC, U/A
o For abdominoperineal prep
o Secure 2 U FWB, PTAC
o Therapeutic: Cefazolin 2g IV LD then 500mg IV q6h ANST
An Elective Low Transverse Cesarean Section was opted and performed by
Dr. N. Ramos (Surgeon) and Dr. Gomez(Anesthesiologist) assisted by
surgical Nurse L. Contiling. Mrs. Cabael had bilateral tubal ligation right after
the successful delivery to a live baby boy at 10:34pm (AS: 7,9).

PRESENT AND PAST MEDICAL HISTORY:

Present History:

91/2hrs PTA, patients started to experienced lumbosacral pain with

irregular uterine contractions.. Due to prolonged labor and descent of fetus
and vulvar edema, she was referred in this institution and was admitted.

Patient undergoes Elective Low Transverse C-Section, the remaining

amniotic fluid thickly meconium stained, placenta implanted posterofundally;
both ovaries and fallopian tubes grossly normal, proceeded to do bilateral
tubal libation(TBL) using modified Pomery Technique.

Past Medical History

• Childhood illness
• Chickenpox and Measles

Immunization
• None

Previous Hospitalization/Operation
• Normal vaginal delivery to 5 children and 1 miscarriage (D&C
performed)

Medications
• None

Allergies
• None

PHYSICAL ASSESSMENT

Mrs. Vicky Cabael is an 36 year old female stands 5’5 she is

conscious and coherent upon interaction with vital signs where taken and
was assessed accordingly.

Assessment of the head

Head is round in shape. Hair is long and thick straight and evenly
distributed. Scalp is smooth and white in color
Assessment of the eyes
Her eyes are symmetrical, black in color. Pupils constricts when
diverted to light and dilates when she gazes afar, conjunctivas are pink.
Eyelashes are equally distributed and skin around the eyes is intact. The
eyes involuntarily blink.

Assessment of the ears

Ears are clean no ear wax was noted and of the same size and shape.
Patient can her normally when spoken softly

Assessment of the nose

With narrow nose bridge there were discharges noted upon inspection.
No swelling of the mucous membrane and presence of nasal hairs were seen.

Assessment of the mouth

She has not had a complete set of teeth with minimal dental caries
noted. Oral mucosa and gingival are pink in color, moist and there were no
lesions nor inflammation noted. Tongue is pinkish and free of swelling and
lesion. Presence of uvula was noted and there is absence of swelling

Assessment of the neck

Lymph nodes noted. Neck has strength that allows movement back
and forth left and right. Patient is able to freely move her neck.

Assessment of the lungs and thoracic region

No reports of pain during the inhalation and exhalation.

Assessment of the heart

Heart was not assessed

Assessment of the abdomen

Abdominal movement as with respiration. There is incision on the lower
abdominal portion. The post operative incision appears reddish as normal
finding for the first few days after the operation. The sutures were intact with
no discharges noted.

Assessment of the upper extremities

Skin: fair in color; presence of marks and scars. Skin is smooth t and soft to
touch.
Hands: Medium in size with 5 fingernails in each side. Nails are short, small
dusty particles are present. A capillary refill of 1-2 seconds was noted.
Arms: Able to move through active ROM. Able to extend arms in front or
push them out to the side.

Assessment of the lower extremities

Size of the feet is undefined with lines on the sole, presence of scars
and lesions. Ten fingers are present. Nails are clean and short therefore
indicate negative Homan’s sign. Edematous on both right and left feet.

Assessment of the genitourinary

Patient urinates 2-4 times a day and is constipated since delivery.

Assessment of the perineum

Absence of lesions and swelling. Vulvar edema no longer evident.

Neurological assessment
Behavior – Patient is silent but is conscious and coherent upon interaction.
She sits and walks if she wants to.

Motor functioning- Able to move extremities through active ROM. Able to

extend arms front and resist active as pushed down/up on his hands.

Reflexes- blinking reflex and deep tendon reflex.

Sensory functioning – patient’s sensory system is intact; she was able to

distinguish touch and pain. Hot and cold.
 ANATOMY AND PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM

The External Reproductive Organs

Mons Pubis or Veneris – pad of fat which lies over the symphysis pubis
covered by skin and at puberty, by short hairs; protects the surrounding
delicate tissues from trauma.

Labia Majora – two folds of skin with fat underneath; contain Bartholin’s
glands (believed to secrete a yellowish mucus which acts as a lubricant
during sexual intercourse. The openings of the Bartholin’s glands are
located posteriorly on either side of the vagina orifice.

Labia Minora – two thin folds of delicate tissues; form an upper fold encircling
the clitoris (called the prepuce) and unite posteriorly (called the fourchetes,
which is highly sensitive to manipulation and trauma that is why it is often
torn during a woman’s delivery.)

Clitoris – small, erectile structure at the anterior junction of the labia minora,
which is comparable to the penis in its being extremely sensitive. Landmark
for catheterization
Vestibule – narrow space seen when the labia minora are separated.

Urethral Meatus – external opening of the urethra; slightly behind and to the
side are the openings of the Skene’s glands (which are often involved in
infections of the external genitalia).

Vaginal orifice/Introitus – external opening of the vagina, covered by a thin

membrane (called hymen) in virgins. Myrtiform carunculae

Perineum – area from the lower border of the vaginal orifice to the anus;
contains the muscles (e.g., pubococcygeal and levator ani) which support the
pelvic organs, the arteries that supply blood and the pudendal nerves which
are important during delivery under anesthesia.

The Internal Reproductive Organ

Vagina – a 3-4 inch long dilatable canal located between the bladder and the
rectum; contains rugae (which permit considerable stretching without
tearing); passageway for menstrual discharges, copulation and fetus.
In the reproductive process, the vagina functions as a two-way street,
accepting the penis and sperm during intercourse and roughly nine months
later, serving as the avenue of birth through which the new baby enters the
world .

Uterus – hollow pear-shaped fibromuscular organ 3 inches long, 2 inches

wide, 1 inch thick, and weighing 50-60 grams in a non-pregnant woman; hold
in place by broad ligaments (from sides of the uterus to pelvic wall; also hold
Fallopian tubes and ovaries in place) and round ligaments (from sides of
uterus to mons pubis); abundant blood supply from uterine and ovarian
arteries; composed of three muscle layers (perimetrium, myometrium, and
endometrium). Consists of three parts: corpus (body) – upper portion with
triangular part called fundus; isthmus – area between corpus and cervix
which forms part of the lower uterine segment; and, - cylindrical portion.
Organ of menstruation, site of implantation and retainment and nourishment
of the products of conception. Main support comes from cardinal ligaments.

Fallopian Tubes – 4 inches long from each side of the fundus; widest part
(called ampulla) spreads into fingerlike projections (called fimbriae).
Responsible for transport of mature ovum from ovary to uterus; fertilization
takes place in its outer third or outer half.

Ovaries – almond-shaped, dull white sex glands near the fimbriae, kept in
place by ligaments. Produce, mature and expel ova and manufacture
estrogen and progesterone.

The Cervix -The vagina ends at the cervix, the lower portion or neck of the
uterus. Like the vagina, the cervix has dual reproductive functions.
After intercourse, sperm ejaculated in the vagina pass through the
cervix, then proceed through the uterus to the fallopian tubes where,
if a sperm encounters an ovum (egg), conception occurs. The cervix is
lined with mucus, the quality and quantity of which is governed by
monthly fluctuations in the levels of the two principle sex hormones,
estrogen and progesterone.
When estrogen levels are low, the mucus tends to be thick and sparse,
which makes it difficult for sperm to reach the fallopian tubes. But when an
egg is ready for fertilization and estrogen levels are high the mucus then
becomes thin and slippery, offering a much more friendly environment to
sperm as they struggle towards their goal. (This phenomenon is employed by
birth control pills, shots and implants. One of the ways they prevent
conception is to render the cervical mucus thick, sparse, and hostile to
sperm.)
INTERNAL REPRODUCTIVE STRUCTURE
PATHOPHYSIOLOGY OF CESAREAN DELIVERY

Release of FSH by

the anterior pituitary gland

Development of the graafian follicle

Production of estrogen (thickening

of the endometrium)

Release of the luteinizing hormone

Ovulation (release of mature ovum from

the graafian follicle)

 Ovum travels into the fallopian tube

Fertilization (union of the ovum

and sperm in the ampulla)

Zygote travels from the fallopian tube

to the uterus

Implantation

Development of the fetus/embryo &

placental structure until full term

PRELIMINARY SIGNS OF LABOR

Lightening Braxton Hicks Contraction Ripening of the cervix

(descent of the fetal (false labor) (Goodell’s Sign

wherein

head into the pelvis) >begin and remain irregular the cervix feels
softer like

>1st felt abdominally consistency of the

earlobe

>pain disappears with ambu-

lation

>do not increase in duration

and intensity

>do not achieve cervical

dilatation
 TRUE LABOR

Uterine Contractions SHOW Rupture of

Membranes
>increase in duration (pink-tinge of blood, (rupture of the
amniotic sac)

and intensity a mixture of blood and fluid)

>1st felt at the back &

radiates to the abdomen

>pain is not relieved no

matter what the activity

>achieve cervical dila-

tation

Failed to progress labor

(due to previous cesarean birth, cervical arrest,

cervical atrophy)

increase risk for fetal distress

(meconium staining, hypoxia)

Increase risk of fetal death

 Emergent cesarean delivery

(the incision made on the lower part of the abdomen)

Expulsion of the fetus

Expulsion of the placenta

(accompanied by bloodless approximately

1000-1500 mL)

Cesarean Delivery or C- Section. Cesarean delivery is defined as the

delivery of a fetus through a surgical incision through the abdominal wall
(laparotomy) and uterine wall (hysterotomy).Caesarean section is a life-
saving procedure firmly ensconced in obstetric practice. With the advances
in anaesthetic services and improved surgical techniques, the morbidity and
mortality of this procedure have come down considerably. This has, albeit
wrongly, emboldened obstetricians to perform more and more Caesarean
sections, generating a universal upswing that has hit both developing and
developed countries.
The words cesarean and section are both derived from verbs that mean to
cut; thus, the phrase cesarean section is a tautology. It is preferable to use
the terms cesarean delivery or cesarean birth.
Pathophysiology
Most of the physiological changes occurring during a cesarean delivery are
secondary to the physiological adaptations to pregnancy, the medical or
obstetrical complication affecting the mother, or secondary to obstetrical
complications directly related to the pregnancy (eg, preeclampsia). The
method of anesthesia used to perform the procedure also impacts the
physiological adaptations that the mother undergoes during the procedure.
Maternal and fetal indicationsIndications for cesarean delivery that benefit
both the mother and the fetus include abnormal placentation, abnormal
labor due to cephalopelvic disproportion, and those situations in which labor
is contraindicated.In the presence of a placenta previa (ie, the placenta
covering the internal cervical os), attempting vaginal delivery places both
the mother and the fetus at risk for hemorrhagic complications. This
complication has actually increased as a result of the increased incidence of
repeat cesarean deliveries, which is a risk factor for placenta previa and
placenta accreta. Both placenta previa and placenta accreta carry increased
morbidity related to hemorrhage and need for hysterectomy. Cephalopelvic
disproportion can be suspected based on possible macrosomia or an arrest
of labor despite augmentation. Many cases diagnosed as cephalopelvic
disproportion are the result of a primary or secondary arrest of dilatation or
arrest of descent. Predicting true primary or secondary arrest of descent due
to cephalopelvic disproportion is best assessed by sagittal suture overlap,
but not lambdoid suture overlap, particularly where progress is poor in a trial
of labor. Continuing to attempt a vaginal delivery in this setting increases the
risk of infectious complications to both mother and fetus from prolonged
rupture of membranes. Less often, maternal hemorrhagic and fetal metabolic
consequences occur from a uterine rupture, especially among patients with a
previous cesarean delivery. Vaginal delivery can also increase the risk of
maternal trauma and fetal trauma (eg, Erb-Duchenne or Klumpke palsy and
metabolic acidosis) from a shoulder dystocia. Contraindications to labor:
Among women who have a uterine scar (prior transmural myomectomy or
cesarean delivery by high vertical incision), a cesarean delivery should be
performed prior to the onset of labor to prevent the risk of uterine rupture,
which is approximately 4-10%.

LABORATORY RESULTS

Urinalysis

Date Ordered: July 13, 2009

Date Performed: July 13, 2009

Microscopic Exam Chemical Exam

Color: Yellow Albumin: Positive
Transparency: Hazy Sugar: Positive
Rection pH: 5.0 (Normal: 7.35-7.45)
Specific Gravity: 5.0 (Normal: 1.010-1.025)
Pus Cells: 1
Bacteria: few
Squamous Cells: few

Hematology

Result Normal Values Interpretation Significance

RBC 5.4 4.5 – 6.0 x 10/L Normal
Indicates
WBC 18.8 5 – 10 x 10/L Increase presence of
infection
HgB 149 110 – 160 g/dl Normal
Indicates hyper
Hct 0.45 0.30 Increase
coagulation
Platelet 195 150 – 400 x 09/L Normal
Blood Type A+

DIFFERENTIAL COUNTING

M 0.033 0.00 – 0.070 Normal

Indicates high
Lymphocytes 0.103 0.20 – 0.40 Decrease risk for acquiring
infection

DISCHARGE PLANNING
NURSING PRIORITIES
1. Promote family unity and bonding.
2. Enhance comfort and general well-being.
3. Prevent/minimize postoperative complications.
4. Promote a positive emotional response to birth experience and parenting
role.
5. Provide information regarding postpartal needs.

DISCHARGE GOALS
1. Family bonding initiated
2. Pain/discomfort easing
3. Physical/psychological needs being met
 4. Complications prevented/resolving
5. Positive self-appraisal regarding birth and parenting roles expressed
6. Postpartal care understood and plan in place to meet needs after
discharge

M – Medication
 Take home medication as prescribed by the Physician.
 Instruct patient and relative about the proper way of taking medications.
 Explain the proper drug dosage and time of intake and as much as
possible comply with drug regimen especially with antibiotics.
 Daily intake of vitamins and iron supplements for 4 to 6 weeks is
recommended for breastfeeding mothers to ensure nutritious milk supply
to the infant.

E – Environment / Exercise
 Instructed patient to stay in calm and clean environment, if possible.
 Home environment must be free from slipping or accident hazards.
 Encourage the patient to exercise (walking and post-partum exercises
such as abdominal breathing, kegel, Chin to chest and arm raising).

T – Treatment
 Stressed the importance of perineal cleaning to prevent infection, to ease
the woman and eliminate odor. Flush perineum with warm water after
each voiding, wipe it dry from front to back. Apply perineal pad from front
to back as well.
 Demonstrate and observe incision site cleaning and watch for signs of
infection (redness, swelling, unusual discharge)

H – Health Teachings
 Instructed mother to come back to the hospital for post-partum check-up/
clinic visit (4 to 6 weeks after delivery).
 Advised mother to visit the hospital or their local Barangay office for the
infant’s immunization and check up.
 Encourage and explain the importance of breastfeeding to the client.
Breastfeeding, especially the first milk, colostrum can reduce postpartum
bleeding/hemorrhage in the mother, and to pass immunities and other
benefits to the baby.
 Advice client to let her child expose to mild sunlight in order to balance
and avoid excess bilirubin in the blood (jaundice).
 Encouraged client to have hot sitz bath.
 Post-partum diet should be rich in protein, iron and vitamins to promote
healing. Lactating women need an additional 500 – 800 calories per day.
 Instructed to promote adequate fluid intake
 Discouraged patient to participate in strenuous activities that might
precipitate stress and trauma to the wound and avoid lifting heavy objects
for 1-2 weeks. Light housekeeping chores may be resumed on the second
week and back to normal activities by 4 to 6 weeks.
 Sexual intercourse is usually resumed after the first post-partum check
up. Usewater soluble lubricant to reduce painful intercourse.

O – Observable Signs and Symptoms

Instructed patient to report to immediately to the hospital or physician report
immediately if any of the following signs and symptoms appear:
 Heavy vaginal bleeding or bright red vaginal discharge
 Fever
 Foul smelling lochia
 Swollen, tender and hot area on her legs
 Burning sensation on urination or inability to void
 Persistent pelvic pain

D – Diet
 Encouraged client to increase intake of high fiber foods to avoid
constipation
 Instructed to increase fluid intake and eat nutritious foods such as fruits
and vegetables.
 Malungay leaves and soups are highly recommended for breastfeeding
mothers.

S – Social Services
 Advised patient to see the Social Services Department of the hospital or a
relative can check with the local municipal office if they can avail of
financial aid so they can settle their hospital bill.

Conclusion and recommendations

With a multitude of health care delivery systems, implementing

universal protocols becomes an onerous task. To actively battle the
unhealthy trend of increasing Caesarean section rates, the impetus for
change has to come from both the individual practitioners and institutional
caregivers. Women have to be well educated on their basic right to a vaginal
delivery. They must also be actively informed that a Caesarean section does
not automatically protect maternal and foetal health.
 NURSING CARE PLAN
NURSING INTERVENTION
ASSESSMENT PLANNING (I = Independent, D = Dependent, RATIONALE EVALUATION
DIAGNOSIS C = Collaborative)
Subjective: Risk for STG: Independent -To establish a Patient is
– none infection related After 4 hours of -Monitor vita lsigns baseline data expected to be
inadequate nursing free of
Objective: primary intervention, -Inspect dressing and perform -Moist from drainage can be infection, as
- dressing dry defenses patient will be wound care source of infection evidenced by
and intact secondary to able to normal vital
- Monitor white - Rising WBC indicates body’s
surgical incision understand signs and
blood count (WBC) efforts to combat pathogens;
-•V/S taken as causative absence of
normal values: 4000 to 11,000
follows: factors, identify purulent
- Monitor Elevated mm3
T: 37.3 signs of drainage from
temperature,
P: 80 infection and wounds,
redness, swelling, increased -these are signs
R: 19 report them to incisions, and
pain, or purulent drainage at of infection
BP: 120/80 health care tubes.
Incision sites
provider
accordingly.
- Wash hands and teach -Washing between procedures
patient to proper hand reduces the risk of transmitting
LTG:
washing procedure. pathogens from one area to
After 2-3 days
another
of nursing
intervention, - Encourage fluid intake of Fluids promote diluted urine and
patient will 2000 ml to 3000 ml of water frequent emptying of bladder;
achieve timely per day reducing stasis of urine, in turn,
wound healing, (unless contraindicated). reduces risk of bladder infection
be free of or urinary tract infection (UTI).
purulent
drainage or These measures reduce stasis
erythema, be - Encourage coughing and of
afebrile and be deep breathing; consider use secretions in the lungs and
free of infection. of incentive spirometer. bronchial tree. When stasis
occurs, pathogens can cause
URI including pneumonia.
Independent:
– Administer antibiotics. Antibiotics have bactericidal
effect that combats pathogens.

NURSING INTERVENTION
ASSESSMENT PLANNING (I = Independent, D = Dependent, RATIONALE EVALUATION
DIAGNOSIS C = Collaborative)
Subjective: Risk for Short Term Goal: INDEPENDENT After 8º of
- Ang sakit ng constipation r/t Within 8º of INTERVENTIONS: nursing
tiyan ko, para post pregnancy nursing · Ascertain normal bowel · This is to determine the interventions,
akong may 2° cesarean interventions, functioning the patient, about normal bowel pattern. the patient was
kabag section the patient will how many times a day does able to identify
 DRUG STUDY
DRUG PHARMACOLOGIC INDICATIONS AND ADVERSE EFFECTS DESIRED NURSING RESPONSIBILITIES/
ORDER ACTION OF DRUG CONTRAINDICATIONS OF THE DRUG ACTION PRECAUTIONS
Ketorolac Inhibits Indications: Edema. Less Analgesic Assess clients history of allergy to
30 mg IV prostaglandin Short-term management of frequently, NSAIDs,
then q6h synthesis, but has a pain, used to treat pain hypersensitivity
after greater analgesic following a procedure but reactions (such as Check VS and peripheral edema
ANST properties than may also be used for such anaphylaxis,
other anti- things as pain caused by bronchospasm, Educate client of the common side
inflammatory kidney stones, back pain or laryngeal edema, effect which may include nausea,
agents. cancer pain. tongue edema, vomiting, peripheral edema, GI
hypotension), upset, purpura or dizziness.
Contraindicated in: flushing, weight gain,
Patients with a previously or fever. Very
demonstrated infrequently,
hypersensitivity to ketorolac, asthenia.
and in patients with the
complete or partial
syndrome of nasal polyps,
angioedema, bronchospastic
reactivity or other allergic
manifestations to aspirin or
other non-steroidal anti-
inflammatory drugs (due to
possibility of severe
anaphylaxis). As with all
NSAIDs, ketorolac should be
avoided in patients with
renal (kidney) dysfunction.
(Prostaglandins are needed
to dilate the afferent
arteriole; NSAIDs effectively
reverse this.) The patients at
highest risk, especially in the
elderly, are those with fluid
imbalances or with
compromised renal function
(e.g., heart failure, diuretic
use, cirrhosis, dehydration).
DRUG PHARMACOLOGIC INDICATIONS AND ADVERSE EFFECTS DESIRED NURSING RESPONSIBILITIES/
ORDER ACTION OF DRUG CONTRAINDICATIONS OF THE DRUG ACTION PRECAUTIONS
Cefazolin Inhibits bacterial Indications: Superfinfections, Antibacterial Assess allergy to cefazolin, if
2g IV LD cell wall synthesis Surgical prophylaxis, treats urticaria, seizures (in allergic do not administer drug.
then and produce a respiratory, urinary ad skin high dozes)
500mg IV bactericidal action. infections, treats bone and Record VS and I and O, report
q6h ANST joint infections, genital abnormal findings which may
The onset of action infections and endocarditis include elevated body