IMPERFORATED

HYMEN
OBJECTIVE:
As the researcher
develops further into
this investigation, the
following objectives
are directed.
General Objectives:
1. To investigate the
case.
2. To identify the
nursing problems and
the factors contributing
to the clients disease
process.
3. To address the
identified problems
and aid in the
recovery and
wellness of client.
Specific Objectives:
1. To know the nursing
history, personal data,
health history and
physical and functional
assessment.
2. To present the
laboratory
examinations carried
out duty for the client,
including its findings
 3. To expound the
normal physiology and
pathophysiology
imperforated hymen.
4. To discuss the
pharmacological
management of the
disease.
5. To lay at hand the
nursing care plan and
the bounds to which the
end are accomplished.
 OVERVIEW OF
IMPERFORATED
HYMEN
Imperforate hymen is at
the extreme of a spectrum
of variations in hymenal
configuration. Variations
in the embryologic
development of the
hymen are common and
result in fenestrations,
septa, bands,
microperforations,
anterior
displacement, and
differences in rigidity
and/or elasticity of
the hymenal tissue.
Inspection of the
external genitalia and
anus are important
components of the
physical examination of
the female neonate and
child. While this
examination can and
should be
accomplished by the
pediatrician, the
observant delivering
obstetrician can learn
much about the normal
variations in genital
configuration by
examining the female
neonate in the delivery
room, keeping in mind
the influence and
structural changes
induced by maternal
estrogens. Under this
influence, the labia
majora are plump, the
hymen is elastic and
often fimbriated, and
the mucosal surfaces
(ie, introitus, fossa
navicularis, vaginal
vestibule) are pale
pink.
Problem
Imperforate hymen has
been diagnosed with
prenatal ultrasound
documentation of
bladder outlet
obstruction due to
hydrocolpos or
mucocolpos.
However, in spite of
the
recommendations for
inspection of the
external genitalia
during the neonatal and
early childhood period,
variations in hymenal
anatomy commonly
escape diagnosis until
the time of menarche.
Different normal
variants in hymenal
configuration are
described, varying from
the common annular, to
crescentic, to navicular
("boatlike" with an
anteriorly displaced
hymenal orifice).
Hymenal variations are
rarely clinically
significant before
menarche. In the case
of a navicular
configuration, urinary
complaints (eg,
dribbling, retention,
urinary tract infections)
may result. Sometimes,
a cribriform
(fenestrated), septate
or navicular configuration
to the hymen can be
associated with retention
of vaginal secretions and
prolongation of the
common condition of a
mixed bacterial
vulvovaginitis.
Occasionally a hymenal
tag will protrude from
the vaginal vestibule,
leading to concerns
about a tumor or other
significant pathology.
These hymenal tags are
of no clinical
significance, and they
do not require therapy if
vaginal origin can be
excluded based on
findings from a careful
examination.
 SIGNS AND SYMPTOMS OF
IMPERFORATED HYMEN
• Abdominal Pain
• Abdominal pain crampy
• Chroic abdominal pain
• Hypogastric pain
• Lower abdominal pain
• RAP syndrome/children
• recurrent abdominal pain
• amenorrhea primary
• bulging dark hymen/exam
• painful coitus or dyspareunia
• suprapubic pain
Treatment of Imperforate
Hymen
Women suffering from such
problem should contact a
gynecologist as early as
possible. Only a gynecologist or
specialist plastic surgeon will be
able to cure the problem after
perforating the hymen
surgically.
Surgical therapy which includes
hymenotomy is recommended
for treatment of Imperforate
Hymen. Needletrip
electrocautery helps in
hemostasis of hymenal edge.
Yankauer suction tip is also
used for treatment of
imperforate hymen. They are
usually inserted through the
vagina or through the cervix
for proper excretion.
Evacuator of high speed is
sometimes required for
proper treatment. Care must
be taken to prevent infection
in the post operational phase
PERSONAL DATA
OF THE CLIENT
NAME: Ms. E
AGE: 14 years old
SEX: Female
CIVIL STATUS: Child
ADDRESS:
Nagsinamoc Lucban,
Quezon Province
NATIONALITY: Filipino
RELIGION: Catholic
PLACE OF BIRTH:
Lucban, Quezon
DATE OF BIRTH:
Lucban, Quezon
DEPARTMENT:
Gynecology, Room
number 455
ATTENDING
PHYSICIAN: Ma.
Teresita Lajara
CHIEF COMPLAINT:
Difficulty urination with
hypogastric pain for 1
week
DIAGNOSIS: Enlarged
midpositioned uterus with
hematometra bilateral
ovaries polycystic pattern.
PAST AND
PRESENT HEALTH
HISTORY

11 Gordon’s Health
Pattern
 PAST PRESENT
Health Does not does not
perception comply to perceive self
  annual check as a healthy
  up person
Does not
have regular
exercise
Perceive
self as a
healthy
person
Nutritional Has good Has poor
metabolic appetite appetite
With good With poor
skin turgor skin turgor
Without
artificial
dentition
Elimination Has pain With difficulty
when voiding in urination;
Urine; moderate in
moderate in amount;
amount; yellowish in
yellowish in color
color
Can pass out
normal stool
Stool soft in
characteristics;
brown in color
Activity- Does not Patient
Exercise go to school has limited
Stays @ activities
home due to the
Loves hospitalizati
on
watching
T.V
Cognitive- Has good With good
Perceptual vision vision
Has good Pain
sense hearing perception high;
touch and tolerable
perception
Has good
decision-
making
Can use
language
effectively
Sleep-Rest Can sleep @ Can sleep @
8 hours every 8 hours from
night 10pm- 9pm-5am
6am
Self- Undisturbed Has disturbed
concept self-concept self-concept
Has poor Has poor
posture posture
Can maintain Cannot
eye contact maintain eye
Soft voice contact
tone Soft voice
tone; usually
not audible
Role With good Shy and
Relationship relationship feels isolated
with the Quiet most
family and of the time
siblings
Usually shy
and home
bud
Stopped
going to
school;
elementary
graduate
Sexually Not Not
reproductive applicable applicable

Coping/ Utilize Usually

Stress support quiet
Tolerance
system Still
Such as dependent
family and to parents
friends to
share own
problem
Value- Roman No
Belief Catholic specific
Believes beliefs
in “quack” related to
doctors or current
“albularyo” condition
and goes to
them when
sick
 PHYSICAL
ASSESSMENT
Date of Assessment:
August 29, 2009 / 5:00
am

General Appearance:
-weak in appearance
- Pale in appearance
Skin
–Skin
–With uniform brown skin color
–Skin warm to touch
–No lesions noted
–With good skin turgor
–No edema
Head
-Rounded and symmetrical
-No infection or infestation
-With thick hair which is
black in color
-Hair evenly distributed
Eyes and Vision
-Pupils are constricted at 2-3
mm in diameter
-Both pupils are equally round
and reactive to light
accommodation
-No discharges noted
-With pale conjunctiva
-Eyebrows symmetrically
aligned
Ears and Hearing
-Color same as facial skin
-Symmetrical
-Firm and not tender
-No lesion
-No discharges noted
-Normal voice tones audible
Nose
-Symmetrical and straight
-With uniform color
-Air moves freely on both nares
-No discharge
-No lesions noted
-No tenderness
Mouth and Tongue
-With pinkish gums
-With good set of teeth, yellowish
in color
-With pale and dry lips
-With non protruding tongue
-
-Tongue whitish in color
-Without halitosis
Neck
-Straight and symmetrical
-Muscles equal in size
-With coordinated, smooth
movements with no
discomfort
-No swelling on lymph
nodes
Chest
-with symmetrical chest
expansion upon
respiration
-right and left shoulders
are at same height
-with bronchovesicular
sound heard on both lung
fields upon auscultation
-skin is intact with uniform
temperature
-no tenderness
-no retraction
Breast
• Symmetrical
• With uniform skin color
• No tenderness, masses or
nodules
• No discharge
Abdomen
-unblemished skin
-with uniform color
-with localized protrusions and
tolerable pain upon palpation
on the right lower quadrant
Back
-With straight alignment of spine
-With clear breath sound on both
lung fields upon auscultation
-No deformities
-No lesions noted
Genito-urinary

-No lesions noted

-With tolerable pain upon
urination
Upper extremities
-With IVF inserted on right
metacarpal vein
-No edema
-No lesion
-No joint deformities
Nails

• Thick and smooth

• With good capillary
refilling time of 2-3 secs.
• With pinkish nail beds
Lower extremities
-No edema
-no lesion noted
-no joint deformities
 ANATOMY AND
PHYSIOLOGY OF
IMPERFORATED
HYMEN
Types of Hymens:
A Guide for Teens
Hymen: a thin membrane that
surrounds the opening to a
young woman's vagina. Hymens
can come in different shapes. .
The most common hymen is
shaped like a half moon. This
shape allows menstrual blood to
flow out of a girl's vagina.
Imperforate hymen: An
imperforate hymen can be
diagnosed at birth but
sometimes the diagnosis isn't
made until the teen years. An
imperforate hymen is a thin
membrane that completely
covers the opening to a young
girl's or young woman's vagina.
Menstrual blood cannot flow out
of the vagina. This usually
causes the blood to back up into
the vagina and the abdomen
(belly) resulting in abdominal
and/or back pain. Some teens
may also have pain with bowel
movements and difficulty
passing urine.
The treatment for an imperforate
hymen is minor surgery to
remove the extra hymenal
tissue and create a normal
sized vaginal opening so that
menstrual blood can flow out of
the vagina.
Microperforate hymen: A
microperforate hymen is a
thin membrane that almost
completely covers the
opening to a young women's
vagina. Some menstrual
blood may be able to flow out
of the vagina but the opening
is very small.
A teen with a microperforate
hymen usually will not be able
to get a tampon into her vagina
and may not realize that she
has a very tiny opening. If she is
able to put a tampon into her
vagina she may not be able to
remove it when it becomes filled
with blood.
The treatment is minor
surgery to remove the extra
hymenal tissue making a
normal sized opening for
menstrual blood to flow out.
Septate hymen: A septate
hymen is when the thin hymenal
membrane has a band of extra
tissue in the middle that causes
two small vaginal openings
instead of one. Teens with a
septate hymen may have
trouble getting a tampon in or
trouble getting a tampon out.
The treatment for a septate
hymen is minor surgery to
remove the extra band of
tissue and create a normal
sized vaginal opening.
Illustrations of Hymen Types
PATHOPHYSIOLOGY
OF IMPERFORATED
HYMEN
 PATHOPHYSIOLOGY OF IMPERFORATED HYMEN

ETIOLOGY

Teratogenic Abnormal/inco
Genetics
Effect mplete
Embryologic
Development
 Urinary Retention Reproductive Mass
Retention Hypogastric
of Vaginal Organ
Pain
Secretion Infection
Hydronephrosis Constipation
Hematometra Back Enlarged
Pain uterus
Bleeding
Difficulty of Urination
Hematocolpos Abdominal Pain

Hematosalphinges Pelvic Pain

Vaginal
Cysts

No menstrual
Bleeding
COURSE IN THE
WARD
 DOCTOR’S ORDER RATIONALE
8-27-09
Please admit to Gyne the patient has an
Ward existing problem in her
reproductive organ
Secure consent to know if the patient
agrees with the
procedures

V/S q 4
for monitoring

NPO
for laboratory
examination
Lab. Req. CBC to know if there is
Blood typing an abnormal value
CT BT that can contribute to
platelet count the patient’s present
Urinalysis condition.
For transrectal to visualize if there
are other organs
ultrasound
affected

IVF D5LR 1L x 12
to maintain the
normal electrolyte
balance with in the
Refer to pedia for co-
BY: Dr. Lajara management
Proceed with purposes
transrectal To remove the
ultrasound done extra hymenal
tissue and create a
normal sized
vaginal opening so
that menstrual
blood can flow out
of the vagina
For BUN, To know the result
creatinine and if there is an
abnormal findings

8-28-09
For hymenectomy For removal of
after pedia clearance imperforated hymen
Follow up BUN, To visualize the
creatinine results other complications
Noted by OR, AOD
Referred to Dr.
Imperial
5:00 pm For CXR To know if there is
deviation in the lungs
8:00pm > NPO For preparation of
patient’s operation
8-29-09
May proceed with
hymenectomy
Thank you for the
following referral, will
follow up patient
6:35pm
Patient is for The procedure is
hymenotomy not not for removal but
hymenectomy for making an
opening in the hymen
POST OP ORDER
To PACU For care of post-op
and post anesthesia
patient
Vital signs every 15
For BP monitoring
mins
IVF t follow D5 LR to maintain the
1L x 20 gtts/mins normal electrolyte
balance with in the
body
Flat on bed for 6 For fast recovery
hrs. Cannot tolerate
NPO for 6 hrs. foods

Antibiotic; post-op;
Start oral meds
after 6 hrs risk for infection
-cefalexine 500 mg
TID
-MFA 500mg TID To relief and
manage pain
-ferrous sulfate OD To have
by: Dr. sufficient iron in
Baldovino the body

8-30-09
Continue meds For continuous
Reffer treatment regimen
by: Dr. Baldovino
8-31-09
Full diet G.I. tract is now in
good condition
Continue all meds
9-1-09
MGH For continuous
By: Dr. Lajara home management
and recovery

9-2-09
MGH still
By: Dr. Baldovino
LABORATORY
RESULT
08/28/09 9:45am
TEST RESULT NORMAL
NAME VALUES
BUN 6.5mg/dl 7.0 to
Kinetic 18.0
UV
Creatinine 0.6mg/dl 0.3 to 1.3
INTERPRETATION
Decrease in BUN is rare, and occur
during liver failure, when protein
metabolism is inhibited, and in
negative nitrogen balance when
protein breakdown exceeds protein
intake. Negative nitrogen balance
may occur during anorexia,
malnutrition or intravenous patient’s
therapy in patient receiving oral
nutrition.
COMPLETE BLOOD COUNT
RESULT
CBC RESULTS REFERENCE
VALUE
HEMOGLOBIN 11.7 MALE 14-
18gm/dl
FEMALE 12-15
gm/dl
HEMATOCRIT 35.2% MALE 40-
50%FEMALE
30-40%
WBC count 9500 5000-10000/ cu
mm
Differential Count
NEUTROPHILS 66 40-60

LYMPHOCYTE 34 35-40

PLATELET 450000/ cu mm 150000-

COUNT 450000/ cu mm
Clotting Time 2.00

Bleeding Time 1.20

INTERPRETATION
-When the hemoglobin level
decrease, anemia is present.
-An increase in neutrophils
indicates the presence of bacterial
infectious process.
-Decrease in lymphocytes are
associated with Hogkin’s disease,
lupus erythematosus, burns
trauma, and the administration of
corticosteroids.
URINALYSIS
 
COLOR: yellow
TRANSPARENCY:
SPECIFIC GRAVITY: 5.0
CHEMICAL TEST
            SUGAR: +
            ALBUMIN: +
PREGNANCY TEST: -
MICROSCOPIC:
            RBC: loaded
            WBC: 1-2
EPITHELIAL: +
CRYSTAL :
A.    URATES:+
ULTRASOUND REPORT
GYNECOLOGY
08/27/09 
PERTINENT DATA: Transrectal
 
I. UTERUS 10.6 x 8.4 x 8.2 cm
midpositioned
 The uterus is dilated by
homogenous medium level echoes
probably a hematometra amounting
to 287cc ( 10.0 x 6.9 x 7.3 cm)
II. ENDOMETRIUM
III. ADNEXAE  Rt. Ovary 4 x 3.7
x 2 cm
Located: Lateral/ Posterolateral/
Posterior to uterus
Left Ovary: 3.0 x 1.8 x 1.4 cm
Both ovaries have polycystic
pattern
IV. CERVIX:  ____x____x____
Nabothian cyst:  Present/ None
V. OTHERS (-) free fluid
in cul de sac
 
DIAGNOSIS:
      Enlarge midpositioned
uterus with hematometra.
      Bilateral ovaries with
polycystic pattern.
EXAMINATION KUB and PELVIC
 Result:
 
The KIDNEYS are normal in size
with intact CMB.
            The right measures (97.12)
x (36.70) x 35.57mm
    CMB= (9.22)mm
            The left measures (95.71) x
(34.38) x (38.28)mm.
         CMB= (9.80)mm
  However, both are heterogenous
with increased echogenecity and
prominent pyramids. No evidences
of stones of hydronephrosis noted.
The ureters are not dilated.
 
                  The URINARY
BLADDER is well-filled with no wall
thickening or irregularities noted.
No intraluminal echoes seen.
  The UTERUS is anteverted and
midline in orientation. It is enlarged
measuring (112.3)mm. In length
(67.30) in thickness and 81.65mm
in width. The endometrial cavity is
fluid distended sand a fluid volume
of 323.2cc.
 
  The ADNEXAE are unremarkable.
CLINICAL IMPRESSION
 
RENAL PARENCHYMAL
DISEASE BILATERAL.
NORMAL URINASRY
BLADDER WITH IONICALLY
HYDROCALPOS MOST
PROBABLY SECONDARY TO
IMPERFORATED HYMEN.
RADIOLOGY RESULT
08/29/09
 CHEST X-RAY
The lungs fields are clear with
normal lung roots.
The heart mediastinum, diaphragm
and costaphrenic sinuses appear
physiologic normal soft tissues and
asseous structures in the chest
wall.
IMPRESSION:  ESSENTIALY
NORMAL CHEST FINDING.
 
DRUG STUDY
Name of Action Indication Adverse Dosage Nursing
Drug Reaction Consider
ation

Cefale Inhibit Chronic Nausea 500mg -if large

doses are
xine cell infectio , TID given or if
therapy is
wall n due vomitin prolonged,
monitor
synthe to g, patient for
super
sis suscept abdomi infection
especially if
increa ible nal patient is high
risk.
sing micro discomf -ask patient
bacteri organis ort skin about past
reaction to
al m rash cephalosporin
or penicillin
growth therapy before
giving first
dose.
Name Action Indication Adverse Dosage Nursing
of Drug Reaction Consider
ation
Mefen Anti- Mild to Headache 500mg -take
inflammat moderatel , TID drug with
amic ory, y severe dizziness, food
Acid analgesic pain nervousne -take only
activities associate ss, GJ a
related to d with disturbanc prescribe
inhibitatio past-op es and GI d dosage
n of and post- bleeding -do not
prostaglan partum take drug
din pain, longer
synthesis menorrha than 1
gia and week
dysmenor
rhea
Name of Action Indication Adverse Dosage Nursing
Drug Reaction Consider
ation
Ferrous Elevates the -dietary Nausea,vom give drug with
senim iron supplement iting, meals
Fumarate (avoiding
concentratio of iron constipation
milk, eggs,
n, which -prevention , diarrhea, coffee and
then helps and dark stools tea) if GI
to form hgh treatment of discomfort is
or trapped in iron severe; slowly
the deficiency build up
eticuloendot tolerance
anemias
helial cells -warm patient
for storage that stool may
be dark or
and eventual
green
conversion
to usable
form of iron.
NURSING CARE
PLAN
ASSESS NURSING NURSING INTERVE RATIONA EVALUA
MENT DIAGNOS GOAL NTION LE TION
IS
S- Anxiety At the •Assesse •To •Goal
“kinakab end of d degree assess partially
r/t of anxiety the level
ahan nursing met.
upcomi interventi and reality of anxiety
ako sa of threat •Seen
ng on the pt.
aking perceived pt
operasy surgical will by the pt.
demonstr comfort
on,” as operati
ate able in
verbaliz on understa bed
ed by nding
the through
patient. use of
effective
coping
behavior.
ASSESS NURSING NURSING INTERVE RATIONA EVALUA
MENT DIAGNOS GOAL NTION LE TION
IS
•Consci •Encourag •To assist “kapag
e client to client to medyo
ous and acknowled identify nahihirapa
•Cohere ge and to
feelings n akong ,
express
nt feelings
and begin itinataas
•Increas to deal ko lang
•Monitor
verbal and
with yung ulo
ed problem ko gamit
non verbal
alertnes responses ang unan”
s . as
verbalized
•Increas
by the pt.
ed humiga
tension
ASSESS NURSING NURSING INTERVE RATIONA EVALUA
MENT DIAGNOS GOAL NTION LE TION
IS
•Pacing •Provid •Helps
back e client to
and accurat identify
forth e what is
inside informa reality
the
tion and based.
room
situatio
•With
n.
blank
expressi
on
ASSESS NURSING NURSING INTERVE RATIONA EVALUA
MENT DIAGNOS GOAL NTION LE TION
IS
S-
”nanglal
ambot
pa rin
ako,” as
verbaliz
ed by
the pt.
ASSESS NURSING NURSING INTERVE RATIONA EVALUA
MENT DIAGNOS GOAL NTION LE TION
IS
S- Activity At the end •Assess •To •Goal met
”nanglal intoleran of the energy assess •Seen pt
nursing limitation walking
ambot ce r/t level
interventio of activity through
pa rin decreas n the pt. •Encour •To the use of
ako,” as e body will age in enhance IV stand
verbaliz strength demonstr active blood and SO
ed by seconda ate and circulation
technique
the pt. ry to passive
s to
previous increase ROM
surgery. activity. exercise
ASSESS NURSING NURSING INTERVE RATIONA EVALUA
MENT DIAGNOS GOAL NTION LE TION
IS
O> •Encourag •To Kinakaya
•With e in reduce kong
complaint adequate fatigue] tumayo
of body rest and dahil
weakness sleep kapag
•With period nakahiga
limited •emphasiz ako lalo
activity •Fluid akong
e
•With intake can nanghihin
adequate
complaint increased a,
of pain fluid
intake maintaine verbalized
•Always d energy
lying on by the pt.
level.
bed
ASSESS NURSING NURSING INTERVE RATIONA EVALUA
MENT DIAGNOS GOAL NTION LE TION
IS
•assist •To
an enhance
blood
ambulati circulation
on •To
•instruct increased
to intake resistance
vitamin / maintain
tolerable
C rich level.
foods
like
citrus
fruits.
ASSESS NURSING NURSING INTERVE RATIONA EVALUA
MENT DIAGNOS GOAL NTION LE TION
IS
S> no Risk for At the end •Monitor •To Goal
subjective infection of nursing visitor/ prevent
caregivers exposure met.
complaint r/t interventio
O> traumatize n the pt. of client The
d tissue will •Change •To patient
With of reduce/cor
presence demonstr was
dressing rect
of wounds ate able to
as needed/ existing
technique, risk
With poor lifestyle
indicated demonst
factors.
hygiene changes rate
Slightly to techniqu
decrease promote es,
in safe
lympocyte
lifestyle,
environme
nt. changes
to
promote
ASSESS NURSING NURSING INTERVE RATIONA EVALUA
MENT DIAGNOS GOAL NTION LE TION
IS
•Encourag •To prevent Safe
e early pneumonia environm
ambulation
ent as
deep
breathing, evidence
couching, by
and improved
position her
change. personal
•Administe hygiene
r •To
medication determine
regimen effectivene
ss of
therapy.
ASSESS NURSING NURSING INTERVE RATIONA EVALUA
MENT DIAGNOS GOAL NTION LE TION
IS
•Adminis •To
ter determin
prophyla e
ctic effective
amitotic ness of
and therapy.
imminic
able as
indicate
d.
ASSESSM NURSING NURSING INTERVEN RATIONAL EVALUA
ENT DIAGNOSI GOAL TION E TION
S
S> Pain r/t At the end •Perform To rule out •Goal
worsing of
“masakit pa tissue of nursing pain partially
underlying
ung intervention assessmen condition of met.
pagkaka-
trauma the pt. t each time organ •Pain
opera sa from scale of 8 pain dysfunction
scale of
requiring
akin, “ surgical out of 10 occurs. treatment. the pt. is
incision will be •Assess for To help down to 3
down to 2 referred determine out of 10.
pain as possibility of
out of 10. •Seen
underlying
appropriate condition of comfortab
. organ ly lying on
dysfunction of bed
requiring
treatment.
ASSESS NURSING NURSING INTERVE RATIONA EVALUA
MENT DIAGNOS GOAL NTION LE TION
IS
•Encourag •To assist •No
e client of further
divertional explore complaint
activities. method. •Seen at
•Encourag •To frequent
e prevent intervals
adequate fatigue
rest
period
ASSESS NURSING NURSING INTERVE RATIONA EVALUA
MENT DIAGNOS GOAL NTION LE TION
IS
•Ascertain •To
client provide
knowledg comfort
e of
expectatio
n about
the pain
managem
ent
ASSESS NURSING NURSING INTERVE RATIONA EVALUA
MENT DIAGNOS GOAL NTION LE TION
IS
•Provide •To
comfort provide
measure non
rs pharmac
ologic
pain
manage
ment.
DISCHARGE PLAN
- CEFALEXIN 500mg isang
beses isang araw. Iinumin
tatlong sa oras ng 8 ng
umaga, 1 ng hapon, at 6 ng
gabi.
-FERROUS FUMARATE isang
beses isang araw. Iinumin sa
oras ng 9 ng umaga.
-MEFENAMIC ACID 500mg
tatlong beses isang araw.
Iinumin sa oras ng 8 ng
umaga, 1 ng hapon, 6 ng
gabi
HEALTH TEACHING
1.Teach patient the
importance of adequate rest
and sleep.
2. Increase fluid intake.
3. Adherence to treatment
regimen.
4. Eat nutritious foods such
as fruits and vegetables.
5. Encourage the client to
use breathing techniques
especially during times of
increased pain.
6. Instruct patient to proper
positioning in times of
difficulty in breathing or when
coughing.
THE
END
Ma’am, thanks for
everything..
We will miss you=)