NCP Drug Study Group 1
NCP Drug Study Group 1
NCP Drug Study Group 1
TEAM MEMBERS
Aguinaldo, Maria Casandra M.
Amago, Jhulliana Cassandra Joy S.
Aritcheta, Mae Louise G.
Bandong, Krizandra Xia F.
Cabasag, Maebelyn M.
David, Dheserie V.
Dela Cruz, Cassandra Grace M.
Erasquin, Kristel B.
GROUP 1 CASE STUDIES: VERSIONS
Mrs. Teresita Aquino a 31 years old pregnant woman at 36 weeks gestation
admitted to the hospital. The woman is known for having a twin pregnancy and
throughout her pregnancy, she had experienced significant nausea and vomiting.
On examination her blood pressure is 110/80, pulse rate is 80 bpm, respiratory
rate is 18 bpm and fundal height is 41 cm. Ultrasound reveals a concordant
growth of the twin, twin pregnancy with dividing membranes with adequate
amniotic fluid, twins are presenting vertex to vertex, and lastly ultrasound
finding shows consistent with vasa previa.
INTRODUCTION
Good Afternoon, Ma’am. We are the Group 1 and we would like to present to
you for today is our NCP’s and Drug Studies. Before presenting, I’ll begin by
explaining the patient’s profile and our case study. Followed by our NCP’s and
Drug Studies.
PATIENT’S PROFILE
NAME: Teresita Aquino DATE OF ADMISSION: Feb. 22, 2021
AGE: 31 yrs. old TIME OF ADMISSION: 2:00 pm
ATTENDING PHYSICIAN: Dr. Claridad
GENDER: Female
DATE OF BIRTH: Jan. 15, 1990
MARITAL STATUS: Married
ADDRESS: Dagupan City, Pangasinan
OCCUPATION: House wife
RELIGION: Roman Catholic
HOBBIES: Cooking and reading books
7 NCP’s
NCP 1
NURSING
ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION
ANALYSIS
Impaired tissue perfusion Vasa previa may lead to Short Term: Independent: Independent: Short Term:
Subjective Data: decrease perfusion due After 8 hours of nursing
related to decreased blood
to the umbilical cord’s intervention, the client will 1. Advise the client to have a 1. Reduces the risk of bleeding After 8 hours of nursing
“Nakakaramdam po ako ng flow
blood vessel being be able to verbalize pelvic rest which means and infection. And that it will intervention, the client was
pagkahina “ as verbalized by keep the client’s higher-risk able to verbalized
the patient compressed by the understanding of risk factors no sexual intercourse or
pregnancy as safe as possible understanding of risk factors or
presenting part of the or condition, therapy pelvic exam
fetus. regimen and when to contact condition, therapy regimen,
healthcare 2. This is to examine the side effects of medications, and
2. Encourage client to go to
Objective Data: clinic for ultrasound developing of the fetus and when to contact healthcare
looks for other birth detects
V/S taken as follows: as well as the problems
BP: 110/60 mmHg Long Term: with the mother Long Term:
HR: 80 bpm After 72 hours of nursing 3. Check vaginal discharge for After 72 hours of nursing
intervention, the client will 3. Dark colored blood means intervention, the client was
FHR: 160 to 180 any signs of bleeding
be able to comply with fetal hemorrhage—less able to comply with prenatal
bpm
prenatal check-ups and oxygen from the baby check-ups and follow doctor’s
follow doctor’s advice to advice to allow the pregnancy
allow the pregnancy to 4. Encourage health teaching 4. To allow pregnancy to to progress and to increase
progress and to increase such as bed rest and follow progress and to increase chances for fetal survival
chances for fetal survival up check up chances for fetal survival
Dependent: Dependent:
5. Betamethasone can help
5. Administer steroids such as speed up fetal lung maturity
Betamethasone as prescribed
by doctor
Subjective:
Risk for fetal Vasa previa is an incredibly rare, Short term goal: 1. Assess the vital signs 1. Assess wellbeing of the Short term goal:
hemorrhage related to but severe, complication of mother and detect After implementing
After implementing
nursing intervention,
vasa previa pregnancy. In vasa previa, some nursing intervention, 2. Monitor fetal heart rate underlying health
the baby is now free
Objective: of the fetal umbilical cord blood the baby will be free problems from any signs of
vessels run across or very close to from any signs of 3. Pelvic rest is suggested hemorrhage
BP: 110/70 mmHg the internal opening of the cervix. distress or hemorrhage 2. Detect abnormal
PR: 80 bpm These vessels are inside the 4. Deliver the baby before responses which indicate
RR: 18 bpm membranes, unprotected by the rupture of the membrane hypoxia or distress Long term goals:
Fundal height: 41 cm umbilical cord or the placenta. As Long term goals: After implementing
such, they are at risk of rupturing After implementing 5. Administer antenatal 3. It is often suggested nursing intervention,
when the membranes break. corticosteroids which means that the baby is now
nursing intervention,
nothing should be delivered safely
the baby will deliver
safely 6. Planned cesarean delivery placed in vagina
between 34-37 weeks of
gestation 4. This can cause the baby
to lose a lot of blood
7. Negative blood should be
available 5. Helps the baby’s lungs
in case need to be
delivered early
6. In order to prevent the
rupturing of fetal blood
vessel
7. In case of severe
anemic neonate
Subjective data: “Bigla na Impaired fetal gas exchange r/t Placenta previa is the After 8 hours of nursing Independent: Provides baseline data on
lang ako dinugo” as development of placenta in the maternal blood loss. After 8 hours of nursing
altered blood flow and interventions, the patient will
vervbalized by the patient lower uterine segment, •Assess vital signs (pulse, interventions, the patient was
decreased surface area of gas verbalize understanding of able to verbalize understanding
exchange at site of placental partially or completely causative factors and respirations, and blood • Systemic rest is mandatory
Objective data: covering the internal cervical pressure every 15minutes). and important throughout all of causative factors and
detachment. appropriate Interventions. appropriate interventions
os. The cause is unknown, but phases of disease to reduce
VS: a possible theory states that the •Maintain bed rest or chair rest fatigue, and improve strength.
BP: 110/70 embryo will implant in the when indicated. Provide
PR: 80 bpm lower uterine segment if the frequent rest periods and •Provide objective evidence
RR: 18 bpm deciduas in the uterine fundus uninterrupted night time sleep. of bleeding.
FUNDAL HEIHGT: 41 cm is not favorable. Complications
CERVIX: 4cm are immediate hemorrhage •Monitor amount and type •To promote placental
FHR: 140 bpm shock, and maternal death; of bleeding. perfusion.
fetal mortality; and postpartum
hemorrhage. •Position mother on her left •Prevent stearing of placenta
side. if placenta previa is the cause
of bleeding.
•Restrict vaginal examination.
•Monitor uterine contractions •Assess whether labor is
and fetal heart rate by external present and fetal status and
monitor. external system avoids cervical
trauma.
•Maintain positive attitude
toward about fetal outcome. •Supports mother and child
bonding.
•Provides adequate fetal
oxygenation despite of lowered
maternal circulating volume
DAVID, DHESERIE V.
NCP 4
ASSESSMENT NURSING DIAGNOSIS NURSING ANALYSIS PLANNING INTERVENTIONS RATIONALE EVALUATION
Subjective: “ Nurse, I feel Deficient Fluid Volume as Deficient Fluid Volume After a 4 hours of Nursing INDEPENDENT: 1. A decrease in circulating blood After a 4 hours of Nursing
Nauseous and Thirsty” as evidenced by Nausea and (also known as Fluid Intervention, the Patient will 1. Monitor and document vital volume can cause hypotension Intervention, the Patient has:
stated by the Mother Vomiting Volume Deficit (FVD), be able to: signs, especially BP and HR. and tachycardia. Alteration in HR
hypovolemia) is a state or is a compensatory mechanism to 1. Demonstrated lifestyle
Objective: condition where the fluid LONG TERM: 2. Monitor active fluid loss from maintain cardiac output. Usually, changes to avoid
VS are taken as follows: output exceeds the fluid 1. Demonstrates lifestyle wound drainage, tubes, the pulse is weak and irregular if progression of dehydration
intake. It occurs when the changes to avoid diarrhea, bleeding, and electrolyte imbalance also
BP: 110/70 mmHg body loses both water and vomiting; maintain accurate occurs. Hypotension is evident in 2. Patient verbalized
progression of
RR: 18bpm electrolytes fro m the ECF input and output record. hypovolemia. awareness of causative
dehydration factors and behaviors
PR: 80bpm in similar proportions.
Fundal Height: 41cm Common sources of fluid 3. Urge the patient to drink the 2. Fluid loss from wound drainage, essential to correct fluid
loss are the gastrointestinal 2. Patient verbalizes prescribed amount of fluid. diarrhea, bleeding, and vomiting deficit.
tract, polyuria, and awareness of causative cause decreased fluid volume and
increased perspiration. factors and behaviors 4. Assess skin turgor and oral can lead to dehydration. 3. Patient explained
essential to correct fluid mucous membranes for signs measures that can be taken
deficit. of dehydration. 3. Oral fluid replacement is to treat or prevent fluid
indicated for mild fluid deficit volume loss.
3. Patient explains measures 5. Note the presence of nausea, and is a cost- effective method
that can be taken to treat vomiting, and fever. for replacement treatment. 4. Patient described
or prevent fluid volume symptoms that indicate the
loss. 6. Monitor BP and HR for 4. Signs of dehydration are also need to consult with health
orthostatic changes detected through the skin. care provider.
4. Patient describes
symptoms that indicate 5. 5.These factors influence intake,
the need to consult with fluid needs, and route of
replacement.
health care provider.
6. A common manifestation of fluid
loss is postural hypotension. It is
manifested by a 20-mm Hg drop
in systolic BP and a 10 mm Hg
drop in diastolic BP.
Subjective data: Deficient Fluid Volume r/t Placenta Previa refers to the Short term goal: Independent: To obtain baseline data Patient will able to
“Bigla na lang sumakit ang Active Blood Loss Secondary to presence of placental tissue that Administer Tocolytics to delay Provides information about understand the cause of
tiyan ko” as vervbalized by the Disrupted Placental your delivery for a short time Monitor Vital Signs active bleeding versus old blood, bleeding and the both
extends over the internal tissue loss and degree of blood
patient Implantation cervical os. Because this can and Plan for C- Section and alsoAssess color, odor, consistency mother and baby are normal
loss
lead to severe antepartum, Decreased Bleeding and amount of vaginal bleeding;
Objective data: intrapartum, and/or postpartum weigh pads Assessment provides
Woman present with a known Long term goal: information about possible
bleeding, placenta Previa is
twin gestation and ultrasound Upon discharge the patient will Assess baseline data and note infection, placenta previa or
associated with high risks for changes. abruption. Warm, moist, bloody
finding consistent with Vasa be free from bleeding and
preterm birth and maternal and normal examination result environment is ideal for growth
Previa, where a fetal vessel fetal/neonatal morbidity. of microorganisms.
Patient will maintain fluid Dependent/ collaborative:
overlies the internal cervical os volume at a functional level
VS: possibly evidenced by adequate Monitor lab. Work as obtained:
BP: 110/70 Lab Work provides information
urinary output and stable vital Hgb & Hct, Rh and type, cross about degree of blood loss;
PR: 80 bpm signs. match for 2 units RBCs, prepares for possible
RR: 18 bpm urinalysis, etc. transfusion. Ultrasound provides
FUNDAL HEIHGT: 41 cm Scheduled for ultrasound as info about the cause of bleeding
CERVIX: 4cm ordered. Intervention increases available
EFFACED: 90% O2 to saturate decreased
PRESENTING PART: Provide supplemental O2 as hemoglobin
VERTIX ordered via face mask or nasal
AFTER 2 HRS OF LABOR, cannula @ 10-12 L/min.
THE PATIENT DILATES TO
6 cm
FHR: 140 bpm BASELINE
AND THEN INCREASES TO
170 bpm
ERASQUIN, KRISTEL B.
NCP 6
NURSING NURSING
ASSESSMENT PLANNING INTERVENTIONS RATIONALE EVALUATION
DIAGNOSIS ANALYSIS
Subjective: Risk of Uterus does not Short term goal: Independent: For baseline data and to monitor the changes of vital Short term goal:
“Ilang araw na simula Postpartum contract strongly after 1-2 hours of Monitor and record vital signs. signs After 1-2 hours of nursing
noong nanganak ako Hemorrhage enough nursing intervention, intervention, the goal met.
pero malakas pa rin related to Vasa the patient will: Assess and record the type, amount, and The amount of blood loss will help to determine the The patient was able to
ang pagdudugo ko” Previa. site of the bleeding; Save all perineal pads appropriate replacement need of the patient. maintain blood pressure of at
Objective: Breaking of uterine Maintain blood used during bleeding and weigh them to least 100/60 mm Hg.
Confusion blood vessels pressure of at determine the amount of blood loss. The degree of the contractility of the uterus will The patient was able to
Irritablity least 100/60 measure the status of the blood loss. Placing one hand maintain a normal respiratory
Vital signs: mm Hg. Assess the location of the uterus and just above the symphysis pubis will prevent possible and heart rate.
B/P: 110/70 mm Hg Maintain a degree of the contractility of the uterus/ uterine inversion during a massage. . The patient was able to
HR: 80 bpm Bleeding normal Massage boggy uterus using one hand and have a balanced 24-
RR: 18 bpm respiratory and place the second hand above the symphysis hour intake and output
heart rate. pubis. This will help in determining the management of the
Have a situation thus preventing further complications. Long term goal: After 3
balanced 24- Review the records and note certain weeks of nursing intervention
hour intake conditions such as retained placental This will help in determining the fluid loss. A urine the goal met.
and output. fragments, any laceration, abruptio placenta, output of 30-50 ml/hr or more indicates an adequate The patient was able to
etc. circulating volume. identify behaviors and
lifestyle changes to enhance
Measure a 24-hour intake and output. The position increases venous return, making sure a recovery
Long term goal: greater availability of blood to the brain and other vital
After 1 week of Maintain a bed rest with an elevation of organs. Bleeding may be decreased with the bed rest.
nursing intervention, the legs by 20-30° and trunk horizontal.
the patient will: Treatment options include drugs to increase muscle
Dependent: contraction. It is suggested that prophylactic
Identify be Administer prescribed medication. administration of a uterotonic will help to reduce blood
haviors and loss and blood transfusion. Also, drugs to help with
lifestyle Notify other healthcare providers. blood clotting.
changes to
enhance Nurses and other healthcare workers must be aware
recovery. of the typical physiologic and psychological changes
that occur in women's bodies and minds
following birth in order to offer comprehensive care
throughout this time.
CABASAG, MAEBELYN M.
NCP 7
NURSING NURSING
ASSESSMENT PLANNING INTERVENTIONS RATIONALE EVALUATION
DIAGNOSIS ANALYSIS
SUBJECTIVE: Short term: After 1-2 INDEPENDENT: Short term:
“Nurse, bigla na lang Risk for fetal Vasa previa occurs hours of nursing The goal met
akong dinugo pero death related to when fetal blood intervention, the 1) Monitor the vital signs of the twin fetus. 1. To obtain baseline status of fetal well-being. Assess the
hindi ko naramdaman. the presence of vessels that are following must be Auscultate and report FHR; note degree of fetal hypoxia. Initial response of a fetus to Short term: After 1-2 hours of
Masyadong mapula na vasa previa unprotected by the attained: bradycardia or tachycardia. Note change in decreased oxygenation is tachycardia and increased nursing intervention, the
may halong itim ang umbilical cord or hypoactivity or hyperactivity. movements. A further deficit will result in bradycardia and following was attained:
kulay ng nailabas placenta run through Plan for decreased activity. Non-reassuring findings need
the amniotic immediate 2. Assess the condition of the twin fetus and immediate intervention. Had an emergency
kong dugo” as do a prenatal monitoring.
membranes and Cesarean Section Cesarean Section.
verbalized by the traverse the cervix. 2. Assessing the conditions may help to identify the
patient. The babies will 3. Observe for the possible complications The babies are safely
These vessels may be delivered contributing factors. Prenatal monitoring may help to delivered.
rupture if the that might occur in the condition of vasa detect cord compression and determine whether the fetus
safely. previa (such as fetal bleeding, prolapsed There were no
OBJECTIVE: membranes break, is in distress.
There will be no cord, fetal distress etc). Record the findings indicators of fetal
The woman has a resulting in fetal indicators of fetal and report it immediately to the physician. 3. Early observation could be beneficial to recognize the distress for the
known twin gestation bleeding,
distress for the possible risk that might complicate the condition of the newborns.
and has an ultrasound exsanguination, or
possibly death. newborns 4. Encourage the mother to do an early and twin fetus. Reporting the findings may help to formulate a
findings with vasa Long term:
previa. frequent ultrasound examination. good care plan.
Long term: After 3-4 The goal met.
days of nursing 5. Do a complete physical exam to the
4. To assess the fetus, detect certain abnormalities and
VITAL SIGNS intervention, the neonates after birth for signs of problems or Long term: After 3-4 days of
determine the possible complications early.
BP- 110/70 mmHg following must be complications. nursing intervention, the
PR- 80 bpm attained: 5. Assessing the neonates after birth is relevant to identify following was attained:
RR- 18 bpm DEPENDENT: their well-being. Finding any problems could help the
Fundal Height: 41 cm Upon discharge, healthcare provider to plan the best possible care. Upon discharge, the
the newborns’ 5. Administer corticosteroids. newborns’ examination
Cervix: 4 cm and after
2 hours of labor, examination 6. Pelvic rest may be advised (avoiding sex 5. Steroids may help to mature the baby’s lungs in case findings were normal
dilates to 6 cm findings will be or putting anything in your vagina). they need to be delivered early.
normal.
Effacement: 90%
COLLABORATION: 6. Pelvic rest may help to avoid risks and complications.
Presenting Part:
Vertex/vertex 7. Vaginal delivery can pinch the blood vessels which cuts
7.) Perform immediate Cesarean Section
FHR: 140 bpm off the blood flow to the baby. Cesarean Section is
delivery.
increases to 170 bpm preferred to help the woman avoid dangerous delivery-
room situations and can be a lifesaver in an emergency.
RIC NAME A single course of PREDNISONE Some notable side effects are: Serious side effects of prednisone may 1. Tell patient to take with food or milk
corticosteroids has been is contraindicated to: Weight gain include: to reduce GI upset
dnisone shown to help with a Dizziness Allergic reactions
ND NAME baby’s development and Hypersensitivity to drug, other Muscle weakness Cardiovascular problems 2. Teach patient to recognize and
corticosteroids, alcohol, Increased hair growth Decrease in bone density immediately report signs and
erapred therefore will increase the
bilsulfite, or tartrazine (with Acne Eye damage symptoms of early adrenal
chance of your baby
SIFICATION surviving, once born. It
some products) Mood changes Fetal toxicity insufficiency and cushingoid effects
Systemic fungal infections Difficulty sleeping High blood sugar
ticosteroid also lessens the chance of Live virus vaccines (with Increased risk of GI perforation 3. Inform patient that drug increases hid
diate acting), your baby having serious immunosuppressant doses) Increased risk of infection risk of infection. Instruct him to
complications after birth
coid, Hormone such as breathing
Active untreated infections Severe depression contact prescriber at first sign of
(except in selection meningitis Shifting body fat infection
ICATION problems owing to the patients) Skin problems
lungs not being fully 4. Caution patient not to stop drug
oid therapy in developed, bleeding into suddenly. Advise him to discuss any
s appropriate to the brain, serious infection changes in therapy with prescriber
cally active or bowel inflammation.
ness; to treat an 5. Tell patient to immediately report
bleeding or joint, muscle, tendon, or
ant suffering abdominal pain
tal lupus-
carditis; in stress 6. Advise patient or significant other to
orticosteroid- immediately report depression or
ents) for labor psychosis
y: and, pre-
induce fetal
ation.
& FREQUENCY
DRUG STUDY 3
NAME OF DRUG MECHANISM OF ACTION CONTRAINDICATIONS SIDE EFFECTS/ADVERSE EFFECT NURSING RESPONSIBILITIES
Magnesium is the second most Parenteral administration CNS: drowsiness, depress reflexes, 1. When giving prolonged or
GENERIC NAME plentiful cation of the intracellular contraindicated inpatient with heart placid paralysis, hypothermia repeated I.V infusions, assess
fluids. It is essential for the activity of block myocardial damage. patellar reflex and monitor for
Magnesium Sulfate many enzyme systems and plays an Use cautiously inpatients with impaired CV: hypotension, arrhythmias, respiratory rate of 15
important role with regard to renal function. circulatory collapse, breaths/minute or more
BRAND NAME neurochemical transmission and Use cautiously in pregnant woman
during labor. GI: nausea, vomiting, cramps, 2. With I.V use, monitor blood
muscular excitability. Magnesium
Epsom Salt sulfate reduces striated muscle
flatulence, anorexia magnesium level. Check for signs
and symptoms of magnesium
contractions and blocks peripheral
CLASSIFICATION neuromuscular transmission by
Skin: diaphoresis toxicity (hypotension, nausea,
vomiting, mental or respiratory
reducing acetylcholine release at the
Anticonvulsant myoneural junction. Additionally,
depression)
Initiate at 2.5-5
mcg/min IV. Increase
gradually as tolerated at
20-30-minute
intervalsTypical effective
dose ranges between
17.5-30 mcg/min IV;
some require doses up
to 70-80 mcg/min
DRUG STUDY 6
NAME OF DRUG MECHANISM OF CONTRAINDICATIONS SIDE EFFECTS ADVERSE EFFECTS NURSING RESPONSIBILITIES
ACTION
GENERIC NAME Hypersensitivity (including Rare side effects of Neurological:
Carboprost is a synthetic anaphylaxis and andioedema) Carboprost: Headache, dystonia and 1. Monitor frequency, duration, and force of
Carboprost prostaglandin. It binds the Acute pelvic inflammatory Skin Rash dizziness. contractions and uterine resting tone. Notify
prostaglandin E2 receptor, disease. Paralysis of the intestines Gastrointestinal: the physician or other health care
causing mymometrial Patients with active cardiac, Slow and fast heartbeat. Vomiting, Nausea Dry
BRAND NAME contractions, causing the pulmonary, renal or hepatic Reaction at the site of throat and mouth, diarrhea
professional if contractions are absent or last
more than 1 minute.
induction of labour of the disease. injection.
Hemabate expulsion of the placenta. Psychiatric:
2. Monitor temperature, pulse and BP
Prostaglandins occur Anxiety and sleep
naturally in the body and act disorders. periodically throughout course of therapy.
CLASSIFICATION Large dose may cause hypertension.
several sites in the body
including the womb (uterus). Temperature elevation beginning 1 to 16 hr.
Therapeutic: They act on the muscles of after initiation of therapy and lasting for
Abortifications the womb, causing them to several hours is not usual.
Pharmacologic:Oxytocic contract.
3. Auscultate breath sounds. Wheezing and
s Pregnancy Category: C sensation of chest tightness may indicate
hypersensitivity reaction.
INDICATION
4. Assess for nausea, vomiting and diarrhea.
Hemabate is indicated Vomiting and diarrhea occur in
for the treatment of approximately two-thirds of patients.
postpartum Premedication with antiemetic and
antidiarrheal is recommended.
hemorrhage due to
uterine atony which has 5. Monitor amount and type of vaginal
not responded to discharge. Notify physician or other health
conventional methods care professional immediately if symptoms
of management. Prior of hemorrhage (increased bleeding,
treatments should hypotension, pallor tachycardia) occur.
include the use of
intravenously
administered oxytocin,
manipulative techniques
such as uterine
REFERENCES
Debra Rose Wilson et al. , Healthline, (2017,September 20), Terbutaline
https://www.healthline.com/health/pregnancy/preterm-labor-terbutaline
REFERENCES
Scribd, Mark Keem Escuadrohttps, Magnesium Sulfate
https://www.scribd.com/document/130509176/Magnesium-Sulfate