COURSE IN THE WARD

DATE/TIME
10/14/15
7:30 am
BP: 100/70
mmHg
HR: 110 bpm
RR: 18 cpm
Temp: 37.3C

DOCTORS ORDER
Please admit to OB ward
Secure consent
TPR q shift
DAT
Diagnostics:

Complete Blood CountT

(CBC),Blood test,Platelet, Hepatitis
B surface antigen (HBsAG)
,Urinalysis withUrine Chorionic

Gonadotrophin
, Cancer antigen -125 (CA 125),
Cancer antigen 19-9 (CA 199),Transvaginal Ultrasound,
Serum glutamic-pyruvic
transaminase (SGPT)/ alanine
aminotransferase (ALT) , Serum

Glutamic Oxaloacetic
Transaminase(SGOT)/ aspartate
aminotransferase (AST),Blood
Urea
Nitrogen,Sodium,Potassium,
Chest x-ray posterior anterior

SCIENTIFIC RATIONALE

Complete Blood
CountT (CBC)- detect a
wide range of disorders,
including anemia,
infection and leukemia.
-test measures several
components and features
of your blood, including:
Red blood cells,
which carry oxygen
White blood cells,
which fight
infection
Hemoglobin, the
oxygen-carrying
protein in red blood
cells
Hematocrit, the
proportion of red
blood cells to the
fluid component, or
plasma, in your
blood
Platelets, which

NURSING INTERVENTION

help with blood

clotting
Platelet count is used
to detect the number of
platelets in the blood.
Hepatitis B surface
antigen (HBsAG)
-Detects protein that is
present on the surface of
the virus
- To screen for, detect,
and help diagnose acute
and chronic HBV
infections; earliest
routine indicator of acute
hepatitis B and
frequently identifies
infected people before
symptoms appear;
undetectable in the
blood during the
recovery period; it is the
primary way of
identifying those with
chronic infections,
including "HBV carrier"
state.
Cancer antigen -125
(CA 125) blood test is
used to measure the
amount of CA-125
protein in the
bloodstream.

 Start PNSS IL @ KVO rate

To secure 1 unit of packed

Cancer antigen 199(CA 19-9) is used to

help differentiate
between cancer of
thepancreas and other
conditions, as well as to
monitor treatment
response and recurrence.
Transvaginal
ultrasound is a type of
pelvic ultrasound used
by doctors to examine
female reproductive
organs. This includes the
uterus, fallopian tubes,
ovaries, cervix, and
vagina.
Serum Glutamic Oxa
Transaminase(SGOT)/a
spartate
aminotransferase
(AST)test is often part of
an initial screening for
liver disease.
Serum glutamicpyruvic transaminase
(SGPT)/ alanine
aminotransferase
(ALT)-test is often part of
an initial screening for
liver disease.

Monitor patient frequently or a signs of

red blood cells

Transfuse blood once
available @ ward
Watch out for BT reaction
Monitor VS q 4 hrs
Monitor I& 0 q 4 hrs
To ward
Paracetamol 300mg IVTT
now
TSB please

10:00 pm

May transfuse available

blood now

Blood Urea
Nitrogen(BUN )screening test for the
evaluation of kidney
function. Potassium
test- is used to measure
the amount of potassium
in your blood and
nutrients into cells.
Chest X-ray- - help spot
abnormalities or diseases
of the airways, blood
vessels, bones, heart,
and lungs.

Chlorpheniramine maleate
1 ampIM prior to Blood
transfusion
Check VS prior & after
blood transfusion

Check 1st the temp. of the pt. before giving the drug
Do not exceed to the recommendation dosage

-to prevent complications

Check for cross matching and typing. To ensure

compatibility
Obtain and record baseline vital signs
Check the
following:Serialnumber,Bloodcomponent,Bloodtype,Rh
factor,Expiration date&Screening test
Identify client properly
Monitor vital signs. Altered vital signs indicate adverse
reaction (increase in temp, increase in respiratory
rate)
Observe for potential complications.

-to prevent further

Assess allergy symptoms prior to & periodically during

-for medication
administration and
serves as BT line

10/15/15
5:00 am

infiltration,signs of phlebitis/infection.
Check the level of the IVF
Check and regulate the drop rate
Change the IVFsolution if needed

-Decrease Hb&Hct

 Watch out for Blood

transfusion reaction

10:00 am
BP: 100/60
mmHg
HR:80 bpm
RR:24 cpm
Temp:36.4C
(+) pallor
(+) vaginal
bleeding

IVF to ff. PNSS 1L @ KVO

rate
Still to secure blood as
ordered & transfuse once
available
For whole abdomen
ultrasound include Pelvic
area
Follow up cancer antigen
125, cancer antigen 19-9
result
Ff. up lab result
Monitor VS q 4hrs

complications
-to assess kidney
function

therapy
Monitor BP & RR

-Treatment of fever

-decrease Hb&hct

ADD:
FESO4 1 cap BID

Lactulose 30cc @ HS

IVF to ff. PNSS 1L @ KVO

-management of severe
allergic or
hypersensitivity reaction,
including anaphylaxis
and transfusion reaction
Take drug with Vit. C or orange juice or with an empty
stomach
Instruct to increase high fiber diet
Caution patient that stool may become dark
Caution patient to make position changes slowly to

rate
Start Cefuroxime 750 mg
IVTT q 8 hrs ANST ()
Still for whole abdomen
with pelvic area
Repeat Complete blood
count today
10/16/15
10:00 am
BP: 90/60
mmHg
HR: 80 bpm
RR: 24 cpm
Temp: 37C

10/17/15
7:00 am
BP: 90/60mmHg
HR: 79 bpm
RR: 23 cpm

Cont. ferrous sulfate

VS q 4hr
Still to secure blood
IVF to ff. PNSS 1L @ KVO
rate
Cont. meds
Repeat complete blood
count today
Still for whole abdomen
include pelvic area
Still to secure blood
VS q 4hrs
May transfuse available
blood now
Check VS prior & after BT
Watch out for BT reaction
Give Chlorpheniramine
maleate 1 amp IM prior to
BT

minimize orthostatic hypotention.

-for medication
administration & series
as BT line
-Decrease Hb&Hct

-can help assess pain, or

other symptoms in the
organ located in the
pelvis or lower abdomen

-Prevention/treatment of
iron-defiencyanemia; iron
supplement

-Treatment of
constipation

Assess pt. for abdominal distention, presence of bowel

sounds & normal pattern of bowel function.
Assess color, consistency & amount of stool produced.

Temp: 36.8C

7:30 pm

10/18/15
8:00 am
BP: 90/60mmHg
HR:80 bpm
RR:20cpm
T: 37C
(+) swelling of
Left leg

10/19/15
7:30 am
(+) pallor
(+)vaginal

- for medication
IVF to ff: PNSS 1L x
administration and
serves as BT line
20gtts/min
Cont. meds
-Antibiotic;preventing
Secure additional blood for bacterial infection
Blood transfusion once
available
VS q 4H

Cont. ongoing Blood

Transfusion
Cont. meds
For whole abdomen
include pelvic area today
For chest Xray posterior
anterior view & ECG
12 lead
Follow up cervical punch
biopsy result
Repeat complete blood
count 6 hrs post blood
transfusion
VS q 4hrs
Please give Tramadol
50mg IVTTnow

IVF to ff. PNSS IL @ KVO

rate

-to determine if there is

increased or decreased
Hb&Hct

-decrease Hb&Hct
- for medication
administration and
serves as BT line
-Decrease Hb&Hct

spotting

5:15 pm
(+) vaginal pain

10/20/15
7:00 am
BP: 90/60
mmHg
HR: 81 bpm
RR:23cpm
T: 36.8C

Cont. meds
Follow up repeat complete
blood result
Follow up whole
abdomen with chest xray result
Follow up cervical punch
biopsy result
VS q 4hrs
Add:
Secure additional 3 units
of Packed Red Blood
Cells&Packed red blood
cellstransfuse once
available
Give Paracetamol 300mg
tab now then q 4hrs for
>38C
IVF to follow PNSS 1L @
KVO rate
Continue Medications
Still to secure bood&
transfuse once available
Follow up whole abdomen
ultrasound,ECG result
Follow up cervical punch
biopsy result
repeat urinalysis
today

Assess type, location, & intensity of pain before &

after administration

-To confirm the presence

of precancerous

conditions

5:00 pm
T: 38.4C

For activated partial

thromboplastin
time (APTT),Prothrombin
Time with International
Normalized Ratio, Total
Protein Albumin Globulin
VS q 4hrs

10/21/15
8:00am
BP:100/ 80
mmhg
HR:83 bpm
RR:23cpm
T: 36.9C

-Indication: moderate to
moderate severe pain

Cont. ongoing IVF @KVO

rate
Shift IV cefuroxime to
cefuroxime 1 cap TID
Still to secure blood &
transfuse once available
Follow up WA UTZ, ECG
result without fail
Follow up cervical punch
biopsy result
VS q 4hrs

Please transfuse available

blood now
Watch out for BT reaction
IVF to follow PNSS 1L @
KVO rate
Cont. meds

- Decrease hemoglobin
and hematocrit

 Follow up whole abdomen

result without fail
Repeat patient
hemoglobin and
hematocrit 6 hrspost
Blood transfusion
VS q 4hrs
10/22/15
10:00 am
BP: 110/80
mmHg
HR: 82 bpm
RR:23 cpm
Temp: 36.8C
(-) vaginal
spotting

IVF to ff: PNSS 1L @ KVO

rate
Cont. meds
Secure additional 2 units
of PRBC/SRBC & transfuse
once available
Follow up cervical punch
biopsy result
VS q 4hrs
Please. transfuse available
blood now
Furosemide 10mg IVTT
post BT: check BP
Soft diet
IVF to follow: PNSS 1L @
KVO rate
Continue medications
Repeat complete blood
count 6 hours post BT

-Decrease hemoglobin
and hematocrit

-to help diagnose the

cause of unexplained
bleeding
-reporting the result of
coagulation test

10/23/15
7:00 am
BP:100/80
mmHg
HR:82 bpm
RR:29cpm
T:36.8C

10/24/15
9:00 am
BP: 100/80
mmHg
PR: 82 bpm
Rr: 24cpm
T:36.8C

3:00 pm

Soft diet
Cont. meds
Secure additional blood
2units & transfuse once
available
VS q 4hrs
IVF to ff: PNSS at KVO rate
Cont. Meds
Repeat CBC
Refer to IM department for
CP evaluation
Follow up cervical punch
biopsy

Cont. IVF
Cont. medication

Refer to IM department for

CP evaluation
Follow up cervical punch
biopsy
Secure 2 units of
PRBC/SRBC for OR use

- to determine if there is
increased or decreased
Hb&Hct

 VS q 4hrs

10/25/15
BP:100/60
mmHg
PR: 82 bpm
RR:22 cpm
T:37.2 C

Cont. medications
Follow up referral to IM
Dept. for CP evaluation w/
out fail
Follow up cervical punch
biopsy result
VS q 4 H
Secure blood for OR use
Tramadol 1 amp IVTT now

10/26/15
BP:: 110/70
mmHg
PR: 89 bpm
RR:21 cpm
T: 37.2C
Hb: 90

10/27/15
10 am
BP: 100/80
mmHg
HR: 100/80bpm
RR: 22 cpm
Temp: 37C

Celecoxib 200mg/tab, 1
tab PO now
Cont. Meds
For Emergency SalphingoOopherectomynext week
Secure blood for OR use
VS q 4hrs
O2 inhalation via nasal
cannula @ 4-5 lpm

Bowel Preparation Day3

Secure blood for OR use
VS q 4 hrs

-to prevent fluid overload

-for easily chewed and

digested

10/28/15
10 am
BP: 120/60
mmHg
HR: 108 bpm
RR: 20 cpm
Temp: 36.9C
Hb: 100

10/29/15
7:00 am
BP:110/70
HR:80: bpm
RR:22 cpm
T:36.9

10/30/15
1:00 am
7:30 am

Bowel Preparation Day3

For Emergency,
Salphingo-Oopherectomy,
Pelvic Floor Center,
InfracolicOmentectomyto
morrow
Secure consent
Secure blood for OR use
VS q 4hrs
Prepare patient for
EmergencyExploratory
laparotomyPelvic Floor
Center, Bilateral
Salphingo-Oopherectomy,
InfracolicOmentectomy
Secure informed consent
Insert another line with
PLR 1L @ 30gtts/ min
Wheel patient to OB-OR
complex @ 8:30 am
Cefuroxime 750 mg/amp
IVTT q 8H
Metoclopramide
10mg/amp IVTT prior to
OR
Ranitidine 50mg/amp IVTT
prior to OR

Assess type, location, & intensity of pain before

& after administration
Explain the actions of the drug, the adverse &
side effects to the patient & SO

8:00 am
BP:120/90
HR:110 bpm
RR:24 cpm
T:36.6C

Monitor VS q 4hrs
To PACU
NPO temporarily
O2 inhalation @ 8lpm via
face mask
Moderate high back rest
-Indication: moderate to
moderate severe pain

10pm

10/31/15
9:00am
BP:120/90
mmHg
HR:116 bpm
RR:28 cpm
Temp:36.8 C
11/01/15
BP: 110/80
mmHg
HR:113 bpm
RR: 24 cpm
Temp: 36.8 C

Monitor VS q 15 mins x 2h
then 30 minsuntil stable
Monitor I & O hourly &
record
Regulate IVF @ 30gtts/min
(left arm);@ KVO rate
(right arm)
IVF to ff. @ Left
arm;PNSS,D5NM,PLR @
30gtts/min
Meds:
1.Cefuroxime 750 mg IVTT
q 8H
2. Ranitidine50mg IVTT
q8H
3. Tramadol 100mg (2
ampules) IVTT now then
50mg IVTT q 6h pm for
pain
4. Side drip with PNSS 1L

-Management of acute
pain

- helps in
givingadequateoxygen to
theclient

Secure consent
Explain to the patient about the procedure

11/02/15

+ Diclofenac Na 150 mg
+tramadol 300mg to run
in 24H @ 80 ugtts/min x
1L
5. Paracetamol 1g IVTT
now
Repeat Hgb , Hct 6 h post
op
Refer to main service for
further order

D1
Clear liquids once with
flatulence
Continue IVF on both arms
Cont. IVTT medications
Maintain on FBC
Continue Diclofenac drip
Transfuse available blood
now
Furosemide 20 mg IVTT
post BT
hold BP <90/60 mmHg
May turn patient side to
side
VS q 4 hrs (record pls)
I & O q shift (record pls)

-to empty and cleanse

the bowel

-usually performed in
patients with acute or
unexplained abdominal
pain, in patients who
have sustained
abdominal trauma, and
occasionally for staging
in patients with a
malignancy

Assess pt. for nausea, vomiting, abdominal

distention & bowel sounds before & after
administration
Assess for epigastric or abdominal pain

Day 2
General liquids with
crackers in AM and soft
diet in PM
IVF to ff: PNSS 1L @ KVO
rate
Shift IV cefuroxime to
cefuroxime 500mg 1 tab
TID
D/C. IVTT meds ;start PO
Celecoxib 200mg 1 tab
TID, Ferrous sulfate 1 cap
BID, Vit. C 1 tab OD
Diclofenac drip to
consume
Repeat Hb&Hct now
Pull out FBC now
May sit up on bed
VS q 4hrs
I & O q shift
DAT once with BM
IVF to ff:PNSS 1L @ KVO
rate
Cont. Meds
Transfuse available blood
now
Furosemide 20 mg IVTT
post BT hold BP with<
90/60
Secure additional 3 units

-Antiemetics;Tx. &
prevention of post
operative N & V
-Anti ulcer agents

-to prevent aspiration

-helps in
givingadequateoxygen to
theclient
-To takeadvantage
ofgravitydecreasingpress
ure onthe diaphragmand
enhancingdrainage

of PRBC/ SRBC
May slowly ambulate
Change dressing today
VS q 4hrs
add:
Lactulose 30cc @ HS

11/03/15
7am
BP:100/80mmH
g
HR: 118 bpm
RR:24 cpm
Temp: 36.9 C

ofdifferent lungsegments
- to prevent further
complications
-to assess kidney
function

-Antibiotic;preventing
bacterial infection
-Antiulcer agents
- Indication: moderate to
moderate severe pain

-works by reducing
substances in the body
that cause pain and
inflammation.

-Treatment of fever

11/04/15
7:30 am
BP:
100/80mmHg
HR: 95 bpm
RR: 22 cpm
Temp: 36.3 C
(-)BM
(+) UO
(+) pallor
Drain- 300 cc

Day 4
DAT
IVF to ff: PNSS 1L @ KVO
rate
Cont. meds
Transfuse available blood
now
Furosemide 20 mg IVTT
post BT hold BP with <
90/60
Still to secure additional
blood
Slowly ambulate
Change dressing
VS q 4H
Add:Celecoxib 200mg 1
tab/BID

-to determine if there is

increased or decreased
Hb&Hct

-Clear liquids are easily

absorbed by the body.
They reduce stimulation
of the digestive system,
and leave no residue in
the intestinal tract. This
is why a clear liquid diet
is often prescribed in
preparation for surgery &
is generally the first diet
given by mouth after
surgery

Transfuse available blood

once available
Watch out for BT reaction
DAT
IVF to ff: PNSS 1L @ KVO
rate
Cont. meds
Transfuse available blood
now

-to prevent pressure

ulcer
-to prevent further
complication

 Furosemide 20 mg IVTT
post BT hold BP with <
90/60
Change dressing
11/05/15
7:00 am
BP:100/60
HR:106 bpm
RR:23 cpm
T:36.5C
(-) BM
(+)UO
(+) pallor
Hb; 69

IVF to ff: PNSS 1L @ KVO

rate
Cont. meds
Secure additional 3 units
PRBC/SRBC, for BT once
available
Monitor I & O
Change dressing

-assess kidney function

-reduce stimulation of
the digestive system

IVF to ff: PNSS 1L @ KVO

rate
Cont. meds
Rpt CBC today
Still to secure additional
blood
Change dressing
Monitor VS q 4H
May transfuse available
blood
Give chlorpheramine
maleate 1 amp IM prior to
BT
Chest VS, chest & lungs
prior & after BT
Watch out for transfusion

-for early
ambulation,prevent post
op complication

-bowel movement return

to normal

Assess pt. for abdominal distention, presence of bowel

sounds & normal pattern of bowel function.
Assess color, consistency & amount of stool produced.

reaction

-to prevent post op

complications

-treatment of
constipation.

11/06/11

11/07/15

11/08/15

11/09/15

11/10/15

 Clear