MODULE_3_-_Postpartum_and_Newborn_Drugs_.pdf

University of San Agustin General Luna St., Iloilo City 5000, Philippines www.usa.edu.ph COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS-NURSING...

University of San Agustin General Luna St., Iloilo City 5000, Philippines www.usa.edu.ph COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS-NURSING PROGRAM Learning Module in NCM 106 PHARMACOLOGY Prepared by: John Ian L. Lamasan, M.A.N., R.N. A Legacy of Excellent Education in Virtus et Scientia Email: [email protected] | Tel. No.: (033) 337-4841 to 44 | Fax No.: (033) 337-4403 jilamasan  University of San Agustin General Luna St., Iloilo City 5000, Philippines www.usa.edu.ph COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS-NURSING PROGRAM NCM 106: PHARMACOLOGY MODULE 3 DRUGS AFFECTING IN THE BODY SYSTEM Module Overview This module is designed for nursing students to have a comprehensive introduction to the concepts, principles of Pharmacology and to Integrate knowledge of physical, social, natural and health sciences and humanities in nursing pharmacology Module Outcomes At the end of the module the learner should be able to: 1. Provide appropriate health education related to drug therapy. 2. Evaluate compliance and response of client to the medications prescribed. 3. Use available clinical evidence that can ensure safe medication administration. 4. Document client’s condition/response/ outcomes related to drug therapy. 5. Manage resources (human, physical, financial, time) efficiently and effectively in safe drug administration. Use appropriate communication/ interpersonal techniques/strategies to ensure a working relationship with the client and/or support system in medication administration. Ensure intra-agency, inter-agency, multidisciplinary and sectoral collaboration in medication administration. Assume personal responsibility to keep abreast with current trends in nursing pharmacology Exemplify love for country in the service of the Filipinos. Discuss various technological advances in ensuring safe medication administration Manifest professionalism and excellence in planning for safe medication practice. Module Content: a. Reproductive System b. Pregnancy and Pre-term labor drugs c. Labor and Delivery and Neonatal drugs d. Postpartum and Newborn drugs e. Women’s Reproductive Health and Menopause f. Men’s Reproductive Health and Reproductive Disorders g. Infertility and Sexually Transmitted Infections A Legacy of Excellent Education in Virtus et Scientia Email: [email protected] | Tel. No.: (033) 337-4841 to 44 | Fax No.: (033) 337-4403 jilamasan  University of San Agustin General Luna St., Iloilo City 5000, Philippines www.usa.edu.ph COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS-NURSING PROGRAM POSTPARTUM AND NEWBORN DRUGS During the puerperium (the period from delivery until 6 weeks postpartum), the maternal body physically recovers from antepartal and intrapartal stressors and returns to its prepregnant state. Purposes of Pharmacologic and Nonpharmacologic Measures (1) Prevent uterine atony and postpartum hemorrhage (2) Relieve pain from uterine contractions, perineal wounds, and hemorrhoids (3) Enhance or suppress lactation (production and release of milk by mammary glands) (4) Promote bowel function (5) Enhance immunity NONPHARMACOLOGIC MEASURES FOR COMMON POSTPARTUM NEEDS INDICATION INTERVENTIONS Uterine  Patient positioned on abdomen with pillow under abdomen for 20-30 min for 3-4 contractions d  Distraction, breathing techniques, therapeutic touch, relaxation, guided imagery, ambulation  No heat to abdomen because of risk of uterine relaxation and increased bleeding Perineal wound  Ice packs/glove (covered in thin, absorbent material to protect tissue) for 6-8 resulting from hours after delivery episiotomy or  Patient positioned on side as much as possible with pillow between legs laceration  Early and frequent ambulation  Perineal exercises (Kegel exercises)  Cool sitz bath 2-3 h after delivery  Warm sitz bath 12-24 h after delivery t.i.d./q.i.d.  Area cleansed front to back using perispray squeeze bottle or cleansing shower  Patient tightens buttocks or squeezes buttocks together before sitting and sits tall and flat, not rolled back onto coccyx  No tampons, douche, or feminine hygiene sprays  No intercourse until after lochia has ceased or as advised by health care provider Hemorrhoids  As above but particularly:  Ice  Sims position to help increase venous return  Warm, moist heat; sitz bath  Witch hazel pads (e.g., Tucks) Lactation  Tight bra worn continuously for 10-14 days suppression  Normal fluid intake  No manipulation or stimulation of breasts  Pyrioxidine (B6) 200 mg for 5 days  Sage tea every 6 hours  Alcohol tincture 3-4 mL every 6 hours Engorgement  As above, plus ice to axillary area of breasts if bottle feeding, or apply warm compresses if breastfeeding  Express small amount of colostrum or milk (if breastfeeding) by hand expression before putting infant to breast to facilitate latching on Sore or cracked  Wear absorbent breast pads to keep moisture away from nipples nipples  Do not use soap on nipples  Air-dry nipples after nursing  Express small amount of breast milk on nipples to use as a protective lubricant  Apply hypoallergenic purified lanolin (Lansinoh, PureLan) to nipples as protective lubricant to promote healing  For cracked nipples, use comfort gel pads (Hydrogel pads)  Do not use nipple shields because they can promote chafing A Legacy of Excellent Education in Virtus et Scientia Email: [email protected] | Tel. No.: (033) 337-4841 to 44 | Fax No.: (033) 337-4403 jilamasan  University of San Agustin General Luna St., Iloilo City 5000, Philippines www.usa.edu.ph COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS-NURSING PROGRAM  Do not limit infant’s nursing time at breast; otherwise milk ducts will not be emptied, and increased pressure may occur  Ensure proper positioning for feeding; nursing initiated on less sore nipple  Break suction with little finger after feeding to prevent pulling on nipple PAIN RELIEF FOR UTERINE CONTRACTIONS “Afterbirth pains” may occur during the first few days postpartum when uterine tissue experiences ischemia during contractions, particularly in multiparous patients and when breastfeeding. Nonsteroidal agents may be used to control postpartal discomfort and pain, with narcotic agents reserved for more severe pain such as that experienced by the patient after cesarean delivery, tubal ligation, or extensive perineal laceration. COMMONLY USED POSTPARTUM SYSTEMIC ANALGESICS acetaminophen (Tylenol) Watch a video clip on postpartum pain by clicking this link : acetaminophen/codeine (Tylenol No. 3) https://www.youtube.com/watch?v=XpQzI NC3AEc acetaminophen and propoxyphene ibuprofen (Motrin) codeine sulfate ketorolac tromethamine (Toradol) acetaminophen and hydrocodone (Lortab) meperidine (Demerol) morphine sulfate nalbuphine oxycodone acetaminophen (Percocet) PAIN RELIEF FOR PERINEAL WOUNDS AND HEMORRHOIDS Pregnancy and the delivery process increase the pressure on perineal soft tissue. The tissue may become ecchymotic or edematous. Increased edema, ecchymosis, and pain may occur if an episiotomy (incision made to enlarge the vaginal opening to facilitate newborn delivery) or perineal laceration is present. The perineum is assessed for Redness, Ecchymosis, Edema, Discharge, and Approximation (REEDA). Hemorrhoids that developed during pregnancy may be exacerbated by the pushing during labor. Comfort measures (ice packs immediately after birth, tightening of the buttocks before sitting, use of peribottles and cool or warm sitz baths) and selected topical agents (witch hazel and dibucaine ointment) may relieve pain and minimize discomfort. Note: Rectal suppositories should not be used by women with fourth-degree perineal lacerations. A Legacy of Excellent Education in Virtus et Scientia Email: [email protected] | Tel. No.: (033) 337-4841 to 44 | Fax No.: (033) 337-4403 jilamasan  University of San Agustin General Luna St., Iloilo City 5000, Philippines www.usa.edu.ph COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS-NURSING PROGRAM DRUGS USED TO RELIEVE PAIN FROM PERINEAL WOUNDS AND HEMORRHOIDS Generic Name Route and Dosage Uses Side Effects and Pregnancy (Brand Name) Special Consideration Category PERINEAL WOUNDS benzocaine Spray liberally Local anesthetic; Contraindicated in (Americaine, t.i.d./q.i.d. 6-12 inhibits impulses from patients with Dermoplast) inches sensory nerves by secondary from perineum decreasing bacterial infection of following perineal permeability of cell tissue and known cleansing. membrane to sodium hypersensitivity Supplied as aerosol ions. benzocaine 20% HEMORRHOIDS hydrocortisone 1 suppository Relieves pain and Available without C acetate 10 mg b.i.d. for 3-6 d itching from irritated hydrocortisone. Wear (Anusol-HC, Tucks anorectal tissue. gloves. Ointment Anusol-HC contains [pramoxine HCl hydrocortisone Contraindicated in 1%, mineral oil acetate, acts as an patients with known 46.7%, zinc oxide antiinflammatory hypersensitivity. 12.5%]) agent. Discontinue if second infection in tissue. If anorectal symptoms do not improve in 7 days or if bleeding, protrusion, or seepage occurs, inform health care provider. Do not use if fourthdegree perineal laceration present. Not known if excreted in breast milk; use cautiously. dibucaine Apply as above Local anesthetic Do not use if rectal C ointment, USP 1% t.i.d./q.i.d., using ointment containing bleeding present. Do (Nupercaine) no dibucaine 1%. Action not use near eyes or more than 1 tube in same as benzocaine. over denuded surfaces 24 h or blistered areas. Do not use if known hypersensitivity to amide-type anesthetics. Side effects: burning, tenderness, irritation, inflammation, contact dermatitis, urticaria, cutaneous lesions, edema. A Legacy of Excellent Education in Virtus et Scientia Email: [email protected] | Tel. No.: (033) 337-4841 to 44 | Fax No.: (033) 337-4403 jilamasan  University of San Agustin General Luna St., Iloilo City 5000, Philippines www.usa.edu.ph COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS-NURSING PROGRAM LACTATION SUPPRESSION In the past, lactation was commonly controlled through drug therapy with one of three agents: chlorotrianisene (Tace), Deladumone OB (combination of estrogen plus androgen in the form of estradiol valerate and testosterone enanthate), or bromocriptine mesylate (Parlodel). Estrogenic substances are much less popular than in the past because of the increased incidence of thrombophlebitis associated with the high dosage needed to suppress lactation and concerns about potential carcinogenic effects. Presently nonpharmacologic measures are recommended for lactation suppression, such as wearing a supportive bra 24 hours a day for 10 to 14 days or using axillary ice packs PROMOTION OF BOWEL FUNCTION Constipation is common during the postpartum period. The residual effects of progesterone on smooth muscle decrease peristalsis. This decreased paristalsis, added to decreased liquid intake during labor, decreased activity, and relaxation of the abdominal muscles, amplifies the problem. Patients who deliver by cesarean section are even more likely to experience constipation and flatus (intestinal gas). DRUGS USED TO PROMOTE POSTPARTUM BOWEL FUNCTION Generic Name Route and Uses Side Effects and Pregnancy (Brand Name) Dosage Special Consideration Category docusate sodium 100 mg PO b.i.d. Reduces surface Docusate salts are C (Colace) 50-400 mg PO tension of the oil- interchangeable 550 mg + 3 mg daily in 1-4 water interface of the (amount of Na, Ca, or sodium, divided doses; stool, resulting in K per dosage is 100-mg cap + 5 mg usual enhanced clinically insignificant). sodium dosage is 50-360 incorporation of water (Dulcolax Stool mg daily and fat and Do not use Softener) 100 mg + 5 subsequent stool concomitantly with mg sodium docusate softening mineral oil. calcium (Surfak) 240-mg cap Contraindicated in patients with intestinal obstruction, acute abdominal pain, nausea, or vomiting. Do not use >1 wk. Prolonged, frequent, or excessive use may cause bowel dependence or electrolyte imbalance. Compatible with breastfeeding. Side effects: rash. bisacodyl USP 2-3 tabs PO or 1 Stimulant laxative. Do not crush tabs C (Dulcolax) supp, 5-15 mg/d Irritates smooth (enteric coated). (suppository given as single muscle of intestine, Do not administer 10 mg or tab 5 mg) dose possibly colon and within 1 h of milk or intramural plexus; antacid, because alters water and enteric coating may electrolyte secretion, dissolve, resulting in increasing intestinal abdominal cramping fluid and producing and vomiting. laxative effect. A Legacy of Excellent Education in Virtus et Scientia Email: [email protected] | Tel. No.: (033) 337-4841 to 44 | Fax No.: (033) 337-4403 jilamasan  University of San Agustin General Luna St., Iloilo City 5000, Philippines www.usa.edu.ph COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS-NURSING PROGRAM Side effects: abdominal cramps, nausea, vomiting, rectal burning, electrolyte and fluid acidosis or alkalosis, hypocalcemia. magnesium 30 mL PO PRN Laxative. Acts by Use with caution in B hydroxide (milk of daily or in increasing and patients with impaired magnesia) divided retaining water in renal function, doses intestinal lumen, because causing distention that hypermagnesemia and stimulates peristalsis toxicity may occur as a and bowel elimination result of decreased renal clearance of absorbed magnesium. Contraindicated in patients with colostomy, ileostomy, abdominal pain, nausea, vomiting, fecal impaction, and renal failure. Drug interactions may occur with tetracyclines, digoxin, indomethacin, iron salts, or isoniazid. Milk of magnesia concentrate is three times as potent as regular-strength product. Side effects: abdominal cramps, nausea. Adverse reactions: hypotension, hypermagnesemia, muscle weakness, and respiratory depression. mineral oil 15-45 mL PO Lubricant laxative Avoid bedtime doses C daily or in eases passage of stool because of risk of divided by decreasing water aspiration (lipid doses absorption and pneumonitis). lubricating the intestine Do not give with food or meals because of risk of aspiration and decreased fat-soluble vitamin absorption. Contraindicated in patients with A Legacy of Excellent Education in Virtus et Scientia Email: [email protected] | Tel. No.: (033) 337-4841 to 44 | Fax No.: (033) 337-4403 jilamasan  University of San Agustin General Luna St., Iloilo City 5000, Philippines www.usa.edu.ph COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS-NURSING PROGRAM ileostomy, colostomy, appendicitis, ulcerative colitis, and diverticulitis. Best administered on an empty stomach. Side effects: nausea, vomiting, diarrhea, and abdominal cramps. senna 10-15 mL syrup Stimulant laxative. Drug interactions may C (Senokot) h.s.; 2-4 tabs PO Acts by local irritant occur with (MAOIs, b.i.d effect on colon to disulfiram, promote peristalsis metronidazole, and and bowel evacuation. procarbazine. Also increases moisture content of May discolor urine or stool by accumulating feces. Liquid syrup fluids in intestine. contains 7% alcohol. May create laxative dependence and loss of bowel function with prolonged use. Contraindicated in patients with fluid and electrolyte disturbances, abdominal pain, and nausea and vomiting. Excreted in breast milk. simethicone 1 tab or softgel Antiflatulent. Acts by Must be chewed (Gas-X chewable q.i.d. p.c. and dispersing and thoroughly before tabs, h.s; preventing formation swallowing; suggest 80 mg; Extra max: 6 tabs or 4 of mucus-surrounded patient drink a full Strength Gas-X softgels/24 h gas pockets in GI tract; glass of water after chewable tab, 125 changes surface tablets are chewed. mg; Gas-X Extra tension of gas bubbles Strength softgel, and allows them to Do not take double 125mg, Phazyme coalesce, making them doses to make up for tab, 90 mg, cap, 125 easier to eliminate as missed doses. Store mg, 180 mg; belching and rectal below Mylanta Gas Relief flatus. 104° F (40° C) in well- chewable tab, closed container. 80 mg; Mylanta Gas Relief Maximum No known side effects. Strength chewable tab, 125 mg) A Legacy of Excellent Education in Virtus et Scientia Email: [email protected] | Tel. No.: (033) 337-4841 to 44 | Fax No.: (033) 337-4403 jilamasan  University of San Agustin General Luna St., Iloilo City 5000, Philippines www.usa.edu.ph COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS-NURSING PROGRAM IMMUNIZATIONS RhO(D) IMMUNE GLOBULIN An Rh-negative patient who lacks the Rh factor in her own blood may carry a fetus who is either Rh-negative or Rh-positive. During pregnancy, minimal amounts of fetal blood may cross the placenta. Also, an abortion (spontaneous, therapeutic, or induced), amniocentesis, ectopic pregnancy, previa, and abruption result in some mixing of maternal and fetal blood. Subsequently, anti-D antibodies develop in an Rh-negative mother with an Rh-positive fetus; with the development of these antibodies, the mother becomes sensitized. To understand more watch this video clip https://www.youtube.com/watch?v=aHZKG75IuHI RH ISOIMMUNIZATION a. During pregnancy or delivery, a small amount of fetal blood may enter the mother’s circulation. b. When the mother is Rh-negative and is pregnant with an Rh- positive fetus, the mother’s immune system responds by producing anti-RhO(D) antibodies. c. In subsequent pregnancies, these antibodies cross the placenta and enter the fetal circulation; when the fetus is Rh-positive, the anti-RhO(D) antibodies will attack the fetal red blood cells and cause hemolysis. RUBELLA VACCINE Maternal rubella, also called German measles, is a potentially devastating infection for the fetus, depending on gestational age. If an unimmunized woman (rubella titer 15 mL Rh positive RBCs) has occurred Given after abortion before 12 gestational wk if less than 2.5 mL of Rh incompatible RBCs were administered A Legacy of Excellent Education in Virtus et Scientia Email: [email protected] | Tel. No.: (033) 337-4841 to 44 | Fax No.: (033) 337-4403 jilamasan  University of San Agustin General Luna St., Iloilo City 5000, Philippines www.usa.edu.ph COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS-NURSING PROGRAM RUBELLA VIRUS VACCINE Rubella Virus subQ: Live virus vaccine for Do not give immune serum C Vaccine 0.5 mL into immunization against rubella globulin (ISG) concurrent outer (German measles). with vaccine. upper arm Contraindicated in pregnant women and patients with anaphylactoid reactions to neomycin and/or gelatin, febrile respiratory illness or other febrile infection, active untreated tuberculosis, or immune deficiency conditions. Vaccinated persons can shed but not transmit virus. Defer vaccination for 3 months after blood or plasma transfusions and also after human serum immune globulin. Postpartum patients who received blood products may be vaccinated if repeat titer is drawn 6-8 wk later to ensure that seroconversion has occurred. Excreted in breast milk; use caution. Important for patient to use contraceptive method for 4 weeks following administration, because rubella is teratogenic. Rubella titer may be reassessed 3 mo after administration. Side effects: burning, stinging at injection site; malaise; fever; headache; slight rash 2-4 wk after injection; joint pain 1-3 d within 1-10 wk of injection. A Legacy of Excellent Education in Virtus et Scientia Email: [email protected] | Tel. No.: (033) 337-4841 to 44 | Fax No.: (033) 337-4403 jilamasan  University of San Agustin General Luna St., Iloilo City 5000, Philippines www.usa.edu.ph COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS-NURSING PROGRAM DRUGS ADMINISTERED TO THE NEWBORN IMMEDIATELY AFTER DELIVERY DRUGS ADMINISTERED TO THE NEWBORN IMMEDIATELY AFTER DELIVERY Generic Name Route and Uses Side Effects and Pregnancy (Brand Name) Dosage Special Consideration Category erythromycin 1/2 -inch Prevention of Chemical conjunctivitis in ophthalmic ribbon of gonococcal about 20% of neonates, ointment ointment conjunctivitis and manifesting as edema and (Ilotycin placed in chlamydial inflammation lasting about Ophthalmic) lower conjunctivitis 24 to 48 hours. conjunctival (ophthalmia sac of each neonatorum) which eye within 1h can cause blindness. of delivery (beginning at Contains antibiotic inner canthus) (erythromycin) in sterile base of mineral oil and white petrolatum. Has bactericidal or bacteriostatic action based on concentration per gram and target organisms present. phytonadione, 0.5-1 mg IM in Prevention of Newborns of mothers who Vitamin K1 vastus hemorrhagic disease received oral (Mephyton, lateralis of the newborn. anticoagulants, Aqua-MEPHYTON) (preferably) or anticonvulsants, rectus femoris Anticoagulant antituberculosis drugs, or within 1 h antagonist. recent antibiotics during after birth pregnancy may need a (check Aqueous colloidal higher dosage 6-8h after health care solution of vitamin K1. first injection. provider or agency Newborn does not Side effects: Pain and standing receive adequate edema at injection site; orders for vitamin K possible allergic reactions dosage) transplacentally and include urticaria and rash; unable to synthesize those who receive larger vitamin initially doses may exhibit because of limited hyperbilirubinemia and intestinal flora; jaundice. therefore production of clotting factors in liver is hindered and low prothrombin levels are evidenced. Phytonadione facilitates production of clotting factors equal to natural vitamin K. A Legacy of Excellent Education in Virtus et Scientia Email: [email protected] | Tel. No.: (033) 337-4841 to 44 | Fax No.: (033) 337-4403 jilamasan  University of San Agustin General Luna St., Iloilo City 5000, Philippines www.usa.edu.ph COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS-NURSING PROGRAM IMMUNIZATION DURING THE NEWBORN PERIOD BEFORE DISCHARGE HEPATITIS B VACCINE The American Academy of Pediatrics and the Centers for Disease Control and Prevention (CDC) have recommended that immunization against hepatitis B virus (HBV) begin in the newborn period. HBV infection may result in serious long-term liver disease, cancer, and death in adulthood HEPATITIS B IMMUNIZATION IN THE NEWBORN PERIOD Generic Name Route and Dosage Uses Side Effects and Pregnancy (Brand Name) Special Consideration Category hepatitis B For newborns of A recombinant Given to all infants regardless C vaccine (Engerix- mothers who have vaccine that of HBsAg status of mother. B, HBsAg-negative, provides Unvaccinated infants 24 weeks (6mo). (preferably) or rectus femoris; never inject IV. Following three Recombivax HB: 0.5 doses, >90% of infants and mL (5 mcg) IM children will seroconvert 95%- within 12 h after 99%. Protection in those who birth (first dose), seroconvert wil last 3-7 y with repeated at 1 mo single booster. and 6 mo. Contraindicated in patients with hypersensitivity to any component of vaccine or yeast. Neonatal side effects: soreness at injection site with edema, warmth, erythema, and induration. A Legacy of Excellent Education in Virtus et Scientia Email: [email protected] | Tel. No.: (033) 337-4841 to 44 | Fax No.: (033) 337-4403 jilamasan  University of San Agustin General Luna St., Iloilo City 5000, Philippines www.usa.edu.ph COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS-NURSING PROGRAM Activity 1- CASE ANALYSIS (Think and Prioritize) Instructions: 1. Read and analyze the given scenario. 2. Identify at least five nursing diagnoses each for the mother and the newborn. 3. List the identified nursing diagnoses according to priority. 4. Write your answer on the box provided below Case Scenario: TA, an older adolescent, was admitted to the hospital for labor induction/augmentation with signs and symptoms of gestational hypertension at 42 weeks’ pregnant (gravida 4, para 1). TA’s mother arrived at the hospital when TA was 8 cm dilated, in time for the late stages of TA’s labor. Her mother remained as TA’s support person throughout the delivery, which occurred at 6:00 AM by vacuum extraction. TA had a continuous epidural for her labor and delivery. An episiotomy was performed at the time of delivery, and a fourth-degree laceration occurred. A cluster of hemorrhoids was evident. Baby JA, weighing 8 lb 7 oz, had Apgar scores of 7 and 9. The infant is alert and active. TA lives with her parents and has been going to high school while working part time in an automotive parts store. TA wants to keep her infant and to breastfeed “for at least 3 months.” She plans to finish school and return to work in 6 weeks. Immediately after the delivery, the nurse conducts an assessment of TA, analyzes the data, and determines and prioritizes TA’s nursing care needs. The same is done for the newborn. Mother Newborn 1. 1. 2. 2. 3. 3. 4. 4. 5. 5. A Legacy of Excellent Education in Virtus et Scientia Email: [email protected] | Tel. No.: (033) 337-4841 to 44 | Fax No.: (033) 337-4403 jilamasan  University of San Agustin General Luna St., Iloilo City 5000, Philippines www.usa.edu.ph COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS-NURSING PROGRAM Activity 2 – Analyze and Share Instructions: 1. Read and analyze the scenario. 2. Write your answers on the box provided below. Case Scenario: Because of her episiotomy, TA is concerned about her first postdelivery bowel movement. It is explained to her that the docusate with sennosides product in her self-administered medication packet will help. Questions: 1. TA says that she does not want to take the docusate because she plans to breastfeed. What is the appropriate nursing diagnosis based on TA’s communication? 2. As a nurse how will you address TA’s concerns, based on knowledge of the product and breastfeeding? 1. 2. A Legacy of Excellent Education in Virtus et Scientia Email: [email protected] | Tel. No.: (033) 337-4841 to 44 | Fax No.: (033) 337-4403 jilamasan  University of San Agustin General Luna St., Iloilo City 5000, Philippines www.usa.edu.ph COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS-NURSING PROGRAM Rubrics for Case Analysis CRITERIA POINTS SCORE 4 3 2 1 Clear Shows superior Shows adequate Shows some Shows little explanation of knowledge of knowledge of the understanding of understanding of key issue/case the issues, key issues, key the issues, key the issues, key problems problems, problems, problems, Appropriate Issue were Issue were Issue were not Inadequate analysis, clearly identified partially identified analysis of the evaluation, identified issue synthesis of the issue/case Interpretation Demonstrate Demonstrate less Lacks critical No critical and critical thinking critical thinking thinking skills thinking skills skills about the skills about the about the topic about the topic application topic and the topic and the student’s own student’s own impressions and impressions and interpretations interpretations of the case of the case Summary Well organized, Well organized, Well organized, Weakly paragraph demonstrates but but organized logical demonstrates demonstrates sequencing and illogical illogical sentence sequencing or sequencing and structure sentence sentence structure structure Grammar and Punctuations There is 1 error There are 2 or 3 There are 4 or spelling and in Punctuations errors in more errors in capitalizations and/or Punctuations Punctuations are correct capitalizations and/or and/or capitalizations capitalizations TOTAL /20 pts A Legacy of Excellent Education in Virtus et Scientia Email: [email protected] | Tel. No.: (033) 337-4841 to 44 | Fax No.: (033) 337-4403 jilamasan