INTESTINAL OBSTRUCTION

Group 4, n-407
INTESTINAL OBSTRUCTION
 isa blockage of your small intestine or colon that prevents
food and fluid from passing through.

 can be caused by many conditions, including fibrous bands

of tissue in the abdomen (adhesions), hernias and tumors.

 Alternative names: Paralytic ileus; Intestinal volvulus; 

Bowel obstruction; Ileus; Pseudo-obstruction - intestinal;
Colonic ileus.

 Etiology of bowel obstruction is pathological prevention of

passage of gastrointestinal luminal content from passing
distally.
 The signs and symptoms of intestinal obstruction are
Abdominal swelling, Constipation, Severe abdominal cramps
, Intermittent abdominal cramps, nausea and Vomiting,
Green vomit, Fecal vomiting (vomit that looks like feces)
Blood-stained mucus passed, Passing jelly-like mucus

 Diseases and conditions that can increase your risk of

intestinal obstruction include: Abdominal or pelvic surgery,
which often causes adhesions — a common cause of
intestinal obstruction. Crohn's disease — an inflammatory
condition that can cause the intestine's walls to thicken,
narrowing its passageway. Cancer within your abdomen,
especially if you've had surgery to remove an abdominal
tumor or radiation therapy
OBJECTIVES (NURSE-CENTERED)

Upon completion of this case study, the student nurse should be able
to:

COGNITIVE

 Recognize and understand the disease condition.

 Identify predisposing and precipitating factors that could possibly
contribute to the occurrence of the disease.
 Understand the normal anatomy and physiology of the organs that
are affected by the underlying disease condition.
 Review literature and background of the signs and symptoms
manifested by the client.
 Identify specific theoretical and/or research-based causes and
clinical manifestations of the disease, and trace the
pathophysiology of the disease condition.
AFFECTIVE

 Establish rapport with the client and SO.

 Maintain sound communication by making use of self as a
therapeutic agent.

PSYCHOMOTOR

 Assess the following such as:

Personal history such as demographic data
Pertinent family health and history by making use of a diagram
History of past and present illness
 Formulate nursing diagnosis that address the needs of the patient
and plan nursing interventions to meet those needs.
 Conduct physical assessment (cephalo-caudal approach, review of
systems)
 Review and monitor diagnostic and laboratory results

 Construct individualized nursing care plans.

 Do discharge planning
II NURSING HISTORY
Personal History
 
Demographic Data
 
Mr. P, is a 39 year old male, he was born on December 1, 1971. He is married
and blessed with 3 children. He is a Filipino citizen, currently living at Lubao,
Pampanga together with his wife and children. His religious view is Roman
Catholic. He is a college undergraduate of Bachelor of Science in Education,
in Don Honorio Ventura College of Arts and Trades.

b.Socio-Economic and Cultural Factors

Mr. P’s family source of daily expenses comes from the money he earns as a
tricycle driver and from her wife’s mini grocery at home. They are earning a
total of P10,000.
Mr.P’s weekly expenses are:
Food 2000x( 4) = 8000/month Monthly Income = 10000
Electric Bill 1000/month Monthly Expenses = 9400
Water Bill 400/month 600
 He wakes up at 5:00 a.m. to take a bath and eat breakfast. By 6:00 am he will
drop by and pick up the 3 elementary students at their house and he will send
them to school. From 8:00 am to 3:00 pm he will stay at the terminal and pick up
passengers. Then at 4:00 p.m he will fetch the students from school and bring
them back home. At 5:00 pm onwards he will watch t.v., eat, or sometimes go to
his neighbors. He usually sleeps at 10:00 in the evening.
 
He smokes 1 pack per day of Philips since he was 27 y/o, but he stopped
smoking 3 years ago. And he drinks 1 1/2 bottle a day of Red Horse.

Pack years = # of packs/day x # of years smoked

= 1 pack/day x 5
= 9 pack years

He only self-medicate when he has headache and fever by taking Biogesic

every 4 hours until the symptoms subside. They also seek help to a
“manghihilot” if they have fever. They also utilize herbal medicines like oregano
and guava whenever one of their family members is having cough and colds and
stomach ache respectively, in which they boil the leaves for 5 to 10 minutes and
drinks 1 glass 3x/day until it subsides.
 
II. Family Health Illness History
 
It was revealed in the diagram that on father side, Mr. T’s grandfather is
hypertensive and has Diabetes mellitus, and his grandmother died because of
old age. On the other hand, on his mother side, Mr. P’s grandparents are both
alive, his grandmother has heart disease while his grandfather is living
healthy. His father was also hypertensive and his mom has heart disease. In
addition his eldest sister is hypertensive and she was diagnosed of Diabetes
mellitus Type II.
Lastly, our client was currently diagnosed of Partial Intestinal Obstruction
secondary to ileocecal tumor. Patient claimed that aside from those, there are
no significant hereditary familial disease like asthma, bone disease and etc.
III. History of Past Illness

The patient has been hypertensive for the past 2 years, according to him he
was taking Norvasc 5mg once a day. He has also irregular bowel habits for the
past 3 months. The patient has also experienced minor illness such as cough and
colds and drinks 2 tablespoon of oregano 3x/day until symptoms subside. He
also experienced having fever once in a while in which he self medicates by
taking Biogesic every four hours until fever is gone.
History of Present Illness

One month prior to admission patient had generalized abdominal pain

associated with 2 episodes of watery diarrhea and 2-3 episodes of vomiting and
he noticed abdominal distention. Patient consulted to the nearest hospital and
was admitted with a chief complaint of abdominal pain. NGT inserted to relieve
his abdominal distention. After 9 days he decided to be discharged when his
abdominal distention was relieved, he signed a refusal form and was advised by
the doctor just to come back once pain persists. Patient had on and off pain after
2 days of being discharged followed by abdominal distention, with a pain scale
of 7/10. He went back to the said hospital, thus, admitted again to have his
operation, Explore Laparatomy, Right Hemicolectomy.
 
 
PHYSICAL ASSESSMENT
III. DIAGNOSTICS AND
LABORATORY PROCEDURES
Diagnostic / Laboratory Indications or Purpose Date Results Normal Values Analysis and
Procedure Ordered Interpretation of
Date Results the Results
were
released
Hematology To aid in diagnosing        
anemia and to monitor
  blood loss and infection        

         

Hct (%) This represents the 9-7-10 .23 .40-.52 Hematocrit is below
  percentage of total blood       the normal range.
  volume composed of       This may be due to
  RBC       the intestinal
          obstruction which
          leads to digestive
          inflammation.
         
         
Hgb (g/dL) This indicates the 9-7-10 120 125-175 g/L Hemoglobin is
  amount of hemoglobin in       slightly decreased.
  a given blood volume.       This may be due to
Hemoglobin is the       the intestinal
component of the blood       obstruction which
that gives its red color.     leads to digestive
    inflammation.
     
     
     
 
 
Diagnostic / Indications or Date Ordered Results Normal Analysis and
Laboratory Purpose Date Results Values Interpretation
Procedure were released of the Results

WBC (x10 9/L) The patient has a 9-7-10 12.4 5-10 x 109/L White Blood Cell
bacterial infection so is Increased
it is important that which may
the WBC be indicate infection.
determined which is
responsible to fight
against infection.
Neutrophils(%) Neutrophils are the 9-7-10 .88 .45-.65 Neutrophils is
most common type   increased which
of white blood cell,   may indicate
comprising about 50-   bacterial
70% of all white   infection.
blood cells. They are
phagocytic, meaning
that they can ingest
microorganism.
Neutrophils are the
first immune cells to
arrive at a site of
infection.
 
Diagnostic / Indications or Date Ordered Results Normal Values Analysis and
Laboratory Purpose Date Results were Interpretation of
Procedure released the Results

Lymphocytes A small white blood 9-7-10 .12 .20-.35 The infection is

  cell (leukocyte) that       caused by bacteria.
  plays a large role in       However, the
defending the body       lymphocytes are
against disease.       low since this is
      indicated for viral
      infections
   
   
   
 
 
Platelet (x10 9/L) Indicates the amount of 9-7-10 .387 150-400 x 10 /L
9
Platelet count is
  platelets present in a       within the normal
  given amount of blood,       range.
  the platelets are the        
  ones responsible for        
  blood clotting and stop        
  bleeding.      
       
         
         
         
       
   
   
NURSING RESPONSIBILITIES

 Prior Administration:
 Check the doctor’s order.
 Prepare the needed materials for laboratory test.
 Explain the purpose and indication of laboratory test to the patient.

 During Administration:
 Instruct the patient to cooperate fully and to follow directions. Direct the
patient to breathe normally and to avoid unnecessary movements.
 If the patient has a history of severe allergic reaction to latex, care should be
taken to avoid the use of equipment containing latex.
 Remove the needle and apply pressure dressing on the puncture site.

 After Administration:
 Label the blood specimen with the name, age and diagnosis of the patient.
 Bring the blood specimen immediately to the laboratory
 Document the laboratory test performed.
 Attach the laboratory test result in the patient’s chart.
Diagnostic / Indications or Purpose Date Ordered Results Normal Analysis and
Laboratory Date Results Values Interpretation of
Procedure were released the Results

Blood Chemistry Blood chemistry tests are        

  often ordered prior to        
  surgery or a procedure to        
  examine the general        
  health of a patient.        
           
           
           
  Random glucose test is a        
  blood sugar test taken        
RBS from a non-fasting        
subject. This is ordered 9-7-10 10.26 3.85 – 9.0 There is an increased
since the patient mmol/L blood sugar which
manifests some signs and could indicate
symptoms of diabetes diabetes mellitus.
mellitus such as This could also be
polydipsia, polyuria, and attributed to stress
weight loss. brought by the
disease condition.
Diagnostic / Indications or Purpose Date Ordered Results Normal Analysis and
Laboratory Date Results Values Interpretation of
Procedure were released the Results

BUN The blood urea 9-7-10 12.8 1.7-8.3 A high level may
nitrogen test is a mmol/L indicate that the
measure of the amount kidneys are
of nitrogen in the functioning less than
blood in the form of normal.
urea, and a
measurement of renal
function.
Sodium It may be ordered to 9-7-10 125.1 136-145 Sodium electrolyte
determine if a disease mmol/L is below the normal
or condition involving range. This may be
the brain, lungs, liver, due to diarrhea,
heart, kidney, thyroid, excessive urination,
or adrenal glands is and vomiting prior
causing or being to admission.
exacerbated by a
sodium deficiency or
excess.
Diagnostic / Indications or Purpose Date Ordered Results Normal Analysis and
Laboratory Date Results Values Interpretation of the
Procedure were released Results

Potassium Essential to regulate 9-7-10 3.16 3.5-5 mmol/L Potassium electrolyte

heartbeat, facilitate is below the normal
normal muscle range. This may also be
contraction, regulate the due to diarrhea,
transfer of nutrients to excessive urination,
cells, and regulate kidney and vomiting prior to
function and stomach admission.
juice secretion,

Chloride This test shows the level 9-7-10 76.7 101-111 Serum Chloride is
of chloride in the blood. mmol/L below the normal
Chloride binds with range. This may also
electrolytes including be due to diarrhea,
potassium and sodium in excessive urination,
the blood and plays a role and vomiting prior to
in maintaining the proper admission.
pH of the blood. Chloride
levels can vary widely if
the patient is dehydrated
or overly hydrated, if the
kidneys are not
functioning properly.
Diagnostic / Indications or Purpose Date Ordered Results Normal Analysis and
Laboratory Date Results Values Interpretation of
Procedure were released the Results

Alkaline Phosphatase Alkaline phosphatase 9-7-10 119.7 64-306 IU/L The alkaline
  (ALP, ALKP) is a phosphatase is within
hydrolase enzyme the normal range.
  responsible for removing
  phosphate groups from
many types of molecules,
  including nucleotides,
proteins, and alkaloids.
 

SGOT/AST SGOT: Serum glutamic 9-7-10 48 10-40 IU/L The SGOT is elevated
oxaloacetic transaminase, which may indicate a
an enzyme that is liver or heart
normally present in liver problem.
and heart cells. SGOT is
released into blood when
the liver or heart is
damaged.
Diagnostic / Indications or Purpose Date Ordered Results Normal Analysis and
Laboratory Date Results Values Interpretation of
Procedure were released the Results

SGPT/ALT Alanine transaminase 9-7-10 25.8 0-39 IU/L The SGPT is within
or ALT is a normal range.
transaminase enzyme
(EC 2.6.1.2). It is also
called serum glutamic
pyruvic transaminase
(SGPT) specific test for
liver function. Since
the patient is taking
anti-TB drugs, it is
important to check for
liver function since one
of its side effects is
hepatotoxicity.
NURSING RESPONSIBILITIES

 Prior Administration:

 Check the doctor’s order.

 Prepare the needed materials for laboratory test.
 Explain the purpose and indication of laboratory test to the patient.

 During Administration:
 Instruct the patient to cooperate fully and to follow directions. Direct the patient to
breathe normally and to avoid unnecessary movements.
 If the patient has a history of severe allergic reaction to latex, care should be taken to
avoid the use of equipment containing latex.
 Remove the needle and apply pressure dressing on the puncture site.

 After Administration:
 Label the blood specimen with the name, age and diagnosis of the patient.
 Bring the blood specimen immediately to the laboratory
 Document the laboratory test performed.
 Attach the laboratory test result in the patient’s chart.
Diagnostic / Indications or Purpose Date Results Normal Values Analysis and
Laboratory Ordered Interpretation of
Procedure Date Results the Results
were
released
Urinalysis To check components of the D.O: 09-07-10 Color: yellow Usual colors are This indicates that the
urine     colorless, straw, urine is concentrated.
D.R: 09-07-10   yellow, amber;  
  less commonly  
 Transparency: pink, red, brown.  Urine normally is
Turbid   clear. Mucus and
  Usual lipid may cause
  appearances turbidity in normal
  (opacity) are clear urine. Increased
  or hazy; less numbers of cells,
  commonly turbid, crystals, casts, or
  cloudy and organisms can
  opaque increase the turbidity
    of urine in disease
    conditions.
     
Albumin: (-)    
     
Sugar: (-)    
    The specific gravity is
Specific  1.010 – 1.025 lower than the
gravity: 1.005   normal range which
    indicates that the
 Puss cells: 12-   urine is concentrated.
16/ HPF   This may be due to
  problem in the urine
  3-6/HPF concentration of the
kidneys.
NURSING RESPONSIBILITIES
Prior Administration:
Check the doctor’s order.
Prepare the needed materials for laboratory test.
Explain the purpose and indication of laboratory test to the
patient.

During Administration:
A urine sample is collected in an unused disposable plastic cup
with a tight-fitting lid.
A randomly voided sample is suitable for routine urinalysis
although the first-voided morning urine is most
concentrated and therefore, preferred.

After Administration:
Label the urine specimen with the name, age and diagnosis of
the patient.
Bring the urine specimen immediately to the laboratory
Document the laboratory test performed.
Attach the laboratory test result in the patient’s chart.
 
Diagnostic / Indications or Purpose Date Results Normal Values Analysis and
Laboratory Ordered Interpretation of
Procedure Date the Results
Results
were
Chest X-Ray To evaluate the lungs, as   released (+) The lungs look  
  well as the chest cage, for   cardiomegaly normal in size and Results show
the presence of     shape, and the lung cardiomegaly or
abnormalities. 9-7-10   tissue looks normal. enlargement of the
To evaluate the size of the   No growths or other heart which may
heart.   masses can be seen indicate that the
To establish the size and 9-7-10 within the lungs. patient has a heart
location of an abnormality   The pleural spaces problem.
prior to performing other   also look normal.
tests, such as a biopsy.   The heart looks
    normal in size,
    shape, and the heart
    tissue looks normal.
  The blood vessels
  leading to and from
  the heart also are
  normal in size,
  shape, and
  appearance.
  The bones
  including the spine
and ribs look
normal.
The diaphragm
looks normal in
shape and location.

 
Diagnostic / Laboratory Indications or Date Ordered Results Normal Analysis and
Procedure Purpose Date Results Values Interpretation of
were released the Results

Electrocardiography Symptoms generally   Sinus Normal Results show a fast

  indicating use of   tachycardi sinus heartbeat which is
electrocardiography   a rhythm: each attributed to the
include: 9-7-10   P wave is heart enlargement
 Cardiac
  followed by since the heart
murmurs
  a QRS; P needs to
 Syncope or 9-7-10 wave rate is compensate in
collapse   not more order to pump
  than 150 enough blood.
 Seizures
  bpm
 Perceived  
dysrhythmia]  
 
 Symptoms of
 
myocardial
 
infarction
 
   
   
 
 
 
NURSING RESPONSIBILITIES

 Instruct client that hospital gown will replace all

clothing on the upper body.

 All jewelry must be removed.

 Pregnant women and should use protective lead

aprons during the procedure because there is
minimal exposure to radiation.

 Ask client to take a deep breath and hold it without

moving while an X-ray picture is taken.
NURSING RESPONSIBILITIES

Clean the skin and clip hair in the area where the electrode tabs will be
placed to ensure adherence and reduce discomfort during removal

Attach the adhesive electrode tabs to the skin where the electrode wires
will be fastened.

Avoid touching the adhesive tabs over bones, scars, and breast tissues.

After the procedure, wipe the area or the electrode tabs especially when
lubricant is used.
SURGICAL MANAGEMENT
 Surgical Management General Description Indications/ Purpose Date Ordered, Date Client’s response to treatment
Performed
Exploratory Laparotomy with Exploratory laparotomy is a Date ordered: The patient complains of pain
A laparotomy is a large incision
Hemicolectomy method of abdominal exploration, a on the incision site.
made into the abdomen. diagnostic tool that allows September 8, 2010
  physicians to examine the  
Exploratory laparotomy is used to Date Performed:
abdominal organs. The procedure
   
visualize and examine the may be recommended for a patient September 9, 2010
who has abdominal pain of  
structures inside of the abdominal unknown origin or who has  
cavity. sustained an injury to the abdomen.  
 
 
The procedure is relatively common  
Hemicolectomy (also referred to  
for treating diverticulitis,
 
as right or left hemicolectomy) is inflammatory bowel disease, benign
 
or malignant polyps of the colon,  
a partial colon-removal procedure and colon cancer. 
in which surgeons excise the right The hemicolectomy procedure
traditionally begins with an incision
(ascending) part of the colon or in the abdomen, opening the area
the left (descending) side of the for access to the colon.  Thereafter,
the surgeon cuts away the infected
colon.  or injured portions of the colon and
reattaches the remaining tissue.
 
 
NURSING RESPONSIBILITIES
Prior

 Explain to the patient how the procedure will be done or what the results will
mean.
 Ask him Ask her to sign the inform consent. Make sure that the patient should
understand the nature and purpose of the diagnostic procedure or treatment, its
risks and benefits, and alternatives, including the option of not proceeding with the
test or treatment.

 Ask him to fill out the medical test information form to understand the importance
of the surgery.

Ask the patient if :

 Areallergic to any medications, including anesthetics.
 Have had bleeding problems or take blood thinners, such as aspirin or warfarin
(Coumadin).
 Get the complete blood count (CBC) and bleeding factors.
 NPO post-midnight before surgery.

 Ask the patient to remove dentures, eyeglasses or contact lenses, hearing aids,
wigs, makeup, and jewelry before the biopsy.
 Ask him to empty bladder
NURSING RESPONSIBILITIES
During
 Maintain aseptic technique.

After
 He may be required to lie flat for two hours following
the procedure to prevent the risk of bleeding.
 Checks the patient's status at two-hour intervals.

 Monitor vital signs.

 Inform the patient that he should report immediately

if the he experiences extreme pain, light-headedness,
or difficulty breathing after the procedure.
 Advise to keep the incision site covered and dry for
48 hours.
PATHOPHYSIOLOGY
MEDICAL MANAGEMENT
POST-OP DRUGS
 Indication Client’s
Generic and General Nursing Responsibilities
(s) /Purpose Response to
Brand name Description  
(s) treatment
GN: Disturbs DNA It is >Compute the ordered The patient
Metronidazo synthesis in prescribed in dosage of the drug twice. responded
le susceptible the treatment   well with no
  bacterial of a variety of > Monitor I.V. site. Avoid signs of
BN: Flagyl organisms. infections prolonged use of infection.
  It is converted to such as indwelling catheter.
Initially, 15 reduction bacterial
mg/kg I.V., products that infections. > Evaluate hematologic
followed by interact with DNA studies, especially in
7.5 mg/kg to cause patients with history of
I.V. q 6 destruction of blood dyscrasias.
hours, not to helical DNA  
exceed 4 structure and >Advise patient to report
g/day for 7 to strand leading to a fever, sore throat,
10 days protein synthesis bleeding, or bruising.
inhibition and cell  
death in >Inform patient that
susceptible prolonged use may result
organisms. in fungal or bacterial
superinfection.
 
> document and sign for
the time of administration.
 Indication Client’s
Generic and General Nursing Responsibilities Response to
(s) /Purpose
Brand name Description   treatment
(s)
GN: Exhibits anti- It is >Advise patient to The patient’s
Celecoxib inflammatory, prescribed for immediately report bloody pain scale
  analgesic, and the treatment stools, vomiting of blood, decreased
BN: Celebrex antipyretic action of acute pain. or signs or symptoms of from 6 to 3.
  due to inhibition liver damage (nausea,
200 mg b.i.d. of COX-2 enzyme fatigue, lethargy, pruritus,  
yellowing of eyes or skin,  
tenderness in upper right
abdomen, or flulike
symptoms).

>Instruct patient to take

drug with food or milk.

>Tell patient to avoid

aspirin and other NSAIDs
(such as ibuprofen and
naproxen) during therapy.
 
> document and sign for
the time of administration.
 Client’s Response to
Generic and Indication (s) Nursing Responsibilities treatment
General Description
Brand name /Purpose (s)  
GN: Interacts with opioid receptor Indicated for >Compute the ordered The patient’s pain
Morphine sulfate sites, primarily in limbic severe to moderate dosage of the drug twice. scale decreased from
BN: Roxanol system, thalamus, and spinal pain.   6 to 3.
  cord. This interaction alters > Monitor I.V. site. Avoid prolonged use of indwelling catheter.  
  neurotransmitter release,  
  altering perception of and > For best response, give at pain onset.
2 to 10 mg/70 kg I.V. tolerance for pain.  
p.r.n. given slowly over >Tell patient and caregiver that drug may cause respiratory
4 to 5 minutes. depression. Instruct them to immediately report respiratory rate of
10 breaths/minute or less.

> Inform patient that drug may cause constipation or urinary

retention. Encourage high-fiber diet and high fluid intake.
>Stress importance of taking drug only as prescribed. Point out
that drug may cause psychological or physical dependence.

>Caution patient to avoid driving and other hazardous activities

until he knows how drug affects concentration, vision, and
alertness.

>Teach patient and caregiver about appropriate safety measures to

prevent injury.

> Caution patient to avoid alcohol and other CNS depressants

during and for 24 hours after therapy.

> Advise patient to avoid herbs, which may worsen adverse CNS
effects.

> As appropriate, review all other significant and life-threatening

adverse reactions and interactions, especially those related to the
drugs, tests, herbs, and behaviors mentioned above.
 
> document and sign for the time of administration.
Generic and Indication (s) Nursing Responsibilities Client’s Response to
General Description treatment
Brand name /Purpose (s)  
GN: Blocks effects but not Used as an >Compute the ordered The patient responded
Promethazine release of histamine and adjunct to dosage of the drug twice. well with no signs of
Hcl exerts strong alpha- postoperative   infection.
  adrenergic effect. Also analgesia and >Monitor I.V. site. Avoid prolonged use of indwelling
BN: Phenergan inhibits chemoreceptor provide catheter.
  trigger zone in medulla sedation.  
25 to 50 mg I.V. and alters dopamine >Monitor neurologic status. Stay alert for signs and
at bedtime effects by indirectly symptoms of neuroleptic malignant syndrome (high fever,
reducing reticular sweating, unstable blood pressure, stupor, muscle rigidity,
stimulation in CNS. and autonomic dysfunction).
 
  > In long-term therapy, assess for other adverse CNS
effects, including extrapyramidal reactions.

>Monitor CBC and liver function tests.

 
>Caution patient to avoid driving and other hazardous
activities until he knows how drug affects concentration,
vision, alertness, and motor skills.

>As appropriate, review all other significant and life-

threatening adverse reactions and interactions, especially
those related to the drugs, tests, herbs, and behaviors
mentioned above.

> document and sign for the time of administration.

 Indication Client’s
Generic and General Nursing Responsibilities
(s) /Purpose Response to
Brand name Description  
(s) treatment
GN: Ampicillin Destroys bacteria by To treat intra- >Compute the ordered The patient responded
sodium and inhibiting bacterial abdominal, and dosage of the drug twice. well with no signs of
Sulbactam sodium cell-wall synthesis skin-structure   infection.
  during microbial infections caused > Monitor I.V. site. Avoid prolonged use of indwelling catheter.
BN: Unasyn multiplication. by susceptible  
  Addition of beta-lactamase- >Instruct patient to immediately report signs and symptoms of
1.5 to 3 g I.V. q 6 sulbactam enhances producing strains. hypersensitivity reaction, such as rash, fever, or chills.
hours drug's resistance to
beta-lactamase, an >Tell patient to report signs and symptoms of infection or other problems at
enzyme that can injection site.
inactivate ampicillin.
>Inform patient that drug lowers resistance to certain infections. Instruct
him to report new signs or symptoms of infection, especially in mouth or
rectum.
 
>Tell patient to promptly report unusual bleeding or bruising.

>Instruct patient to avoid activities that can cause injury. Advise him to use
soft toothbrush and electric razor to avoid gum and skin injury.

>Inform patient that he may need to undergo regular blood testing during
therapy.

>As appropriate, review all other significant and life-threatening adverse

reactions and interactions, especially those related to the drugs and tests
mentioned above.
 
> document and sign for the time of administration.
VI. CLIENT’S DAILY PROGRESS
NURSING CARE PLAN
THANK YOU
Godbless…