OPERATIVE TECHNIQUES

Pre-Operative Techniques
Patient Assessment:

 Patient was brought to the operating room, checked identity of the patient using 2 identifiers.
Obtain/ Verified consent for operation. Received IVF of PNSS 1L + 10 units oxytocin fast drip.

 Verified time of NPO, usually 6-8hours before the operation.

 Verified pre-operative administration of antibiotics, and checked for any kind of allergies.

 Informing the patient about the procedure, what to expect, and post-operative care.

Intra-Operative Techniques
1. Anesthesia

 Patient as placed in supine position under spinal anesthesia. Administering the chosen
anesthesia method (commonly spinal or epidural anesthesia for LSCS. Circulating nurse timed
the start of anesthesia.
 Insertion of IFC was done aseptically and connected to urine bag. Internal exam revealed cervix
6cm dilated, 60% effaced, breech, station -1, ruptured bag of water, thickly meconium stained.

 Circulating nurse timed the start of anesthesia

2. Surgical Preparation:

 Scrub nurse done aseptic handwashing and don gowning and gloving, with the team. Scrub
nurse prepared the instruments needed and confirmed counting with the circulating nurse.
Asepsis/Antisepsis. Sterile drapes were placed.

3. Incision:

 Making a transverse incision in the lower segment of the uterus. Circulating nurse timed the
start of the operation.

 Incising through the skin, subcutaneous tissue, and fascia.

4. Uterine Access:

 Making a transverse incision in the lower segment of the uterus. Circulating nurse timed the
start of the operation.
 Incision layer by layer until the fascia was reached using surgeons’ knife and Metz scissors with
simultaneous sponging and clamping of bleeders. Rectus muscle was split, reaching the
peritoneum
 Peritoneum was opened exposing gravid uterus
 Bladder retractor was positioned, vesico-uterine field of peritoneum was grasped and incised
transversely. Bladder was mobilized.
 The uterine cavity is entered through a transverse curvilinear incision on the lower uterine
segment about 1cm before the upper margin of peritoneal reflection. Incision was extended
laterally using surgeons index finger.
  Amniotic membrane was incised, adequate and thickly meconium stained, amniotic fluid was
suctioned.
 Hand was slipped into the uterine cavity between symphysis pubis and fetal hand.

5. Delivery of the Fetus:

 Fetal hand was gently elevated with left foot and right foot followed by delivery of the buttocks
and shoulders and the head, delivering a live baby boy. Circulating nurse timed baby out and
confirmed gender of the baby. Immediate assessment of the newborn (Apgar score, suctioning
if necessary)

6. Placenta Delivery:

 Umbilical cord was doubly-clamped and cut after the pulsations have stopped. Placenta was
located posteriorly and was extracted by controlled cord traction, with simultaneous suctioning
of blood. Inspection of the placenta for completeness.
 Uterine cavity was cleaned with dry visceral pack. Re-application of the bladder retractor.

7. Closure:

 Clamping of the uterine angles using allis forceps

 Uterine incision closed in layers

A. I- continuous interlocking polyglactin suture 1

B. II- simple continuous polyglactin suture 1

 Hemostasis and inspection for bleeders was done.

 Inspection of other pelvic organs revealing the bilateral fallopian tubes, ovaries and appendix
were grossly normal.
 Abdominal wall was closed in layers after complete sponge and instrument count was done
twice:
a.Fascia- simple continuous polyglactin suture 1
b.Subcutaneous- simple continuous polyglactin suture 2.0
c-Skin-subcuticular polyglactin suture 3.0
 Incision wound was applied with antiseptic and covered with pressure dressing.
 Vaginal vault was evacuated of blood clots

8. After Care:
 Perineal care done. Scrub nurse washed all the instruments, assisted in cleaning the OR and
prepared patient for transfer in the PACU

Post-Operative Techniques
1. Immediate Post-Operative Care:

 Monitoring vital signs, uterine tone, and bleeding in the recovery area.

 Assessing the newborn and facilitating skin-to-skin contact if possible.

2. Pain Management:

 Administration of analgesics (e.g., NSAIDs, opioids) as needed.

  Consideration of regional anesthesia for pain control.

3. Wound Care:

 Monitoring the surgical site for signs of infection, hematoma, or dehiscence.

 Educating the patient on wound care and signs of complications.

4. Mobilization:

 Encouraging early ambulation to prevent thromboembolic events and promote recovery.

 Gradual resumption of normal activities as tolerated.

5. Breastfeeding Support:

 Providing support and education for breastfeeding.

6. Follow-Up Care:

 Scheduling follow-up appointments to monitor recovery and address any concerns.

 Providing information on contraception and future pregnancies.

PATIENTS PROFILE
PATIENT: F.J.G.
AGE: 24

GENDER: FEMALE

ADDRESS: AURORA HILL., BAGUIO CITY

PRE-OPERATIVE DIAGNOSIS: G1P0 PREGNANCY UTERINE 32 5/7 WEEKS AGE OF GESTATION, INCOMPLETE
BREECH IN PRETERM LABOR; PRETERM PRELABOR RUPTURE OF MEMRANES 3X

POST-OPERATIVE DIAGNOSIS: 51P1 (0101) PREGANCY UTERINE DELIVERED BREECH PRETERM (35-36 WEEKS)
LIVE BABY GIRL (BW:2.24KG) APPROPRIATE FOR GESTATIONAL AGE BY EMERGENCY

OPERATION PERFORMED: EMERGENCY PRIMARY LOW SEGMENT TRANSVERSE CESAREAN SECTION

HISTORY OF PRESENT ILLNESS

Patient is a 24-year-old female, currently in her first pregnancy (G1P0), who is 32 5/7 weeks age of gestation.
She reports that her pregnancy has been generally uncomplicated until recently. She notes experiencing mild
to moderate abdominal discomfort and described characteristics as sharp constant pain. With the obstetric
history taken in the ER, she reports that her previous ultrasound has shown normal fetal growth and
development and patient was compliant with prenatal checkup, vitamins and no known allergies. Patient have
no history of hypertension, diabetes and have no history of any surgeries or significant medical issues in the
past. Upon performing internal examination, fetal head is described as having 6cm dilated at -1 station, 60%
effaced 5 hours ago and in breech presentation. Given the circumstances with the failure of descent, decision
was made to proceed with an emergency cesarean section delivery to ensure safety of both the mother and
the fetus.

PATHOPHYSIOLOGY:

Emergency cesarean sections (LSCS) are indicated primarily for fetal distress, failure to progress in labor, and
maternal complications such as severe bleeding or pre-eclampsia. Other reasons include breech presentation
and prolapsed umbilical cord, which can compromise the safety of both the mother and the fetus.

In this case, the patient is a 24-year-old female at 32 weeks and 5 days of gestation, currently experiencing
mild to moderate abdominal discomfort characterized as sharp and constant pain. This discomfort may be
attributed to several pathophysiological factors related to her pregnancy and the fetal position.

Initially, the patient had an uncomplicated pregnancy, with normal fetal growth and development confirmed by
ultrasound. However, as the pregnancy progressed, the fetal head was noted to be at -2 station, indicating that
it had not yet engaged in the pelvic inlet, which is critical for normal labor progression. The breech
presentation of the fetus further complicates this situation, as it can prevent the fetal head from descending
properly into the birth canal. In a breech presentation, the fetal buttocks or feet are positioned to deliver first,
which can lead to increased intra-abdominal pressure and discomfort for the mother, as well as potential
obstruction of the birth canal.

The sharp, constant abdominal pain reported by the patient may be a result of several factors: the pressure
exerted by the fetal body on the maternal pelvic structures, uterine contractions attempting to facilitate labor,
and possible stretching or irritation of the uterine and abdominal ligaments. Additionally, the failure of the
fetal head to descend adequately can lead to increased tension in the uterine muscles, resulting in pain.

Given that the patient has no significant medical history, including hypertension or diabetes, and has been
compliant with prenatal care, the decision to proceed with an emergency cesarean section was made to
mitigate the risks associated with prolonged labor in a breech presentation. The failure of descent, combined
with the potential for fetal distress due to the abnormal positioning, necessitated surgical intervention to
ensure the safety of both the mother and the fetus. The cesarean section would allow for the safe delivery of
the fetus while avoiding complications such as umbilical cord compression, fetal hypoxia, or maternal injury
associated with obstructed labor. Thus, the pathophysiological considerations in this case highlight the
interplay between fetal positioning, maternal discomfort, and the need for timely intervention to ensure
optimal outcomes for both mother and child.

DIAGRAM:

SAMPLE CHARTING
PRE-OPERATIVE CARE
F> PRE-OPERATIVE CARE

D> Received lying on bed with an ongoing IVF of PNSS 1L x 8 hours at 750cc level infusing well on her left hand. Not in
any form of distress upon assessment, with latest FHT of 148bpm. Afebrile. For emergency cesarean section.

A> Assessed general health status. Monitored vital signs and recorded accordingly. Ensured safety and attended to health
needs. Administered medications as ordered. Encouraged to do deep breathing exercises as a relaxation technique.
Instructed to remove dentures, jewelries and makeup. Advised to do fasting prior to operation. Assisted in wearing gown
without undergarments prior ton OR. Instructed to do oral care and empty bladder before transfer to OR. Encouraged
verbalization of feelings and concerns.

R> Patient verbalizes understanding of the situation and procedure and was calm and cooperative.

INTRA-OPERATIVE CARE
F> Emergency cesarean section

D> Into OR per wheelchair with an ongoing IVF of PNSS1L x 8 hours with 10 units of oxytocin at 680cc level. Verified
identity. Assisted to stretcher; put on bouffant cap. Ensured signed consent fore procedure and anesthesia care. Transfer
to OR, assisted to OR bed, oriented to set-up, hooked to oxygen and cardiac monitor.

A>Positioned to a recumbent position for anesthesia.

6:30am> Anesthesia induced via SAB by Dr. Cong-o. Assisted to shift position to a supine position after inducing
anesthesia, prepared skin using asepsis and aseptic technique. Time out done. Initial count of instruments and sponges
done. Offered prayer.

6:36AM> Operation started by Dr.Bangasan and assisted by Dr.Vinluan. Sponging done. Initial inspection done. Final
count of instruments, sponges and needles cone and complete. Final inspection done. Sterile dressing applied.

7:15AM> Operation done. Post operative care done.

7:20AM> Transfer to PACU via stretcher for further care and management with initial vital signs of:

BP: 110/80mmHg, HR:90bpm, RR:19cpm, SPO2:98%, TP:36.5C

R>Transferred to PACU in stable condition. Endorsed for continuity of care and monitoring.

POST-OPERATIVE CARE
F>post-operative care

D>Patient tolerated the procedure well and was transferred to PACU in a stable condition. Alert, awake and conversant.
Wound dressing was intact with minimal drainage. No signs bleeding and infection noted upon inspection.

A> Assessed general health status. Monitored vital signs every 15mins for the first hour and every 30mins for the next
hour and recorded accordingly. Ensured safety and attended to health needs. Administered pain medications as ordered.
Inspected wound site for any signs of bleeding and infection. Educated on wound care, changing of dressing and
importance of keeping the wound dry. Encouraged to verbalize feelings and concerns.

R>Patient’s vital signs remained stable throughout the post-operative period.

INSTRUMENTS FOR LSCS

NAME AND ILLUSTRATION OF INSTRUMENT PURPOSE
A blade holder is used to
securely hold a surgical blade
(scalpel) during procedures. It
allows for precise control when
making incisions and can be
adjusted to change the angle of
the blade. It minimizes the risk of
injury to the surgeon and staff by
providing a safe grip on the
sharp blade.

 A surgical blade is a sharp cutting

instrument used for making
incisions in the skin and other
tissues during surgical
procedures. Surgical blades
come in various sizes and shapes
(e.g., #10, #11, #15) to
accommodate different types of
incisions and surgical techniques.
They are typically attached to a
scalpel handle for ease of use.
The sharpness and precision of
the blade allow for clean
incisions, which are essential for
minimizing tissue trauma and
promoting optimal healing.

 The curved Kelly clamp is a

hemostatic forceps used to
clamp blood vessels or tissue. Its
curved design allows for better
access in deeper surgical sites. It
is commonly used to control
bleeding during procedures by
occluding blood vessels.

 The straight Kelly clamp is similar

to the curved version but has
straight jaws. It is used for
clamping blood vessels or tissue
and is particularly useful in
superficial procedures or when a
straight approach is needed.
 Towel clips are used to secure
drapes and towels in place
during surgery. They help
maintain a sterile field by
preventing drapes from shifting
and exposing non-sterile areas.
They can also be used to grasp
tissue or hold other items
temporarily.

 The Allis clamp is a type of

forceps used to grasp and hold
tissue securely. It has
interdigitating teeth that provide
a strong grip, making it useful for
holding heavy tissue or organs
during surgery. It is often used in
gynecological and abdominal
surgeries.

 Thumb forceps, also known as

tissue forceps, are used for
grasping and holding tissue. They
have a tweezer-like design and
are commonly used for
manipulating tissue during
dissection or suturing. They
come in various designs,
including serrated or smooth
tips.

 Tissue forceps are designed for

grasping and holding soft tissue
during surgical procedures. They
often have a more delicate
design than thumb forceps and
may have teeth or serrations to
provide a secure grip without
damaging the tissue.
  A needle holder is a surgical
instrument used to hold needles
while suturing. It has a locking
mechanism that allows the
surgeon to securely grip the
needle, providing better control
during the suturing process.

 The Richardson retractor is a

handheld retractor used to hold
back tissue and provide exposure
during surgical procedures. It has
a broad blade that can be
adjusted to different angles,
making it useful for retracting
abdominal or thoracic tissues.

 A bladder retractor is used to

hold the bladder out of the
surgical field during pelvic or
abdominal surgeries. It helps
provide better visibility and
access to the surgical site while
protecting the bladder from
injury.

 Mayo scissors are designed for

cutting heavier tissues and are
commonly used in surgical
procedures. They have a broader
and sturdier blade compared to
Metz scissors, making them
suitable for cutting through
tougher tissues, such as fascia,
muscle, and sutures. Mayo
scissors come in both straight
and curved varieties, allowing for
versatility in different surgical
situations.

 Metz scissors, also known as

Metzenbaum scissors, are used
 primarily for cutting delicate
tissues. They have long, slender
blades with a fine tip, making
them ideal for precise dissection
in areas such as the abdomen or
during gynecological procedures.
They are particularly useful for
cutting through soft tissue, such
as fascia and muscle, and are not
typically used for cutting heavy
or dense materials.

 Sutures are used to close

wounds or surgical incisions.
They can be made from various
materials (absorbable or non-
absorbable) and come in
different sizes and types,
depending on the tissue being
sutured and the desired healing
characteristics.

 A cord clamp is used to occlude

the umbilical cord after delivery
of a newborn. It is applied to
prevent blood loss from the cord
and to facilitate the safe
separation of the newborn from
the placenta. The clamp is
typically placed about 1-2 inches
from the newborn's abdomen
and is designed to securely hold
the cord until it is cut.

 A placental bowl, also known as

a placenta basin or placenta
bowl, is a specialized surgical
instrument used primarily in
obstetric and gynecological
settings. The primary function of
a placental bowl is to collect the
placenta after delivery. It
provides a safe and sterile
container for the placenta,
ensuring that it is handled
properly and disposed of
according to medical protocols.

SURGICAL CONSIDERATIONS:
1. Indications for Surgery:
 Confirm the necessity for an emergency cesarean section based on clinical findings such as fetal
distress, failure to progress in labor, breech presentation, or maternal complications ( severe
hypertension, uterine rupture).

2. Preoperative Assessment:

 Conduct a thorough preoperative assessment, including maternal history, physical examination,

and review of laboratory results (CBC, blood type and crossmatch).

 Assess fetal well-being through continuous fetal monitoring to identify any signs of distress.

3. Anesthesia Considerations:

 Determine the appropriate anesthesia method (spinal, epidural, or general anesthesia) based
on the urgency of the situation and the patient's medical history.

 Ensure that the anesthesia team is prepared and available for immediate administration of
anesthesia.

4. Surgical Technique:

 Prepare for a Pfannenstiel incision (transverse lower abdominal incision) or a vertical incision if
indicated ( in cases of morbid obesity or previous surgeries).

 Ensure proper surgical technique to minimize complications such as infection, hemorrhage, or

injury to surrounding structures.

5. Infection Control:

 Administer prophylactic antibiotics (Cefazolin) prior to incision to reduce the risk of

postoperative infections.

 Maintain strict aseptic technique throughout the procedure.

6. Fetal Considerations:

 Be prepared for immediate neonatal resuscitation, if necessary, especially in cases of fetal

distress or if the infant is born in poor condition.

 Ensure that a pediatric team is available for the newborn's assessment and care.

7. Hemorrhage Management:

 Be vigilant for signs of hemorrhage during and after the procedure, particularly in cases of
uterine atony or placenta previa.

 Have blood products readily available for transfusion if needed.

8. Postoperative Care:

 Plan for immediate postoperative monitoring of the mother for vital signs, uterine tone, and
bleeding.

 Provide pain management and support for early mobilization to prevent complications such as
deep vein thrombosis (DVT).

9. Documentation:

 Ensure thorough documentation of the surgical procedure, including indications, findings,

techniques used, and any complications encountered.
 DRUG NAME MECHANISM INDICATIONS CONTRAINDICATIONS ADVERSE EFFECT NURSING
OF ACTION RESPONSIBILITIES
GENERIC NAME: Inhibits proton >Symptomatic >Contraindicated in CNS: asthenia, BEFORE: Check
OMEPRAZOLE pump activity GERD without patients dizziness, headache doctors order,
BRAND NAME: by binding to esophageal hypersensitive to GI: abdominal pain, dose, route/site.
PRILOSEC OTC, hydrogen- lesions drug or it’s constipation, Check vital
PRILOSEC potassium >Erosive components and in diarrhea, flatulence, signs, and if
PACKETS adenosine esophagitis patients receiving nausea, vomiting, patient has any
Therapeutic triphosphatase, >Pathologic rilpivirine- acid regurgitation allergies to
class: Antiulcer located at the hypersecretory containing products MUSKULOSKELETAL: medication.
drugs decretory conditions >Use cautiously in back pain, weakness Prepare
Pharmacologic surface of >Duodenal patients with RESPIRATORY: medication
class: Proton gastric parietal ulcer hypokalemia and cough appropriately.
pump inhibitor cells, to Helicobacter respiratory alkalosis SKIN: rash DURING:
Route: IV suppress pylori and in patients on a Identify patient
Dose: 40mg gastric acid infections low sodium diet using 2
Frequency: as secretion >Short term identifiers,
needed in OR treatment of check patency
Antidote: no active benign of route, inform
specific antidote gastric ulcer the patient
>Frequent about the
REFERENCES: heartburn medication and
Kluwer, W. >Dyspepsia its side effects.
(2022). Nursing Administer
2022 drug medication
handbook. (42nd orally with full
ed.). Wolters glass of water,
Kluwer Medical. 30 minutes
before meals in
morning and
evening. Advise
patient to report
any side effects.
AFTER: Observe
and monitor
patient for any
side effects, re-
assess vital
signs, lab results
and condition.
Report to NOD.
Document.
 DRUG NAME MECHANISM INDICATIONS CONTRAINDICATIONS ADVERSE EFFECT NURSING
OF ACTION RESPONSIBILITIES
GENERIC NAME: Inhibits >Acute >Contraindicated in CNS: vertigo, BEFORE: Check
FUROSEMIDE sodium and pulmonary patients headache, dizziness, doctors order,
BRAND NAME: chloride edema hypersensitive to weakness, fever dose, route/site.
LASIX, LASIX reabsorption >Edema drug and in those CV: orthostatic Check vital
SPECIAL at the >HTN with anuria hypotension signs, weight,
Therapeutic proximal and >Use cautiously in EENT: blurred vision, BP, and if
class: distal tubules patients with hepatic tinnitus patient has any
Antihypertensives and the cirrhosis and in those GI: abdominal allergies to
Pharmacologic ascending allergic to discomfort and pain, medication.
class: Loop loop of Henle sulfonamides. diarrhea, anorexia, Prepare
diuretics nausea and vomiting medication
Route: IV GU: nocturia, appropriately.
Dose: 10mg polyuria, frequent DURING:
Frequency: as urination, oliguria Identify patient
needed HEMATOLOGIC: using 2
Antidote: agranulocytosis, identifiers,
Pralidoxime aplastic anemia, check patency
leukopenia of route, inform
REFERENCES: HEPATIC: jaundice, the patient
Kluwer, W. hepatic dysfunction, about the
(2022). Nursing increased liver medication and
2022 drug enzymes its side effects.
handbook. (42nd METABOLIC: volume Administer
ed.). Wolters depletion and medication
Kluwer Medical. dehydration, through slow IV
impaired glucose push. Advise
tolerance, patient to
hypokalemia, report any side
hypocalcemia effects.
MUSCKULOSKELETAL: AFTER: Observe
muscle spasm and monitor
SKIN: dermatitis, patient for any
toxic epidermal side effects, re-
necrolysis assess vital
OTHERS: gout signs, input and
output,
electrolyte and
BUN and
condition.
Report to NOD.
Document.
 DRUG NAME MECHANISM INDICATIONS CONTRAINDICATIONS ADVERSE EFFECT NURSING
OF ACTION RESPONSIBILITIES
GENERIC NAME: Thought to >Moderate >Hypersensitive to CNS: dizziness, BEFORE: Check
TRAMADOL bind to opioid to drug, opioids and headache, seizures, doctors order,
HYDROCHLORIDE receptors and moderately it’s components. vertigo, asthenia, dose, route/site.
BRAND NAMES: inhibit severe > Contraindicated in fever, tremor, Check vital signs,
Tridural, Durela, reuptake or chronic pain patients with: malaise pain severity and
Zytram XL norepinephrine -Severe renal or CV: vasodilation, location and if
Therapeutic and serotonin. hepatic impairment HTN, peripheral patient has any
class: -Acute intoxication edema allergies to
ANALGESICS from alcohol, EENT: visual medication.
Pharmacologic hypnotics, centrally disturbances, Prepare
class: SYNTHETIC acting analgesics, pharyngitis, medication
CENTRALLY opioids or sinusitis, rhinitis appropriately.
ACTIVE psychotropic drugs GI: constipation, DURING: Identify
ANALGESICS -Significant N/V, abdominal patient using 2
Route: IV respiratory pain, diarrhea, dry identifiers, check
Dose: 50mg depression or acute mouth, flatulence patency of route,
Frequency: as or severe asthma or METABOLIC: weight inform the
needed for pain hypercapnia loss patient about the
Antidote: -GI obstruction, MUSCULOSKELETAL: medication and
naloxone/ including paralytic hypertonia, neck its side effects.
diazepam ileus pain, myalgia Administer
RESPIRATORY: medication
REFERENCES: respiratory through slow IV
Kluwer, W. depression, push. Advise
(2022). Nursing bronchitis patient to report
2022 drug SKIN: diaphoresis, any side effects.
handbook. (42nd pruritus, rash AFTER: Observe
ed.). Wolters OTHERS: chills. and monitor
Kluwer Medical. patient for any
side effects, re-
assess vital signs,
pain severity and
condition. Report
to NOD.
Document.
 DRUG NAME MECHANISM INDICATIONS CONTRAINDICATIONS ADVERSE EFFECT NURSING
OF ACTION RESPONSIBILITIES
GENERIC Inhibits cell >Uncomplicated >Hypersensitive to GI: BEFORE: Check
NAME: wall gonococcal drug or other Pseudomembranous doctors order,
CEFTRIAXONE synthesis, vulvovaginitis cephalosporins and colitis, diarrhea dose, route/site.
SODIUM promoting >UTI; lower penicillin HEMATOLOGIC: Check vital signs
BRAND osmotic respiratory >Use cautiously in Eosinophilia, and if the patient
NAMES: instability, tract, patients with history thrombocytosis, has any allergies
Ceftrisol plus, usually gynecologic, of colitis, renal leukopenia to medication.
Rocephin, bactericidal bone or joint, insufficiency, or GI or SKIN: pain, Prepare
Keptrix intra- gallbladder disease induration, medication
Therapeutic abdominal, skin, tenderness at appropriately.
class: or skin- injection site, rash DURING: Identify
Antiobiotics structure OTHER: the patient using
Pharmacologic infection; Hypersensitivity 2 identifiers,
class: Third- septicemia reactions, serum check the patency
generation >Meningitis sickness, of the route, and
cephalosporins >Preoperative anaphylaxis inform the
Route: IV prophylaxis patient about the
Dose: 2g >Acute bacterial medication and
Frequency: OD otitis media its side effects.
as pre-op >Acute otitis Administer
meds media medication
Antidote: no through IV slow
specific push. Advise the
antidote patient to report
any side effects.
REFERENCES: AFTER: Observe
Kluwer, W. and monitor the
(2022). patient for any
Nursing 2022 side effects, and
drug re-assess vital
handbook. signs, and
(42nd ed.). condition. Report
Wolters Kluwer to NOD.
Medical. Document.
 DRUG NAME MECHANISM INDICATIONS CONTRAINDICATIONS ADVERSE NURSING
OF ACTION EFFECT RESPONSIBILITIES
GENERIC NAME: Binds with >Moderate to >Hypersensitive to CNS: dizziness, BEFORE: Check
NALBUPHINE opioid severe pain drug, opioids and it’s headache, doctors order,
HYDROCHLORIDE receptors in >Adjunct to components. sedation, dose, route/site.
BRAND NAMES: the CNS balanced > Contraindicated in vertigo Check vital signs,
Nubain altering anesthesia, patients with: CV: pain severity and
Therapeutic class: perception of preoperative -Respiratory bradycardia, location and if
Opioid analgesics and emotional and depression hypotension patient has any
Pharmacologic response to postoperative -known or suspected EENT: dry allergies to
class: Opioid pain. analgesia, GI obstruction, mouth medication.
agonist- obstetric paralytic ileus GI: nausea and Prepare
antagonists-opioid analgesia -Acute or severe vomiting medication
partial agonists during labor asthma RESPIRATORY: appropriately.
Route: IV and delivery respiratory DURING: Identify
Dose: ½ amp depression patient using 2
Frequency: as SKIN: identifiers, check
needed clamminess, patency of route,
Antidote: diaphoresis inform the patient
Naltrexone about the
medication and its
REFERENCES: side effects.
Kluwer, W. Administer
(2022). Nursing medication
2022 drug through IV slow
handbook. (42nd push. Advise
ed.). Wolters patient to report
Kluwer Medical. any side effects.
AFTER: Observe
and monitor
patient for any
side effects, re-
assess vital signs,
pain severity and
condition. Report
to NOD.
Document.
 Or tech
AND
DRUG
STUDY
(OR-BGHMC)
JAN 30-FEB 1, 2025 (11-7)

SUBMITTED BY:

DANIELLE LOUISSE G. SANTOS

BSN 4E-3

SUBMITTED TO:

SIR. DARWIN PAUL SAGUN, RN