Tarlac State University
College of Science
Department of Nursing
PHARMACOLOGY FINAL REQUIREMENT
BSN 2-C, 2-3, 2-4, 2-B
1st Semester SY 2023-2024
Student Name: Grenielle Kylle Decano
Year and Section: BSN 2-3
Part 1
A.
Personal Data
Name:
A.
Age:
18 years old
Sex:
Female
Civil Status:
Single
Occupation:
Student
Role/Position in the family:
Housewife
Address:
Brgy. Matatalaib Tarlac City
Date of Birth:
December 11, 2003
Nationality:
Filipino
Chief Complaint:
Labor Pain
History of Past Illness
The patient did not have any documented childhood illnesses. However, on July 2, 2021, she experienced
a car accident, leading to a left arm fracture. The fracture was addressed at the hospital, where a cast was applied for
treatment. The patient asserts that she received all required childhood vaccinations and does not have any known allergies
to medications, animals, foods, insects, or environmental factors. During her pregnancy, she underwent three checkups at
a private medical clinic and two at a health center. Regarding tetanus toxoid, the patient has received two out of the
prescribed five doses.
History of Present Illness
The patient presented at the hospital citing labor pain as the primary concern, currently at 38 weeks'
gestation. She characterized the pain as intense, persistent, and insufferable, extending from the abdomen to the back and
groin. One day prior to admission, the patient encountered consistent uterine contractions lasting 10 seconds at 5-minute
intervals, accompanied by the presence of a bloody show. Promptly seeking medical assistance due to the severity of the
pain, she expressed abdominal discomfort and a sense that the baby was prepared for delivery. Subsequently, the patient
was admitted to the hospital, and active labor commenced.
Nursing Assessment
Subjective:
-Altered urinary functioning; the patient reports an altered sleep-wake cycle.
-The patient stated that the pain feels like a dull ache in the back and lower abdomen.
-Pain radiates from the back to the front core.
-The pain was rated 8/10 by the patient (1 as the lowest and 10 as the highest).
-The patient mentioned that the pain intensity slowly rises, peaks, and then slowly decreases.
Objective:
-Facial Grimace was present.
-The pain seems like a wave; its intensity increases gradually, peaks, and then falls. Restless
-Altered muscle tension, diaphoresis.
-Contractions become longer, stronger, and more frequent as the labor progresses.
-Bloody show or blood-tinged mucus was present.
Vital Signs: Temp: 36°C BP: 120/80 mmHg RR: 26 bpm Pulse Rate: 118 beats per minute O2stat: 92%
Medical Assessment/Diagnosis
Admitting Diagnosis:
G1P0 pregnancy uterine 38 weeks of gestation Cephalic in Labor.
Final Diagnosis:
G1P1 pregnancy uterus delivered, term, cephalic, live baby boy, APGAR score 9.9.
Birthweight 3.39 kgs, appropriate for gestational age via spontaneous vaginal delivery with right medio-lateral
episiotomy of vagina and 2nd degree perineal laceration under local anesthesia
Pharmacological Management
Name
of
drugs
Route
(generic
and
brand
administration,
name)
dosage,
frequency
of
General action
Side
Effects
or
Mechanism of action
Adverse Effect
Stimulates uterine smooth muscle,
•
Abdominal Pain
producing uterine contractions similar
•
Nausea
and
of
administration
Brand Name:
10
units/ml
Pitocin
Intramuscular Injection
Generic Name:
to those in spontaneous labor. Has
Oxytocin Injection
vasopressor and antidiuretic effects.
Vomiting
•
Headache
•
Water Retention
D5LRs, or Dextrose 5% in Lactated
•
Local Irritation
Ringer's
•
Electrolyte
Drug Classification:
Uterotonic Agent
Brand Name: D5LRS
(Lactated Ringer's)
Generic
Name:
Lactated Ringer's in 5%
Dextrose
IVF
Classification:
Hypertonic
solution,
function
as
an
intravenous fluid with a specific mode of
Imbalance
action. This solution combines 5%
•
Fluid Overload
dextrose, a source of energy, with
•
Hyperglycemia
Lactated
Drug
and
Ringer's,
a
balanced
electrolyte solution containing sodium,
chloride,
lactate.
potassium,
The
calcium,
primary
and
mechanism
involves providing both hydration and
glucose to the body, making it suitable
for various medical situations, such as
fluid replacement, maintenance, and
correction of imbalances.
Lidocaine acts as a local anesthetic by
•
Nausea or Vomiting
blocking nerve signals in the area
•
Headache
where it is applied or injected. It inhibits
•
Lightheadedness
Eurocaine
the influx of sodium ions into nerve
•
Tingling
Drug
cells, preventing the generation and
Brand
Name:
Lidocaine
Generic
Name:
Classification:
Local Anesthetics
conduction of nerve impulses, thereby
producing
a
temporary
loss
sensation in the localized region.
of
Part 2
Bedside Availability of Prepared Oxytocin and Rapid Administration After Delivery to Prevent Postpartum
Hemorrhage: An Observational Study in Karnataka, India
ABSTRACT
Postpartum hemorrhage is a leading cause of maternal death worldwide. Rapid provision of uterotonics
after childbirth is recommended to reduce the incidence and severity of postpartum hemorrhage. Data obtained through
direct observation of childbirth practices, collected in a study of the World Health Organization’s Safe Childbirth Checklist in
Karnataka, India, were used to measure if oxytocin prepared for administration and available at the bedside before birth
was associated with decreased time to administration after birth. This was an observational study of provider behavior: data
were obtained during a baseline assessment of health worker practices prior to introduction of the Safe Childbirth Checklist,
representing behavior in the absence of any intervention. Analysis was based on 330 vaginal deliveries receiving oxytocin
at any point postpartum. Oxytocin was prepared and available at bedside for approximately 39% of deliveries. We found
that advance preparation and bedside availability of oxytocin was associated with increased likelihood of oxytocin
administration within 1 minute after delivery (adjusted risk ratio = 4.89, 95% CI = 2.61, 9.16), as well as with decreased
overall time to oxytocin administration after delivery (2.9 minutes sooner in adjusted models, 95% CI = -5.0, -0.9). Efforts to
reduce postpartum hemorrhage should include recommendations and interventions to ensure advance preparation and
bedside availability of oxytocin to facilitate prompt administration of the medicine after birth.
What did you learn about the research article?
Imagine stepping into the bustling world of maternal healthcare, where a dedicated student researcher
unveils the critical role of oxytocin in averting the shadow of postpartum hemorrhage (PPH) looming over expectant mothers
worldwide. Our scholarly journey takes us to Karnataka, India, a vibrant backdrop for a study delving into the dance between
oxytocin's advance preparation, bedside availability, and the delicate timing of its lifesaving administration after childbirth.
In this academic exploration, I have discovered that when oxytocin is a prepped backstage star, ready at
the bedside before the grand entrance of a new life, the chances of its spotlight moment within a mere 60 seconds after
delivery significantly increase. It's as if the healthcare stage is set for a perfectly choreographed routine, aligning gracefully
with international guidelines aiming to pirouette away the risks of PPH.
While passionately reading the findings, it emphasizes the pivotal role of healthcare providers' backstage
rituals. They advocate for a script rewrite in provider behavior, urging for the availability of essential medications as a
spotlight-stealing move to elevate the timely and effective management of postpartum hemorrhage. It's a call for a symphony
of change in the delivery room, a crescendo of improved practices ensuring that the drama of maternal mortality takes a
backseat, allowing the miracle of birth to rightfully take center stage.
How can you apply this research to your practice as a student and as a future professional nurse?
As a student and aspiring professional nurse, the insights from this research on the timely administration
of oxytocin in preventing postpartum hemorrhage resonate profoundly with my commitment to providing optimal maternal
care. The study underscores the importance of proactive measures, such as preparing oxytocin in advance and ensuring
its bedside availability, aligning with international recommendations. This knowledge serves as a guiding principle in my
practice, motivating me to advocate for streamlined processes, improved healthcare provider behavior, and the accessibility
of essential medications in maternal healthcare settings. Embracing these findings, I envision myself contributing to a
healthcare environment where the timely administration of oxytocin becomes a standard practice, fostering positive maternal
outcomes and reducing the global burden of postpartum hemorrhage.
Part 3
In the Pharmacology Lecture class, I have gained a substantial amount of knowledge, even though I won't
deny that the course was quite challenging. The intricacies of drug mechanisms, interactions, and classifications required
a significant effort to grasp, but the experience has been incredibly rewarding. I've learned about the pharmacokinetics and
pharmacodynamics of various drugs, as well as their therapeutic uses and potential side effects. Understanding how
different medications work in the body and their implications for patient care has been enlightening. While it was undoubtedly
a tough journey, the knowledge acquired in this class has deepened my understanding of pharmacology, and I feel more
confident about applying this knowledge in my future career as a healthcare professional.
Among the various topics covered in the Pharmacology Lecture class, I found respiratory drugs particularly
fascinating. Learning about the intricacies of how these medications impact the respiratory system and contribute to patient
care was both interesting and valuable. On the other hand, some of the challenges revolved around understanding the
diverse spectrum of antibiotics and their specific actions, which required a keen grasp of details. To cope with the challenges,
I adopted a comprehensive approach, diligently moving from video-to-video lesson and lecture to lecture. By immersing
myself in a variety of learning resources, I ensured a well-rounded understanding of the subject matter. This multifaceted
study strategy not only helped me grasp complex concepts but also fostered a genuine love for the process of learning and
understanding the nuances of pharmacology.
Understanding pharmacology is paramount in establishing a holistic foundation for nursing practice, as it
serves as a crucial link between various nursing subjects. In subjects like Pathophysiology, pharmacology knowledge
enables a deeper comprehension of disease processes and the rationale behind pharmacotherapeutic interventions. In
Maternal and Child Health, pharmacology plays a pivotal role in addressing the unique healthcare needs of pregnant
women, infants, and children. Moreover, in Community Health Nursing, understanding pharmacology aids in health
promotion and disease prevention strategies. Overall, pharmacology serves as a common thread weaving through the fabric
of nursing education, connecting theoretical concepts to practical patient care scenarios across diverse nursing subjects,
thereby enhancing the quality and safety of nursing practice.
And also, I would like to express my heartfelt gratitude to you, Dr. Bildan, for guiding us through the
rollercoaster of emotions and knowledge in the Pharmacology Lecture class this semester. Your dedication to teaching,
even when the topics were challenging and brought a few tears, has been truly commendable. Thank you for your
unwavering support, patience, and the effort you put into making the subject matter not only educational but also engaging.
Your passion for pharmacology has inspired me to navigate through the complexities of drug mechanisms and interactions.
I appreciate your commitment to our learning journey, and I am genuinely grateful for the valuable insights and lessons
you've imparted. Thank you, Dr. Bildan, for a semester of growth, learning, and the occasional tears that come with
understanding the world of pharmacology. See you around, Doc! Thank you po sa isang SEM! Ako po ay natuto (at umiyak)
at ito po ay aking papalawakin at aaraling Mabuti.
Reference:
Moucheraud, C., Gass, J., Lipsitz, S., Spector, J., Agrawal, P., Hirschhorn, L. R., Gawande, A., & Kodkany, B. (2015).
Bedside Availability of Prepared Oxytocin and Rapid Administration After Delivery to Prevent Postpartum
Hemorrhage: An Observational Study in Karnataka, India. Global health, science and practice, 3(2), 300–
304. https://doi.org/10.9745/GHSP-D-14-00239