Northeastern College – Santiago city Campus

Santiago City, Isabela

College of Nursing

A case study: Incomplete Abortion

In Partial Fulfillment of the requirements for

CARE OF MOTHER CHILD RLE

Submitted by:
Ballesteros Whella Mhay C.
Cabato, Laica Dennie Jhane C.
Fabros, Janelle Faye L.
Gomez, Lord Allen B.
Membrado, Elaine A.
Mendoza, Joie Antonette J.
Redrendo, Trishia Regine O.
Sagario, Jhizel A.
Tanwangco, Morgan Chinsue B.

Clinical Instructor:
Ms. Tiffany L. Torres, RN
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing

General Objectives:

This case study is meant to assist us as nursing students in broadening our

knowledge and providing the best nursing care possible for a patient with
G4P2 (2022) Incomplete Abortion at 11 ½ weeks AOG non septic non
induced previous LTCS 1x for malpresentation (2010 EAMC) S/P Completion
Curettage.

This study aims to improve nursing interventions that could help the patient
understand their needs, increase awareness of everyone who may have this
sort of disease, and implement suitable nursing care for patients with G4P2
(2022) Incomplete Abortion at 11 ½ weeks AOG non septic non induced
previous LTCS 1x for malpresentation (2010 EAMC) S/P Completion
Curettage.

Specific Objectives:

This study specifically aims to:

1.Familiarize the nursing students with the background of the G4P2 (2022)
Incomplete Abortion at 11 ½ weeks AOG non septic non induced previous
LTCS 1x for malpresentation (2010 EAMC) S/P Completion Curettage is all
about.
2. Explain and illustrate the Pathophysiology of G4P2 (2022) Incomplete
Abortion at 11 ½ weeks AOG non septic non induced previous LTCS 1x for
malpresentation (2010 EAMC) S/P Completion Curettage.

Overview
An incomplete abortion is the partial loss of the products of conception within
the first 20 weeks. Incomplete abortion usually presents with moderate to
severe vaginal bleeding, which may be associated with lower abdominal
and/or pelvic pain.

Types
•threatened abortion
A threatened abortion is defined as vaginal bleeding before 20 weeks
gestational age in the setting of a positive urine and/or blood pregnancy test
with a closed cervical os, without passage of products of conception and
without evidence of a fetal or embryonic demise.

•inevitable abortion
Inevitable abortion is diagnosed in the presence of cramping, vaginal
bleeding, an open cervical os on the physical exam but no passage of the
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing
products of conception. The intrauterine pregnancy may be either viable or
nonviable on ultrasound.

•Incomplete abortion
An incomplete abortion is the partial loss of the products of conception
within the first 20 weeks. Incomplete abortion usually presents with moderate
to severe vaginal bleeding, which may be associated with lower abdominal
and/or pelvic pain.

•complete abortion
Complete abortion is defined as a 'complete passage of all conception
products.Recurrent abortion is defined as three or more consecutive
pregnancy losses.

•Septic abortion
Septic abortion refers to any abortion, spontaneous or induced, that is
complicated by uterine infection, including endometritis. Septic abortion
typically refers to pregnancies of less than 20 weeks gestation while those ≥
20 weeks gestation with intrauterine infection are described as having
intraamniotic infection.

• missed abortion
Missed abortion is when a pregnancy stops developing, where the
embryo/fetus/embryonic tissue or close. Symptoms may include pain,
bleeding or no symptoms at all.

Signs and symptoms

•Heavy cramps
•Vaginal bleeding
•Passing of blood clots through the vagina
•Pelvic pain
• fever
• uterine tenderness

Causes and Risk Factors

•Abnormal uterine shape.
•Amniocentesis.
•Congenital heart disease.
•Exposure to environmental and workplace hazards (high levels of radiation or
toxic agents)
•Hormonal irregularities.
•Immune system disorders.
•Improper implantation of fertilized egg in the uterine lining.
•Incompetent cervix.
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing
Complications
Severe hemorrhage or sepsis from an incomplete septic abortion.
Prompt surgical management is indicated when the patient is unstable. It is
also important to rule out ectopic pregnancy, presenting with vaginal bleeding
and lower abdominal and/or pelvic pain.There are several other complications
that can arise after the management of incomplete abortion including death,
uterine rupture, uterine perforation, subsequent hysterectomy, multi system
organ failure, pelvic infection, cervical damage, vomiting, diarrhea, infertility,
and/or psychological effects.

Medical and surgical management:

surgical management with dilation and curettage is another treatment
modality that may be utilized but is normally reserved for unstable patients.

Prevention
•not smoking during pregnancy
•not drinking alcohol or using illegal drugs during pregnancy
•Eating a healthy, balanced diet with at least 5 portions of fruit and vegetables
a day
•making attempts to avoid certain infections during pregnancy, such as
rubella.

Treatment
Some obstetricians will manage incomplete abortions medically with Oxytocin
to help control the bleeding and misoprostol to help the uterus contract and
complete the process of abortion

II. Demographic Data

Name: Patient M
Age: 31 years old
Sex:Female
Weight: N/A
Height: N/A
Date of Birth: December 31, 1991
Address: Rizal Luna, Cordon
Marital Status: Single
Religion: Roman Catholic
Nationality: Filipino
Primary Language: Tagalog
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing
Educational Attainment: High School Graduate

Ward: OB Ward
Date/Time of Admission: April 24, 2023 8:46PM
Chief Complaint: Abdominal Pain

Admitting Diagnosis: G4P2 2012 Incomplete Abortion at 11 1/2 weeks AOG

Non Seption Non Induced Previous Low Transverse Cesarean Section 1x for
Malpresentelation 2010

Final Diagnosis: G4P2 2012 Incomplete Abortion at 11 1/2 weeks AOG Non
Seption Non Induced Previous Low Transverse Cesarean Section 1x for
Malpresentelation 2010

III. Patient’s History

A. Past History

According to the patient this is her 3rd hospitalization. Her 1st hospitalization
was in the year 2016 when she gave birth on her 1 st Cesarean baby with her
first live in partner. 2nd hospitalization was in the year 2018 when she gave
birth on her 2nd baby in normal delivery.

B. Present History

On April 23, 2023 1 day prior to admission, patient X has been experiencing
abdominal pain with the scale of 10 being the most painful. During on her
admission, April 24, 2023 at 8:46 pm,the patient stated that she feels early
labor and has been admitted at Southern Isabela Medical Center with the
admitting diagnosis of G4P2 2012 Incomplete Abortion at 11 1/2 weeks AOG
Non Seption Non Induced previous Low Transverse Cesarean Section 1x For
Malpresentelation 2010 and her final diagnosis of G4P2 2012 Incomplete
Abortion at 11 1/2 weeks AOG Non Seption Non Induced previous Low
Transverse Cesarean Section 1x For Malpresentelation 2010

C. Family History

According to the patient they are 4 children's, total 2 girls and 2 boys and she
is the youngest among them. Her father and mother is a farmer and they both
have hypertension while the other survival siblings are not ill. Patients added
that they don’t have any sensitivities in foods and medications.
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing

D. Psychological History

The patient is experiencing signs of postpartum depression due to

miscarriage.

E. Social History

The patient is a nonsmoker and mostly drink alcohol occasionally. When she
has spare time, she uses her cellphone. She does household chores and
carrying sacks of corn in the farm.

IV. Laboratory Values

TEST TEST PRINCIPLE RESULT NORMAL VALUES

THYROID FUNCTION
TEST

THYROID CHEMILUMINISCENE 2,596 0.1298-3.120IU/

STIMULATING Ml(m IU/ L)
HORMONE (TSH3)

FREE TRI- CHEMILUMINISCENE - 4.26-8.10 pmol/L

IODOTHYRONINE (FT3)

FREE THYROXINE CHEMILUMINISCENE - 10.0-28.2 pmol/L

(FT4)

TOTAL TRI- CHEMILUMINISCENE 1.94 0.970-1.69 nmol/L

IODOTHYROXINE (TT3)

TOTAL THYROXINE CHEMILUMINISCENE 95.7 71.2-141.0 nmol/L

(TT4)
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing

TUMOR MARKERS

ALPHA-FETO PROTEIN CHEMILUMINISCENE - < 7.22 IU/ ml

(AFP)

BETA HUMAN CHEMILUMINISCENE - < 6.15 m IU/ml

CHORIONIC (IU/L)
GONADOTROPIN
(BHCG)

CA 125 CHEMILUMINISCENE - < 30 U/ ml

CA 15-3 CHEMILUMINISCENE - < 30 U/ml

CA 19-9 CHEMILUMINISCENE - < 37 U/ml

CARCINO- CHEMILUMINISCENE - <3.0 ng ml

EMBRAYONICANTIGEN
(CEA)

PROSTATE SPECIFIC CHEMILUMINISCENE - < 4 ng/ml

ANTIGEN-TOTAL (PSA)

PROTATE SPECIFIC CHEMILUMINISCENE - 0.015-50 ng/ml

ANTIGEN-FREE (PSA)

OTHERS

DIRECT total iron CHEMILUMINISCENE - 261-497 ug/dl

binding capacity
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing

TROPONIN I CHEMILUMINISCENE - 0.120 ng/ml

COMPLEMENT C3 CHEMILUMINISCENE - 40-380 mg/’dl

HEMATOLOGY CBC- 5 PARTS

DATE PERFORMED: April 24, 2023

PARAMETERS RESUL REF.RANGE INTERPRETATION

T UNIT
WHITE BLOOD CELLS N: 4.00-20.0 10^9/L Normal
C: 4.00-12.0 10^9/L
A: 5.00-10.0 10^9/L
NEUTROPHILS NUMBER N: 40.0-80.0% Normal
C: 50.0-70.0%
A: 50.0-65.0%
LYMPHOCYTE NUMBER N: 10.0-60.0% Normal
C: 20.0-60.0%
A:25.0-35.0%
MONOCYTE NUMBER N: 3.00-13.0% Normal
C: 3.00-12.0%
A: 3.00-7.00%
EOSINOPHIL NUMBER N: 0.50-5.00% Normal
C: 0.50-5.00%
A: 1.00-3.00%
BASOPHILS NUMBER 0.00-1.00% Normal
RBC N: 3.5-7.0 10^12/L Normal
C: 3.5-5.2 10^12/L
AM: 3.5-5.0 10^12/L
A: 4.0-5.5 10^12/L
HEMOGLOBIN N: 17.0-20.0 g/dl
C: 12.0-16.0 g/dl
AM: 13.0-18.0 g/dl
A: 11.0-16.0 g/dl
HEMATOCRIT N: 38.0-68.0%
C:35.0-49.0%
AM:40.0-54.0%
A:37.0-54.0%
MCV N: 95.0-125 fl Normal
C: 80.0-100 fl
A: 80.0-97.0 fl
MCH N: 30.042.0 pg
C: 27.0-34.0 pg
A: 26.0-32.0 pg
MCHC N: 30.0-34.0 g/dl
C: 31.0-37.0 g/dl
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing
A:31.0-36.0 g/dl
PLATELET Normal
ESR M: 0-10 mm/hr
F: 0-20 mm/hr
RETICULOCYTE COUNT AM: 0.5-2.5%
AF: 0.5-4.0%
N:1.8-8.0%
TOXIC GRANULES
BSMP
BLOOD GROUP O
RH TYPE Positive

HEMATOLOGY

Parameters Result Ref. Parameters Result Ref. Interpretation

Unit Ranges Unit Ranges
WBC 10.56 4.00- MCH 30.2 pg 27.0-
10^9/L 10.00 334.0
Neu% 86.1% 50.0-70.0 MCHC 33.5 g/dL 32.0-36.0
Lym% 9.8% 20.0-40.0 PLT 200 150-450
10^9/L
Mon% 3.6% 3.0-12.0 RDW-CV 13.2% 11.0- 16.0
Eos% 0.4% 0.5-5.0 RDW-SD 44.0fL 35.0-56.0
Bas% 0.1% 0.0-1.0 MPV 9.6fL 6.5-12.0
RBC 3.13 3.50-5.00 PDW 15.9 15.0-17.0
10^12/L
HGB 9.4 g/dL 11.0-15.0 PCT 0.193% 0.108-
0.282
HCT 28.2% 37.0-47.0 NRBC% 0.00% 0.00-
9999.99
MCV 90.2 fL 80.0-
100.0

URINALYSIS

Particle Category p/HPF Ref.(p/HPF) Modified

RBC 100+ 356.2 0..2 No
WBC 5-10 9.75 0..2 No
EPI Rare <1.14 0..2 No
YEA Negative 0 0..1 No
BAC Few 11.8 0..1 No
MUC Moderate 5.1 0..1 No

Analyte Result Note

COL Yellow
CLA Clear
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing
SG 1.013
pH 7.5
URO 0.2 E.U./dL Negative
GLU 2+
BIL Negative
KET Negative
BLO 3+
PRO Negative
NIT Negative
LEU Negative
ALB 10 mg/L NEGATIVE

Immunology / Serology Result Form I

TEST METHOD RESULT

HBs Ag IMMUNOCHROMATOGRAPHY NONREACTIVE
Syphilis IMMUNOCHROMATOGRAPHY NONREACTIVE

V.Physical Assessment

DATE: APRIL 27, 2023

TIME: 10:33am
GENERAL SURVEY: Patient X is sitting in bed, conscious, coherent, and
responsive as soon as we entered in the ward. The 31 years old has an
ectomorphic body and she has a tanned skin appropriate in her ethnicit.
Patient x is not well groomed and her nails in hands is dirty and also in her
foot.

VITAL SIGNS
Temp: 36.00
Blood pressure: 100/70
Respiratory rate: 16
Pulse rate: 102
Oxygen saturation: 98%

AREA MODALITY FINDINGS INTERPRETATION

SKIN Inspection ● No
discoloratio
n lesions
and warm to
touch

Palpation ● With good

 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing
skin turgor, Normal
when skin is
pinched it
goes to
previous
state
immediately
(2 seconds)

HAIR AND SCALP Inspection ● The hair is

dyed to
golden
brown, thin
and equally
distributed,
no presence
of lice and
dandruff

Palpation ● No
presence of Normal
tenderness
and no
deformities
and lumps

HEAD Inspection ● Head is

round in
shape

Palpation ● No Normal
presence of
mass and
tenderness

FACE Inspection ● Symmetric

facial
movement,
no lesions Normal
and
symmetric
nasolabial
folds
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing
EYEBROWS Inspection ● Eyebrows
are
symmetricall
y aligned
and have
equal
movement. Normal
Black in
color. No
lesions

EYELASHES Inspection ● Equally

distributed
and curled
slightly Normal
outward

EYELIDS Inspection ● Eyelids skin

does not
have any
discoloratio
n upper lid
covers
upper
portion of
Normal
cornea
when the
patient is
looking
straight

EYES ● Eyes are

symmetric
in size and
position,
black in
color. Sclera
appeared Abnormal,
wite, no because of the
abnormal blurred vision of
secretion the left eye
● Pupils are
equally
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing
round,
reactive to
light and
accommoda
tion
● Perform
Snellen
Chart to test
the Eye
vision: left
eye is in
blurred
vision and
the right eye
is in clear
vision;
eyeglasses
50/50

EARS Inspection ● No
discoloratio
n and warm
to touch.
Clean; no
abnormal
secretion or Normal
any
tenderness

AURICLES Inspection ● The color of

auricle is
same as the
facial skin,
symmetric,
firm, non- Normal
tender and
pinna
recoils after
being folded

EXTERNAL EAR Inspection ● With ear Normal

CANAL wax
blockage
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing
HEARING ACUITY Inspection ● Voice sound Normal
TEST audible

NOSE Inspection and ● Symmetric

palpation and straight/
midline, no
discharge,
no swelling,
both nostrils
are patent, Normal
no
tenderness

MOUTH Inspection ● Not dry lips

(moist)
● Appear light
pink Normal

● No lesion

BUCCAL Inspection ● Pinkish,

MUCOSA tonsillar
pillars
symmetrical
, no
enlargement
of tonsils, Normal
soft, moist
and elastic
texture

GUMS Inspection ● Light pink,

smooth and
moist, no
bleeding Normal

TEETH Inspection ● Yellowish,

tooth decay
in right and
left teeth
● No. of upper Abnormal,
teeth is 12, because of tooth
1 is missing,
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing
no. of lower decay, indicates
teeth is 14, poor oral hygiene
2 is missing of the patient

TONGUE Inspection ● Central in

position
without
whitish
coating and
veins Normal
prominent in
the floor of
the mouth

NECK Inspection ● Neck is

symmetric
with head,
midline of
the body, no
lesions and
no swelling

Normal
Palpation ● No palpable
lymph
nodes, no
neck vein
enlargement
and no
tenderness

CHEST AND Inspection

LUNGS ● Chest is
symmetric,
no visible
deformities,
no muscle
retraction Normal
when
breathing

Auscultation ● Normal
breath
sounds
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing
without
dyspnea.
quiet, Normal
rhythmic
and
effortless
respiration

UPPER Inspection and

EXTREMITIES palpation ● Symmetry,
no lesions
and
tenderness
with normal
skin Normal
temperature
.

NAILS Inspection ● Nails are Abnormal. poor

long with hygiene as well as
dirt on its the dirt on the nails
ends

Palpation ● Good Normal

capillary
refill time of
2 seconds

ABDOMEN Inspection ● She has

PUPPP in
her belly
● Have a
vertical
caesarean
incision

Palpation ● No Normal
tenderness
or masses

Auscultation  Presence of Normal

bowel
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing
sound
(borborygm
us)

LOWER Inspection ● Symmetry,

EXTREMITIES no lesions
and
tenderness
with normal
skin
temperature Normal
. ROM is
good, dirty
toe nails
with cuticle,
and with
good
capillary
refill

Palpation ● Equal in
size both
sides of the
body,
smooth
coordinated
movements,
100% of
normal full
movement
Normal
against
gravity and
full
resistance.
No
deformities
or swelling,
joints move
smoothly.
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing

VI. Gordon’s 11 Functional Pattern

PATTERN BEFORE DURING

HOSPITALIZATION HOSPITALIZATION

HEALTH The patient doesn't She doesn't consume

PERCEPTION- smoke, and she only serpentina; all she does is
HEALTH drinks on special take the prescribed
MANAGEMENT occasions. she also medication and still the
PATTERN believes in “Hilot”. most important to her is her
She takes serpentina health and to heal.
to reduce abdominal
pain and they consult
doctor first before
taking any
medications. She also
stated that she is
breastfeeding mom
and the most
important to her is
health.

NUTRITIONAL- The patient consumes The patient stated that she

METABOLIC vegetables like loses appetite, she only
PATTERN alukbati and sitaw eats when she feels
often and she eats hungry. she consumes half
pork sometimes. She a liter of water. The patient
prefers to consume now weighs 41 kg.
small amounts of food
frequently. She
consumes 1 liter of
water and three meals
each day.
Additionally, she
occasionally eats a
biscuit like skyflakes
for a snack in the
afternoon. Currently,
the patient weighs
50kg.
ELIMINATION The patient urinates The patient said that She
PATTERN and defecates two to urinates 2-3x day with a
three times daily with yellowish color and
a light yellow urine defecates 1x a day. Stool
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing
color, no presence of color is brown, hard and no
bubbles. She urinates strong smell and still having
when she wakes up in difficulty in defecating.
the morning and in the
afternoon. She poops
right after lunch as
well. The stool is
brown in color, hard
and no strong smell.
She added that she
has difficulty in
defecating.

ACTIVITY- According to her, she

EXERCISE usually does all
PATTERN household chores, The patient said that her
they harvest corn in activities have been limited
the farm and taking since she has been
care of her children. In hospitalized and the only
the afternoon, she diversional activity she
takes a nap for her to does is checking her social
rest and when she media through her cell
has spare time she phone.
uses her phone. She
added that she
doesn’t like to
socialize with others.

SLEEP- REST According to the During her hospitalization,

PATTERN patient, she sleeps she said that she can’t
7pm and wake up continuously sleep. She
8am without sleep 10pm and wake up 8
interruption. am in the morning

COGNITIVE Patient stated that her She claims that she might
PERCEPTUAL eyes is not clear in still forget something, And
PATTERN vision and she is She continues to wear
using glasses. Visual glasses.
acuity of 50/50.
sometimes she forget
something, she don’t’
have difficulty in
learning new things
and she added that
we she felt upset she
just take a deep
breath and rest.
SELF The patient stated that According to the patient she
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing
PERCEPTION- she is contented is worried that her current
SELF CONCEPT about her looks but situation may affect their
PATTERN sometimes she is entire life. She added that
worried about her she loses hope for a while
weight loss. She
added that she
became angry when
her husband doesn’t
do the things she
wants to do and
sometimes she loses
hope.

The patient shares a She claims that despite

home with her live-in their hardships, their
ROLE- partner and their families are growing
RELATIONSHIP children. Also, they stronger.
PATTERN occasionally disagree
on things and have
misunderstandings
with her partner but
they talk about it
calmly.
COPING STRESS according to the Patient stated that her
PATTERN patient they face current situation is another
hardship in life, her challenge for her and it is
coping mechanism is difficult for her now to move
by harvesting corn in on her coping mechanism
the farm and for now is to cry.
sometimes she just
cry about the problem.

SEXUALITY- The patient states that

REPRODUCTIVE they engage in sexual
PATTERN activity everyday with They have share bedrooms
her first boyfriend and already, and they have
they are not using been together for 2 years.
contraceptives like
condom because her
partner wants to have
a baby. After the birth
of her 1st child, they
are not sexually active
anymore. Her second
boyfriend which is her
live-in partner today is
sexually active they
also not using any
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing
contraceptives like
condom, after the
birth of her 2nd child
they are still sexually
active. There are no
issues with the
contraceptives she
uses, such as pills,
and depo. She started
having regular
menstrual periods at
the age of 13 .

VALUE- BELIEF She's a Roman She hasn't been able to

PATTERN Catholic, and they go attend church since the
to church every pandemic; her only access
Sunday with her to the Bible is through
family. She believes in television. She added that
“HILOT”, “PAMAHIIN”, she only takes the medicine
and “KULAM”. She prescribed by the doctor
constantly prays at and has stopped using
night. medicinal herbs.

VII. Course In The Ward

DATE/TIME PROGRESS DOCTOR’S INTERPRETATION

NOTES ORDER
4/24/23  Vaginal Please admit To provide care,
9:30PM Bleeding under the service evaluation of
 (+) passage of Dr. R patient’s condition
meaty material and proper medical
G4P4(2012) management
incomplete
abortion at 11
1/7 weeks AOG
 NSN1
 Previous LTCS
for
malpresentation
2010 EAMC
Secure consent For legality
purposes. To have
ethical
considerations and
to protect
patient to make
Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing
health care
decision
NPO To allow the
affected organ to
rest
IVF D5LRS 1L + Use for daily
10 units oxytocin maintenance of
to run at 20 bloody fluids and
gtts/min nutrition, and for
rehydration
Diagnostics;
CBC It is done to know
any underlying
condition that
produces changes
in the blood
components.
Blood Typing to find a compatible
blood type for
transfusion

Urinalysis used to find the

cause of – or
monitor – urinary
tract infections,
bleeding in the
urinary system, or
kidney or liver
disease.
VDRL a screening test for
syphilis .
HBsAB To check the
antibodies
produced by the
immune system in
response to the
Hepa B Virus
HBA lC to check the
average blood
sugar of the patient

TSH, FT3, FT4 These tests are

variably indicated
for investigation of
possible hypo- or
hyper- thyroidism
MEDICATION Used to treat
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing
Cefuroxime 1.5g certain infections
IV ANST now caused by bacteria
For completion Prevent infection or
curettage heavy bleeding by
clearing tissues
that remain in the
uterus after a
miscarriage or
abortion.
Secure consent The patient must
be competent to
make a voluntary
decision about
whether to undergo
the procedure or
intervention.
Secure 1 unit to prevent tissue
PRBC for hypoxia.
possible use
Inform AOD,
NOD OR team
V/S record Q1 To monitor closely
any changes and
unussalties in the
vital signs

Refer For further

assessment and
treatment.
4/24/23 SP E Completion POST to ensure patients
10:20 pm Curettage ANAESTHESIA are comfortable in
ORDER terms of pain
-To Pacu management and
controlling nausea.
O2 at 3pm To know if the
blood is carrying
enough oxygen
DAT once fully It is interpreted
awake according to the
client's appetite
and ability to eat
and to tolerate
food.
IVF D5LRS + 10 used to reduce
units oxytocin q8 bleeding.
MEDICATIONS
Mefenamic Acid -used for short term
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing
500g/tab, 1 tab relief mild to
TID x 3 days moderate pain
after meals for
pain
Moderate High to maintain muscle
back rest mass and ensure
adequate blood
supply
Monitor VS q4 To monitor if there
are abnormalities in
the VS of the
patient

Monitor I and O Monitoring the fluid

status of the patient
WOF: Nausea, if there are signs of
Vomiting, moderate
Desaturation, dehydration.
Dyspnea,
Dizziness
4/25/23 DAT High OFI
6:00 am once fully awake It is interpreted
according to the
client's appetite
and ability to eat
and to tolerate
food.

Start oral
medication
-Cefuroxime 500 --Used to treat
mg 1 tab BID x 7 certain infections
days caused by bacteria
-to relieve the mild
-Mefinamic Acid moderate pain
500 mg 1cap TID
for pain
-To prevent low
-Ferous + Folic blood levels of iron
Acid tab OD

-Vitamin B3 + -
Calcium Tab OD
IVF to consume
WOF profuse To monitor the
bleeding patient.
Daily Perineal To prevent getting
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing
Hygiene irritated, odors and
infection.
For Discharge IE
Tomorrow
Record V/S q4 To monitor closely
any changes and
unussalties in the
vital signs

Refer For further

assessment and
treatment.
4/26/23 Minimal vaginal Continue present
7:00 Am bleeding management
Monitor v/s q4
refer For further
assessment and
treatment.
4/27/23 Scanty vaginal MGH anytime
7:45 AM bleeding
Oral meds as
home meds
For FBS as OPD To measure the
basis amount of sugar in
the blood.
Follow up at OB The patient must
OPD on 5/24/23 do follow up check
up to continue post
care.
Daily Perineal It prevents getting
Care infections, odors
and irritation.
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing

VIII. Anatomy and Physiology

‘
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing

IX.Pathophysiology

PRECIPITATING FACTOR PREDISPOSING FACTOR

 Works 5 days in a week  Age
 Work relates stressors  Sex
 Environmental factor  Previous Abortion
 Premature separation of the
normal placenta

Implanted egg, slightly separates or tears from the uterus

Blood collects between the chorionic membrane ( a

membrane that develops around a fertilized egg)
And the wall of the uterus

Blood leaks in the cervix

Abdominal Contraction

Abdominal Pain

Cervical Dilation and mild

uterine contraction

Vaginal Bleeding
for 3 days

Subchorionic Hemorrhage
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing

Severe subchorionic bleeding can lead

to rupture of subchorionic membrane
s

Fetal distress

passing of blood clots Fever and uterine

Vaginal Bleeding Heavy cramps Pelvic pain
through the vagina tenderness

Risk for miscarriage and Threatened abortion

Incomplete Abortion

If not treated
Treatment Medical/surgical Management

 Oxytocin Dilatation and Curettage

 Misoprasol Continued vaginal Bleeding

Anemia
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing

X. Nursing Care Plan

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

SUBJECTIVE: Risk for infection After 3 hours of 1. Perform hand1. Hand hygiene is the After 3 hours of
“Dinugo ako noong related to excessive nursing intervention hygiene before and most important nursing intervention
umaga ng lunes” blood loss the client will after each care procedure in the client verbalized
verbalize activity preventing infection understanding of the
understanding of the individual causative
OBJECTIVE: individual causative 2. Educate the client 2. Caution the client to or risk factors
-bleeding or risk factors about the proper wipe her perineal -the client is free
-fatigue -the client will be perineal hygiene area from front to from infections and
free of signs of back after voiding inflammation
infection and 3. Emphasize the and particularly after -the client achieved
inflammation importance of follow defecation to timely wound healing
- the client will up checkups prevent the spread
achieve timely of bacteria from the
wound healing rectal are.

3. The client needs

follow up check up
counseling to assist
her to learn better
problem solving
methods in the
future
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

SUBJECTIVE: Acute Pain related After 3 hours of 1. 1. Provide comfort 1. 1. Promoting After 3 hours of
“masakit na yung to expulsion of the nursing measures such as relaxation is basic nursing intervention
tyan ko nung lingo” fetus intervention the relaxation and to all other the clients identifies
client will identify or breathing techniques methods of pain or used methods
OBJECTIVE: use methods that management and that provides relief
provides relief and2. 2.Instruct the client requires and state that
state that to report pain as concentration. discomfort is
discomfort is soon as it begins as minimized and
minimized/ timely 2. 2. It is more likely controlled.
controlled. to be successful in
3. alleviating pain
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing

ASSESSMEN DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

T
SUBJECTIVE: Anxiety related to After 2 hours of nursing1. Establishing a therapeutic
1. They drive comfort from After 3 hours of nursing
“Tuwing stress possibly intervention relationship, conveying health professionals acts of intervention the client begins to use
gabi Umiiyak evidenced by -the client will begin to empathy kindness positive coping strategies to adjust
ako at kapag impaired use positive coping to the situation
hindi ko attention strategies to adjust to 2. Provide comfort measures 2. Being relaxed may encourage -the client use support system
nakukuha the situation such as breathing and the client to verbalize feelings, effectively
yung gusto relaxation techniques thus reducing anxiety and fear. -the client reports anxiety reduced
ko” -the client will use to a manageable level
OBJECTIVE: support systems 3. Encourage questions and 3. This may provide an
-depression effectively provide time for the opportunity to identify and
expression of fears clarify misconceptions and
-the client will report offer emotional support.
anxiety reduced to a 4. Provide a support person/
manageable level family member to stay 4. The presence of a familiar
with the client person can help reduce client
anxiety and promote
relaxation and coping
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing

XI. Drug Study

Drug name Mechanism of action Indication Contraindication Side effect / adverse effect Nursing responsibilities
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing
Generic Cefuroxime is a Used to treat certain Contraindicated in Black, tarry stools, chest pain, Before:
name: broad spectrum. infections caused by patients fever, painful or difficult - Identify the Patient
Cefuroxime Inhibits cell-wall bacteria hypersensitive to urination, shortness of breath, - Check doctor’s order
synthesis, promoting drug or other swollen glands, unusual - 10 Rights
Brand name: osmotic instability; cephalosporin. bleeding or bruising, unusual
Zinacef usually bactericidal. tiredness or weakness During:
- Explain Procedure
CNS: Headache, Dizziness - Do skin testing
Doctor’s GI: Diarrhea, Nausea,
order: Vomiting, Abdominal Pain, After:
Cefuroxime Anorexia - Document
1.5g IV Skin: Rashes, Urticaria - Monitor patient for signs and symptoms
Other: Hypersensitivity of super infection and diarrhea and treat
Cefuroxime reaction, serum sickness and appropriately
500mg tablet, Anaphylaxis
OD

Classification:
Cephalospori
n antibiotic

Drug name Mechanism Indication Contraindication Side effect / adverse effect Nursing responsibilities
of action
Generic vitamin D is indicated for the  Arrhythmias Before:
name: the treatment of specific - Identify the Patient
Vit D3 maintenance medical conditions  Confusion - Check doctor’s order
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing
of normal like refractory rickets  Constipation - 10 Rights
Brand name: levels of (or vitamin D resistant
Forti-D serum rickets),  Dry mouth
calcium and hypoparathyroidism,  Headache During:
Doctor’s phosphorus and familial
order: in the hypophosphatemia  High levels of calcium in After:
1 tablet, OD bloodstream the blood - Document
by enhancing -
the efficacy (hypercalcemia)
Classification: of the small  Lethargy
intestine to
 Metallic taste in the
absorb these
minerals mouth
from the diet  Muscle or bone pain
 Nausea
 Sluggishness
 Vomiting

Drug name Mechanism Indication Contraindication Side effect / adverse effect Nursing responsibilities
of action
Generic name: Mefenamic For the contraindicated in patients with  diarrhea. Before:
Mefena0premic acid binds treatment of salicylate hypersensitivity or NSAID  constipation. - Identify the Patient
Acid the rheumatoid hypersensitivity who have  gas or bloating. - Check doctor’s order
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing
prostaglandin arthritis, experienced asthma, urticaria, or  headache. - 10 Rights
Brand name: synthetase osteoarthritis, other allergic reactions after taking  dizziness.
Ponstan receptors dysmenorrhea, aspirin or other NSAIDs. Severe,  nervousness.
COX-1 and and mild to rarely fatal, anaphylactoid reactions  ringing in the ears. During:
COX-2, moderate pain, to mefenamic acid have been
Doctor’s order: inhibiting the inflammation, reported in such patients. After:
500mg capsule, action of and fever. - Document
every 8hours prostaglandin -
synthetase.

Classification:
non-steroidal
antiinflammatory
and
antirheumatic
products,
fenamates.

Drug name Mechanism of action Indication Contraindication Side effect / adverse effect Nursing responsibilities
Generic Iron combines with Used for the Contraindicated in patients •Feeling or being sick (nausea or Before:
name: porphyrin and globin prevention and with peptic ulceration, - Identify the Patient
Ferrous chains to form treatment of iron regional vomiting) •Losing your appetite - Check doctor’s order
Sulfate hemoglobin, which is deficiency anemia enteritis, ulcerative colitis, •Constipation •Diarrhea • Black tarry - 10 Rights
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing
critical for oxygen in adults and hemosiderosis, primary stool •Heart burn •Fever • Stomach
Brand name: delivery from the children. hemochromatosis, or
lungs to other tissues. hemolytic anemia (unless Pain During:
Mol-Iron
Iron deficiency patient also has iron
causes a microcytic deficiency anemia) and in After:
Doctor’s anemia due to the those receiving repeated - Document
order: formation of small blood transfuse. -
1 Tab OD erythrocytes with Use cautiously on long-
insufficient term basis.
Classification: hemoglobin.
Oral Iron
Bivalent
preparations
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing

XII. Discharge Plan

Method Rationale
MEDICATIONS:

Patient should take her medication Taking the medication with a right
with a right drug, time, dose, and drug time, dose, and frequency is the
frequency as prescribed by the best way to make your prescription
doctor. works properly.

Explain to the patient the side effects This will help the patients determine
of each Medications. whether a medication is working
appropriately.
Advise the client not to miss the
intake of medications given by her Because missing a dose may make
physician upon discharge. the medicine less effective.
ENVIRONMENT:

Maintain a quiet, pleasant Relaxing can make the flow of blood

environment to promote relaxation. increase around the body giving more
Provide a comfortable environment. energy.

EXERCISE:

Advise patient to have exercise such Walking and short or long stroll can
as walking,yoga and Some house help you get moving Yoga and other
hold chores stretching exercises can help tone
your body and improve flexibility a
certain aerobic exercise like walking
can produce more red blood cells,
which boost the amount of
hemoglobin and iron in the body.
Health teaching

•Encouraged the patient to increase •Best diet for a person with anemia
the amount of iron they consume and includes plenty of foods rich in iron
Eat Food that reach in vitamin C and other foods that help the body to
absorb iron. A person should also be
avoid some foods can make it harder
aware of foods that can inhibit iron
for your body to absorb iron. These absorption.
include coffee, tea, milk, egg whites,
fiber, and soy protein.

•Instructed the patient to drink plenty •To prevent dehydration and support
 Northeastern College – Santiago city Campus
Santiago City, Isabela
College of Nursing
their overall health.
of water
•Sleep keeps us healthy and
•Instructed the patient to sleep 7-9 functioning well.
hours every night.

Outpatient Follow up

•Instructed the patient to Visit the •follow up check-up can help you to
Doctor for Follow up check-up and If identify misunderstandings and
necessary answer questions, or make further
assessments and adjust treatments
and to determine if the medication is
effective.
Spiritual Care

•Showed support for religious •To show respect

practices by being present and
assisting with patient prayer. •Having Faith to God in every
Decision you pray about that thing
that you are worrying