202458482-final-case-presentation-abnormal-uterine-bleeding.doc

8/9/2019 202458482-Final-Case-Presentation-Abnormal-Uterine-Bleeding.doc

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Introduction

Abnormal uterine bleeding is a condition in which a woman bleeds from

her uterus at an unexpected time or in a way that is unusual for her. For example,

bleeding between periods, a period that is heavier longer-lasting than normal,

bleeding after sexual intercourse, clots or spots in the menstrual blood and any

bleeding after menopause may all be considered abnormal uterine bleeding.

The most common reason for irregular uterine bleeding is pregnancy.

Spotting or very light bleeding may occur with no real significance, but you

should always check with your doctor if you re bleeding while pregnant. Another

common reason for abnormal menstrual bleeding is having too much or too little

of certain hormones. This often occurs during adolescence, when hormone levels

fluctuate. !ntrauterine device "!#$% can cause abnormal bleeding by irritating theuterine lining. The bleeding is usually accompanied by cramping. Also called

Stein-&eventhal syndrome, 'olycystic (varian Syndrome occurs when you don t

ovulate regularly. !f your period comes with pain or foul-smelling greenish

discharge you may have an infection of a pelvic organ, such as your uterus,

cervix or ovaries. )leeding would commonly follow sex or douching. These

infections are often caused by sexually transmitted diseases. Fibroid tumors are

non-cancerous tumors that grow in the uterine muscle. They usually affectwomen in their *+s or +s. most common among black women, they are also

fairly common among white women, but extremely rare in Asian women. (ther

possible reasons for abnormal menstrual bleeding include polyps, small growths

that develop in the cervix or uterus. Their causes are unclear, but are related to

an excess of estrogen, which may be result of an infection, hormone treatment or

some types of ovarian tumors.

The most probable etiology of abnormal uterine bleeding relates to the

patient s reproductive age, as does the likelihood of serious endometrial

pathology. The specific diagnostic approach depends on whether the patient is

premenopausal, perimenopausal or postmenopausal. !n premopausal women

with normal findings on physical examination, the most likely diagnosis is

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dysfunctional uterine bleeding "$#)% secondary to anovulation, and the

diagnostic investigation is targeted at identifying the etiology of anovulation.

Abnormal uterine bleeding "A#)% in nonpregnant women is a common

problem. !n fact, A#) accounted for almost million outpatient visits "mostly to

physicians offices% in the #nited States in /. !ndeed, this problem may

prompt more than 0+1 of all visits to ()2345s, and may account for more than

one fourth of all hysterectomies. A#) is rare in prepubertal females. 5ewborn

girls occasionally have a slight bloody vaginal discharge secondary to withdrawal

of placental estrogens. A#) is common in adolescents because of the - to 6-

year delay in development of regular ovulatory menstrual cycles after menarche.

A#) also tens to be more common during the fifth decade of life "the

perimenopausal years%. !n the worst case, A#) may be a sign of atypicalendometrial hyperplasia, which, if undiagnosed and untreated, can progress to

uterine cancer-the most common female genital cancer. !n 7, estimated

*/, ++ women were diagnosed with uterine cancer, which led to approximately

/,*++ deaths.

(ne popular form of treatment for abnormal uterine bleeding is birth

control pills, which contain hormones that can prevent the uterus lining from

thickening. !f birth control pills are nt stopping the bleeding, a doctor mayprescribe an intrauterine "!#$% device. An !#$ is a plastic device that is inserted

into a woman s uterus to prevent pregnancy. !n rare cases, surgery may be

needed to stop abnormal bleeding. Two surgical procedures are recommended8

hysterectomy and endometrial ablation.

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OBJECTIVES

3eneral (b9ectives

This study attempts to examine the case of the client with abnormal

uterine bleeding, specifically it attempts8

. To obtain clients data

0. To perform thorough physical assessment to the client

*. To discuss the anatomy and physiology of the reproductive system

. To trace the pathophysiology of abnormal uterine bleeding

6. To present laboratory results and its interpretation

/. To formulate appropriate nursing diagnosis who has abnormal uterine

bleeding

:. To develop nursing care plan for client based to identifies nursing

problems.

7. To present drug studies as medications given to client as a part of

treatment regimen.

. To provide health teaching to patient and significant others about

prevention of recurrence of A#).

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PERSONAL DATA

5ame8 ;risty ducational Status8 Second year high school

5ationality8 Filipino

MEDICAL DATA

?ospital8 @idapawan edical Specialists ;enter !nc.

Bard8 5S 0

=oom C )ed 5o. =oom 0 7-A

;hief ;omplaints8 'rofuse menstruation2 enometrorrhagia$ate C Time Admitted8


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FAMILY BACKGROUND

!. Hi tor! o" Pr# #nt I$$n#

The condition started about month prior to admission as onset of

prolonged vaginal bleeding lasting for 6 days soaking -/ pads per day

associated with dysmenorrhea. 5o consultation done and no medications taken.

Two days prior to admission patient s vaginal bleeding spontaneously

regressed.

(ne day prior to admission patient s vaginal bleeding recurred and

completely soaked several pads associated with pallor and diDDiness prompting

to consult an ()-3ynecologist "$r. 'hillen $rama #reta% and subseEuent

admission.

II% Hi tor! o" P& t I$$n#

'atient was hospitaliDed last arch 0+ + at Antipas ?ospital due to

profuse vaginal bleeding and was treated with $iane pills taken with poor

compliance. She is non-asthmatic, non-diabetic, non-hypertensive with no known

food and drug allergies.

III% M#dic&$ Hi tor! o" F&'i$!

5o heredofamilial diseases such as hypertension, diabetes, asthma and

cancer were reported in the family.

,

IV% P#r on&$ &nd Soci&$ Hi tor!

'atient is a second year high school student at Arakan 5ational ?igh

School. She is the second child among * siblings. ?er father is a farmer and her

mother is a plain housewife. She is a non-smoker, an occasional alcohol

beverage drinker and denies any use of prohibited drug. She has a boyfriend but

denies coitus at her age. She spends most of her time watching television.

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V% M#n tru&$ Hi tor!

She started her menarche at the age of * years old, with an interval of

07-*+ days and duration of -/ days. Amount of blood is heavy soaking *- pads

per day accompanied with dysmenorrhea.

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DEVELOPMENTAL DATA

A(#)St&(# $escription according to Theories Analysis• *+ !)o

H&,i(-ur t-Adolescence

Eri. on-Adolescence " 0-0+%

Ko-$/#r(-Adolescence and

Adulthood

?avighurst >rikson @ohlberg(n ?avighursttheory, the patienthas met theindicators of anadolescent exceptachievingassurance ofeconomicindependence.

(n >rikson s theory,client indicatespositive resolution,she has a sense ofself and plans toactualiDe herabilities.

(n @ohlberg stheory, the client isconcerned inmaintainingexpectations andrules of the familygroup.

Ado$# c#nc#. Achieving new and more

mature relations with age-matesof both sexes

0. Achieving masculine orfeminine social role*. Accepting one s physiEue andusing the body effectively

. Achieving emotionalindependence from parents andother adults.6. Achieving assurance ofeconomic independence./. Selecting and preparing for anoccupation:. 'reparing for marriage andfamily life.7. $eveloping intellectual skillsand concept necessary for civiccompetence

. $esiring and achieving socially

responsible behavior +. AcEuiring a set of values andethical system as a guide tobehavior.

C#ntr&$ t& .-!dentity vs. =ole ;onfusion

Indic&tor o" Po iti,#R# o$ution-;oherent sense of selfG'lans to actualiDe one sabilities

Indic&tor o" N#(&ti,#R# o$ution

-feelings of confusion.!ndecisiveness and possibleanti-social behavior

Con,#ntion&$ L#,#$-'erson is concerned inmaintaining expectations and

rules of the family group,nation or society. A sense ofguilt has developed andaffects behavior. The personvalues conformity, loyalty andactive maintenance of socialorder and control. ;onformitymeans good behavior or whatpleases or helps another andis approved.

L&0 &nd Ord#r Ori#nt&tion-The person wantsestablished rules fromauthorities, and the reason for decision and behavior is thatsocial and sexual rules andtraditions demand theresponse.

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PHYSICAL ASSESSMENT

$ate of Assessment8

I% G#n#r&$ A11#r&nc#

$ate8


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VI% E&r

?earing is normal upon assessment using Beber s test, no gross

deformities noted. She is able to locate the direction of the sound of her ringing

celphone.

VII% No #

5o asymmetry, no nasal discharges noted and can identify odors.

VIII% N#c.)T-ro&t

5o neck vein engorgement, no lymphadenopathy, tonsils are in normal

siDe, no difficulty on swallowing. The neck can move from left to right and can be flexed,

extended and hyper extended.

I2% C-# t &nd Lun(

>Eual chest expansion, no retractions noted, clear breath sounds and with

bilateral chest movements. ==8 7 cpm

2% H#&rt &nd Circu$&tion

$istinct heart sounds, regular rhythm, )'8 +2 +mm?g'=8 :+ bpm.

2I% Br#& t

)reast siDe and symmetry are relatively eEual with slight variation. Shape

is round and firm. ;olor is flesh and skin surface is smooth. 5ipples are pink in color

with no discharges noted. She uses brassieres, no lumps or masses noted upon

palpation.

2II% A/do'#n

5o scars noted, soft, normoactive bowel sounds noted. 5o tenderness.

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2III% G#nito3urin&r!

5ormal external genitalia, abundant pubic hair with moderate bleeding.

5o alteration in urinary and bowel habits. She experiences 6 days of menstruation

and soaks -/ sanitary napkins a day. She also urinates every 0+ minutes during this

period.

2IV% E4tr#'iti#

A. U11#r E4tr#'iti#

5o skin lesion is noted. 5o growth deformities. She can move her upper

extremities freely and are both symmetrical in siDe and length. Bith '5SS & H 0+

gtts2min at the level of 0++ cc infusing well H right metacarpal vein.). Lo0#r E4tr#'iti#

5o skin lesion is noted. 5o growth deformities. ?er lower extremities are

both symmetrical in siDe and length with limitation of movement because movement and

straining or any forceful activity can aggravate profuse vaginal bleeding.

2V% Food Pr#"#r#nc#

'atient verbaliDes fondness of eating meat, fish and vegetables.

2VI% Id#nti"i#d N##d

The patient needs to maintain fluid and electrolyte balance, needs to keep

body clean and well groomed and protect the integument and needs

performance of activities of daily living.

2VII% Nur in( Di&(no #

• =isk for Fluid Jolume $eficit =2T #terine )leeding

• =isk for Activity !ntolerance related to decreased hemoglobin

• Self-care deficit8 bathing2 hygiene related to decreased motivation

• >asy fatigability related to decreased hemoglobin

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TERMINOLOGIES

A/nor'&$ Ut#rin# B$##din( K excessive and prolonged menstruation.

Endo'#trio i K ectopic growth and function of endometrial tissue.

Fi/roid K a fibroma or myoma particularly of the uterus

Fi/ro'& K a benign neoplasm consisting largely of fibrous or fully developed

connective tissue.

M#no'#trorr-&(i& - excessive menstrual and uterine bleeding other than that caused

by the menstruation.

M#norr-&(i& - abnormally heavy or long menstrual periods. enorrhagia occurs

occasionally during the reproductive years of most women s lives.

M#trorr-&(i& K uterine bleeding other than that caused by menstruation. !t may be

caused by uterine lesions and may be a sign of uro-genital malignancy.

M!o'& K a common benign fibroid tumor of uterine muscle.

Po$!1 K small, tumor like growth that pro9ects from a mucous membrane surface.

Pro$i"#r&tion K the reproduction or multiplication of similar forms.

R#tro,#rt#d ut#ru - titled or tipped backwards.

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Sn#$$#n5 C-&rt 3 an eye chart used by eye care professionals and others to measure

visual acuity. !t is printed with eleven lines of block letters. The first line consists of one

very large letter, which may be one of several letters, for example >,? or 5. subseEuent

rows have increasing numbers of letters that decrease in siDe.

Sn#$$#n5 T# t K a test wherein a person covers one eye and reads aloud the letters of

each row beginning at the top. The smallest row that can be read accurately indicates

the visual acuity in that eye.

6it-dr&0&$ /$##din( K the passage of blood from the uterus, associated with theshedding of endometrium that has been stimulated and maintained by hormones.

6#/#r5 T# t K a test for differentiating conductive hearing impairment from

sensorineural hearing impairment. A vibrating tuning for is applied to one of several

points in the middling of the foreheadG if the sound is heard better in the impaired ear,

the middle-ear apparatus is at faultG if the sound is heard better in the normal ear, the

hearing impairment is caused by diseased sensorineural apparatus.

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ANATOMY AND PHYSIOLOGY

V&(in&7The vagina is a fibro muscular tubular tract leading from the uterus to the

exterior of the body in female mammals . The vagina is the place where semen from the

male is deposited into the femaleLs body at the climax of sexual intercourse , commonly

known as e9aculation .

C#r,i47

The cervix is the lower, narrow portion of the uterus where it 9oins with the

top end of the vagina . !t is cylindrical or conical in shape and protrudes through the

upper anterior vaginal wall. Approximately half its length is visible, the remainder lies

above the vagina beyond view. The vagina has a thick layer outside and it is the

opening where baby comes out during delivery. The cervix is also called the neck of the

uterus.

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http://en.wikipedia.org/wiki/Vaginahttp://en.wikipedia.org/wiki/Cylinder_(geometry)http://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Mammalhttp://en.wikipedia.org/wiki/Vaginahttp://en.wikipedia.org/wiki/Semenhttp://en.wikipedia.org/wiki/Sexual_intercoursehttp://en.wikipedia.org/wiki/Ejaculationhttp://en.wikipedia.org/wiki/Cervixhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Vaginahttp://en.wikipedia.org/wiki/Cylindricalhttp://en.wikipedia.org/wiki/Cone_(geometry)http://en.wikipedia.org/wiki/Vaginahttp://en.wikipedia.org/wiki/Cylinder_(geometry)http://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Mammalhttp://en.wikipedia.org/wiki/Vaginahttp://en.wikipedia.org/wiki/Semenhttp://en.wikipedia.org/wiki/Sexual_intercoursehttp://en.wikipedia.org/wiki/Ejaculationhttp://en.wikipedia.org/wiki/Cervixhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Vaginahttp://en.wikipedia.org/wiki/Cylindricalhttp://en.wikipedia.org/wiki/Cone_(geometry)


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Endo'#triu'!s the inner membrane of the mammalian uterus . The endometrium

functions as a lining for the uterus, preventing adhesions between the opposed walls of

the myometrium , thereby maintaining the patency of the uterine cavity. $uring the

menstrual cycle or estrous cycle , the endometrium grows to a thick, blood vessel-rich,

glandular tissue layer. This represents an optimal environment for the implantation of a

blastocyst upon its arrival in the uterus. The endometrium is central, echogenic

"detectable using ultrasound scanners%, and has an average thickness of /.:mm.$uring

pregnancy , the glands and blood vessels in the endometrium further increase in siDe

and number. Jascular spaces fuse and become interconnected, forming the placenta,

which supplies oxygen and nutrition to the embryo and fetus .

O,&r!

!s an ovum -producing reproductive organ, often found in pairs as part of

the vertebrate female reproductive system. (varies in females are homologous to

testes in males, in that they are both gonads and endocrine glands . (varies are ovalshaped and, in the human, measure approximately * cm x .6 cm x .6 cm "about the

siDe of a 3reek olive%. The ovary "for a given side% is located in the lateral wall of the

pelvis in a region called the ovarian fossa . The fossa usually lies beneath the external

iliac artery and in front of the ureter and the internal iliac artery .

Ut#ru or 6o'/

!s a ma9or female hormone-responsive reproductive sex organ of most mammals

including humans . !t is a flattened, pear-shaped, hollow organ in the pelvis of the humanfemale. The uterus consists of a body, a base or fundus, a neck or cervix, and a mouth.

Suspended in the pelvis, it lies with the base directed upward and forward and the

cervix directed slightly backward. !t is connected to the vagina by the cervix. (n either

14

http://en.wikipedia.org/wiki/Mammalianhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Myometriumhttp://en.wikipedia.org/w/index.php?title=Patency_(medicine)&action=edit&redlink=1http://en.wikipedia.org/wiki/Menstrual_cyclehttp://en.wikipedia.org/wiki/Estrous_cyclehttp://en.wikipedia.org/wiki/Implantationhttp://en.wikipedia.org/wiki/Blastocysthttp://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/wiki/Blood_vesselhttp://en.wikipedia.org/wiki/Placentahttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Embryohttp://en.wikipedia.org/wiki/Fetushttp://en.wikipedia.org/wiki/Ovumhttp://en.wikipedia.org/wiki/Homology_(biology)http://en.wikipedia.org/wiki/Testiclehttp://en.wikipedia.org/wiki/Gonadhttp://en.wikipedia.org/wiki/Endocrine_glandhttp://en.wikipedia.org/wiki/Ovarian_fossahttp://en.wikipedia.org/wiki/External_iliac_arteryhttp://en.wikipedia.org/wiki/External_iliac_arteryhttp://en.wikipedia.org/wiki/Ureterhttp://en.wikipedia.org/wiki/Internal_iliac_arteryhttp://en.wikipedia.org/wiki/Sex_organhttp://en.wikipedia.org/wiki/Mammalhttp://en.wikipedia.org/wiki/Humanhttp://en.wikipedia.org/wiki/Mammalianhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Myometriumhttp://en.wikipedia.org/w/index.php?title=Patency_(medicine)&action=edit&redlink=1http://en.wikipedia.org/wiki/Menstrual_cyclehttp://en.wikipedia.org/wiki/Estrous_cyclehttp://en.wikipedia.org/wiki/Implantationhttp://en.wikipedia.org/wiki/Blastocysthttp://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/wiki/Blood_vesselhttp://en.wikipedia.org/wiki/Placentahttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Embryohttp://en.wikipedia.org/wiki/Fetushttp://en.wikipedia.org/wiki/Ovumhttp://en.wikipedia.org/wiki/Homology_(biology)http://en.wikipedia.org/wiki/Testiclehttp://en.wikipedia.org/wiki/Gonadhttp://en.wikipedia.org/wiki/Endocrine_glandhttp://en.wikipedia.org/wiki/Ovarian_fossahttp://en.wikipedia.org/wiki/External_iliac_arteryhttp://en.wikipedia.org/wiki/External_iliac_arteryhttp://en.wikipedia.org/wiki/Ureterhttp://en.wikipedia.org/wiki/Internal_iliac_arteryhttp://en.wikipedia.org/wiki/Sex_organhttp://en.wikipedia.org/wiki/Mammalhttp://en.wikipedia.org/wiki/Human


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side of the uterus lies an ovary. >ggs produced by the ovaries reach the uterus through

the fallopian tubes.

ETIOLOGY

PREDISPOSINGFACTOR

ACTUAL RATIONALE

. Age

- Abnormal uterine bleeding is one of the most common reasons womensee their doctors. !t can occur at anyage and has many causes ."http822www.acog.org2publications2patientMed

ucation2bp+ 6.cfm %

Age8 years old.0. 3ender - The uterus or womb is a ma9or

female hormone-responsivereproductive sex organ of mostmammals including humans .(http822en.wikipedia.org2wiki2#terus %

Female

PRECIPITATINGFACTOR

ACTUAL RATIONALE

. 'oorcompliance totreatment

5oncompliance and poor compliancemay lead to relapse, aggravation of the disease state, hospitaliDation,escalating health care costs, andeven death."http822www.pharmacytimes.com2issue2pharmacy20++*20++*-+:20++*-+:-:* + %

;omplying only for month andstopping thereafter.

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http://www.acog.org/publications/patient_education/bp095.cfmhttp://www.acog.org/publications/patient_education/bp095.cfmhttp://en.wikipedia.org/wiki/Sex_organhttp://en.wikipedia.org/wiki/Mammalhttp://en.wikipedia.org/wiki/Humanhttp://en.wikipedia.org/wiki/Uterushttp://www.pharmacytimes.com/issue/pharmacy/2003/2003-07/2003-07-7310http://www.pharmacytimes.com/issue/pharmacy/2003/2003-07/2003-07-7310http://www.pharmacytimes.com/issue/pharmacy/2003/2003-07/2003-07-7310http://www.acog.org/publications/patient_education/bp095.cfmhttp://www.acog.org/publications/patient_education/bp095.cfmhttp://en.wikipedia.org/wiki/Sex_organhttp://en.wikipedia.org/wiki/Mammalhttp://en.wikipedia.org/wiki/Humanhttp://en.wikipedia.org/wiki/Uterushttp://www.pharmacytimes.com/issue/pharmacy/2003/2003-07/2003-07-7310http://www.pharmacytimes.com/issue/pharmacy/2003/2003-07/2003-07-7310http://www.pharmacytimes.com/issue/pharmacy/2003/2003-07/2003-07-7310


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SYMPTOMATOLOGY

SYMPTOMS ACTUAL RATIONALE. ore than to /

days of menstruation.;auses may be due to disruption of normal hormonal regulation of periods or disorders of the endometrial lining of theuterus ."http822en.wikipedia.org2wiki2 enorrhagia %

She experiences 6 days of menstruation.

0.)lood loss ofgreater than 7+ ml.

Bithout subseEuent progesteronesecretion, estrogen secretion continuesand causes extreme proliferation in theendometrium." aternal and ;hild health 5ursing,Jolume 0, th edition , 'illitteri%

>asily soaks to / sanitary napkins a

day. " sanitary napkin is eEual to 06 ml%*.Anemia

N $iDDinessN 'allor

)leeding causes loss of blood. Thiscauses an abnormally low number of redblood cells which causes anemia. =edblood cells, also called erythrocytes,contain hemoglobin, a red, iron-richprotein that carries oxygen in the bloodto the body s tissues.These symptoms include pale skin,shortness of breath, rapid heartbeat, lowvitality, diDDiness, and, if left untreated,

stroke or heart failure. " icrosoft O>ncarta O 0++7. P *-0++: icrosoft;orporation.%

;lient has pale con9unctiva and nailbeds. She experiences diDDiness

16

http://en.wikipedia.org/wiki/Endometriumhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Menorrhagiahttp://en.wikipedia.org/wiki/Endometriumhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Menorrhagia


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P&t-o1-! io$o(!

18

'redisposing Factors3ender K Female

Age - Adolescent

'recipitating Factors'oor medical;ompliance

(J#&AT(=4

!rregular Sloughing of>ndometrial )asalis &ayer

5o ;orpus &uteum isformed

>strogen levels remain thesame

5o production of progesterone

?yperplasia of >ndometrium

As follicles degenerate,estrogen levels decreases


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NURSING CARE PLANS

19

?eavy 'rolonged )leeding"$uration of 6 days enstruation

and soaking -/ 'ads per day%. Anemia$ecreased Serum

?emoglobin

Abnormal #terine )leeding

$ecreased ( 0 ;arrying;apacity of )lood

"$iDDiness%$iDDinessand 'allor !f not treated

;omplications

$eath

!f treated8

)ack to normal?omeostasis

eds. A&T?>A Tab.

(.$ * monthsFeS( Tab. 0++mg )!$

'rognosis3ood


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$ate8 ncouragedincrease oral fluidintake

. 'romoted highwater contentfruits.

$ependent

. !JF '5SS & H7+cc2hr

0. Tranexamic Acid6++mg R!$ asordered byphysician

N!ndirectindicators offluid status.

NServes asbaseline data

N To providevolume tovolumereplacement

N Toreplacefluidlost.

N Fluidreplacement.

N!t stopsbleeding.

N3oal met.

After 7 hours of nursingcare, patient was ableto8 Show good fluidvolume status asevidenced by

a% inimalbleeding

b% Jital Signswithin normalrange

c% &ips andmucousmembranes aremoist with goodskin turgor.

$ate8


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A # '#nt N##d Di&(no i Go&$ Int#r,#ntion R&tion&$# E41#ct#dOutco'#

Su/8#cti,#Cu# 7 N5o sub9ectivecues

O/8#cti,# Cu# 7N 'alecon9unctivaN 'ale nail bedsN ?gb +0"normal value8

0+- +%N BeaknessN $iDDiness

PHYSIOLOGICNEEDS

- need for activity

" aslow s?ierarchy of

5eeds%

N=isk for Activity!ntolerancerelated todecreasedhemoglobin

Sci#nti"icB& i 8?emoglobinin the blood is whattransportsoxygen fromthe lungs orgills to therest of thebody "i.e. thetissues%where it

releases theoxygen forcell use.

NAfter 7 hoursof nursingcare, patientwill be able toidentifyalternativeways tomaintaindesired activitylevel andendureperformanceof Activities of$aily&iving"A$&%

!ndependent

. $iscussed withclient therelationship ofillness to inabilityto perform desired

activities.

0. Assisted client indoing basicactivities

*. >ncouragedpatient to takefoods rich in iron.

$ependent

. FeS( tab)!$ as ordered byphysician.

N#nderstandingtheserelationships canhelp withacceptance of

limitations orrevealopportunity forchanges ofpractical value.

Nto conserveenergy andpromote safety.

Nto replace ironlost

N 'rovideselemental iron anessentialcomponent in theformation ofhemoglobin.

N3oal met. ;lientwas able to endureC sustain basicactivity such asmoving to and fromthe bathroomwithout assistance.

$ate8


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A # '#nt N##d Di&(no i Go&$ Int#r,#ntion R&tion&$# E41#ct#dOutco'#

Su/8#cti,# Cu# 7N QBala pa koyligoI clientverbaliDed

O/8#cti,# Cu# 7N dirty nail notedN unfixed hairnoted.

PHYSIOLOGICNEEDS

- need to keepbody clean andwell groomed

and protect theintegument" aslow s

?ierarchy of 5eeds%

NSelf-caredeficit8

bathing2hygienerelated todecreasedmotivation.

Sci#nti"icB& i 8

otivationis thepsychological featurethatarouses anorganism toactiontoward adesiredgoal."http822www.thefreedictionary.com2motivation%

.After 7 hoursof nursingcare, patientwill be able

to8'erformproperhygiene

!ndependent

. onitoredvital signs.

0. 'erformedcleansing bedbath to patient.

*.>ncouragedpatient to take abath explain thepossible risks for infection.

. >ncouragedpatient to dooral care.

6. Trimmedpatients nails.

N Serves asbaseline data.

N To promotecomfort andreduce risk for infection.N To denoteimportance ofproperhygiene.

N To promotetaste anddecreasebacteria.

N To preventmicroorganism fromstaying undernails.

N3oal met.

After 7 hours of nursing

care, patient was ableto perform properhygiene and goodgrooming.

$ate8


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A # '#nt N##d Di&(no i Go&$ Int#r,#ntion R&tion&$# E41#ct#d)Outco'#

Su/8#cti,# Cu# 7 NI 3inakapoygud koI clientverbaliDed.O/8#cti,# Cu# 7

N 'alecon9unctivaN 'ale nail bedsN Always lying onbed.NFeeling ofweakness.N ?gb +0N 6 days ofmenstruationN to / sanitarypads a day.

PHYSIOLOGICNEEDS

- need for activity" aslow s

?ierarchy of 5eeds%

N>asyFatigability=2T

decreasedhemoglobin.

Sci#nti"icB& i 8?emoglobin in theblood iswhattransportsoxygenfrom thelungs orgills to therest of thebody "i.e.thetissues%where itreleasesthe oxygenfor cell use

!n the 7 hoursof nursingcare, patientwill be ableto8

N'articipatewillingly innecessarydesiredactivities suchas going tothe bathroom,eating,standing andwalkingwithoutambulatory.

!ndependent

. 5oted clientreports ofweakness

and2or fatigue.

0. Ad9ustedactivitiesaccording toclient scondition.

*. Assisted clientwith activities.

$ependent

. FeS( tab)!$.

N Symptomsmay be resultof2or to

contribute to!ntolerance toactivity.N To prevent(verexertion

N To preventclient fromin9ury.

N'rovideselemental ironan essentialcomponent inthe formationofhemoglobin.

N3oal met.

After 7 hours of nursingcare, patient was able

to8N 'erform the desiredactivities such as goingto the bathroom withassistance.

23

http://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Gillhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Gill


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LABORATORY RESULTS

$iagnosticTest

'urpose =esult !nterpretation 5ursing!mplication

;omplete)lood ;ountD&t#7 Ju$! 9:;97 delivers(0 through circulation tobody tissues and returns ;(0from tissues to lungsH#'&tocrit =Hct>7 indicatesrelative proportions of plasmaand =);s " volume of=);s2& whole blood%P$&t#$#t8 total number ofplatelets in circulationL!'1-oc!t# 7 integralcomponent of immunesystemS#('#nt#r 7Monoc!t# 7

T# t R# u$t Nor'&$ V&$u#The H#'o($o/inlevels are below thenormal range.

The H#'&tocrit levelsare below than thenormal levels.

)elow than normallevels of ?emoglobinare found in iron-deficiency anemia"Fischbach, 77%.)elow than the normalof hematocrit arefound in Acute,massive blood loss."Fischbach, 77%.

B);

?gb?ct'lt.ct&ymphoSegs

ono

. " + e g2&%

*


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$iagnosticTest

'urpose =esult !nterpretation 5ursing!mplication

)leeding Timeand ;lottingTimeD&t#7 Ju$! 9:;9


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$iagnosticTest

'urpose =esult !nterpretation 5ursing !mplication

#rinalysisD&t#7 Ju$!9:; 9rb s, 0++:%5ormal value for puscells in urine is +-62hpf"http822www.medhelp.org2posts2#rology2#rinalysis-interpretation2show2:* *

: %The girl is not pregnant.The human chorionicgonadotropin "h;3% testis done to check for thehormone h;3 in blood or urine. Some h;3 testsmeasure the exactamount and some 9ustcheck to see if thehormone is present. ?;3is made by the placentaduring pregnancy . Theh;3 test can be used tosee if a woman ispregnant or as part of a

C-#'ic&$ E4&'in&tion Albumin8 Trace p?reaction8 6.+Sugar8 5egative Specific3ravity8 .+0+

Micro co1ic "indin('us cells8 -*2hpf =ed )lood;ells8 'acked

S#ro$o(!#rine ?;3 - 5egative

26

http://%20optionsdisplay%28%27../glossary/diagnostic.html')http://%20optionsdisplay%28%27../glossary/diagnostic.html')http://www.labtestsonline.org/understanding/conditions/kidney.htmlhttp://www.labtestsonline.org/understanding/conditions/kidney.htmlhttp://www.labtestsonline.org/understanding/conditions/uti.htmlhttp://www.labtestsonline.org/understanding/conditions/uti.htmlhttp://www.labtestsonline.org/understanding/conditions/uti.htmlhttp://www.labtestsonline.org/understanding/analytes/urinalysis/test.htmlhttp://www.labtestsonline.org/understanding/analytes/urinalysis/test.htmlhttp://www.labtestsonline.org/understanding/analytes/albumin/glance.htmlhttp://www.labtestsonline.org/understanding/analytes/urinalysis/ui_exams.htmlhttp://www.labtestsonline.org/understanding/analytes/urinalysis/ui_exams.htmlhttp://www.labtestsonline.org/understanding/analytes/urinalysis/ui_exams.htmlhttp://www.labtestsonline.org/understanding/analytes/urinalysis/ui_exams.htmlhttp://www.medhelp.org/posts/Urology/Urinalysis-interpretation/show/731397http://www.medhelp.org/posts/Urology/Urinalysis-interpretation/show/731397http://www.medhelp.org/posts/Urology/Urinalysis-interpretation/show/731397http://www.medhelp.org/posts/Urology/Urinalysis-interpretation/show/731397http://www.medhelp.org/posts/Urology/Urinalysis-interpretation/show/731397http://www.medhelp.org/posts/Urology/Urinalysis-interpretation/show/731397http://www.webmd.com/baby/human-chorionic-gonadotropin-hcghttp://www.webmd.com/baby/human-chorionic-gonadotropin-hcghttp://www.webmd.com/hw-popup/hormonehttp://www.webmd.com/hw-popup/placentahttp://www.webmd.com/baby/default.htmhttp://%20optionsdisplay%28%27../glossary/diagnostic.html')http://www.labtestsonline.org/understanding/conditions/kidney.htmlhttp://www.labtestsonline.org/understanding/conditions/uti.htmlhttp://www.labtestsonline.org/understanding/conditions/uti.htmlhttp://www.labtestsonline.org/understanding/analytes/urinalysis/test.htmlhttp://www.labtestsonline.org/understanding/analytes/urinalysis/test.htmlhttp://www.labtestsonline.org/understanding/analytes/albumin/glance.htmlhttp://www.labtestsonline.org/understanding/analytes/urinalysis/ui_exams.htmlhttp://www.labtestsonline.org/understanding/analytes/urinalysis/ui_exams.htmlhttp://www.labtestsonline.org/understanding/analytes/urinalysis/ui_exams.htmlhttp://www.medhelp.org/posts/Urology/Urinalysis-interpretation/show/731397http://www.medhelp.org/posts/Urology/Urinalysis-interpretation/show/731397http://www.medhelp.org/posts/Urology/Urinalysis-interpretation/show/731397http://www.webmd.com/baby/human-chorionic-gonadotropin-hcghttp://www.webmd.com/baby/human-chorionic-gonadotropin-hcghttp://www.webmd.com/hw-popup/hormonehttp://www.webmd.com/hw-popup/placentahttp://www.webmd.com/baby/default.htm


27/41

P#$,icU$tr& oundD&t#7 Ju$!9@; 9


28/41

DRUG STUDIES

N&'# Do &(# &ndIndic&tion

M#c-&ni ' o" Action

Ad,#r # E""#ct Contr&indic&tion Nur in( R# 1on i/i$iti#

3eneric5ame8

F#rrouSu$"&t#

)rand 5ame8M&(ni"#rron

;lassification8H#'&to$o(icDru( 7H#'&tinic

!ron $eficiency0++ mg

'.( )!$

'rovideselemental iron

an essentialcomponent inthe formation of

hemoglobin.

GI7 5ausea, epigastricpain, vomiting,

constipation, blackstools, diarrhea,anorexia.Ot-#r7 temporarilystained teeth in liEuidforms

;ontraindicated inpatients with

?emosiderosis,primaryhemochromatosis,hemolytic anemia"unless patientalso has irondeficiencyanemia%, 'epticulceration,ulcerative colitis or regional enteritisand in thosereceiving repeatedblood transfusions.#se cautiously onlong term basis.

. !dentify the clientcorrectly using the

appropriate means ofidentification, such aschecking the identificationbracelet or asking theclients name.0. !f the client is unfamiliarwith the medication, thenurse should explain theintended action as well asany side effects or adverseeffects that may occur.*. Administer drug in theprescribed dosage by theroute intended and thecorrect time.

. =ecord the medicationgiven, dosage, time, anycomplaints or assessmentsand your signature.6. >xplain to the client thatshe may have black stoolas effect of the drug./. Administer the drug with

9uice for faster absorption.

28


29/41


M#c-&ni ' o" Action

Ad,#r # E""#ct Contr&indic&tion Nur in( R# 1on i/i$iti#

3eneric5ame8Tr&n#4&'icAcid)rand 5ame8H#'o t&n ;lassification8H#'&to$o(icDru( 7H#'&tinicamino acidantifibrinolytics.

!ndicated forshort term usefor hemorrhageor risk ofhemorrhage inthose withincreasedfibrinolysis orfibrinogenolysis. &ocalfibrinolysis asoccurs inmenorrhagia.

tab 6++mgR!$

Tranexamicacidcompetitivelyinhibitsactivation ofplasminogen"via binding tothe kringledomain%,therebyreducingconversion ofplasminogen toplasmin"fibrinolysin%,an enDyme thatdegrades fibrinclots,fibrinogen, andother plasmaproteins,including theprocoagulantfactors J andJ!!!.

GI7 nausea, vomiting,diarrhea may occurbut disappear whenthe dosage isreduced.

!n patients withacEuired defectivecolor vision, sincethis prohibitsmeasuring oneendpoint thatshould be followedas a measure oftoxicity.!n patients withactiveintravascularclotting.

. !dentify the clientcorrectly using theappropriate means ofidentification, such aschecking the identificationbracelet or asking theclients name.0. !f the client is unfamiliarwith the medication, thenurse should explain theintended action as well asany side effects or adverseeffects that may occur.*. Administer drug in theprescribed dosage by theroute intended and thecorrect time.

. =ecord the medicationgiven, dosage, time, anycomplaints or assessmentsand your signature.6. ;heck for presence ofspontaneous bleeding.

29


30/41

Tranexamicacid alsodirectly inhibitsplasminactivity, buthigher dosesare reEuiredthan areneeded toreduce plasminformation.

30


31/41


M#c-&ni ' o" Action Ad,#r #E""#ct

Contr&indic&tion Nur in( R# 1on i/i$iti#

3eneric5ame8C!1rot#ron#&c#t&t#)rand 5ame8

A$t-#&;lassification8N&tur&$ &nd

#'i !nt-#tic # tro(#n %

(;, control ofacne Chsirsutism, regulation ofmenstrual

cycle, reductionof premenstrualtension , relieffrom pain Cexcessbleeding duringmenstruation .

Take tabstarting on the

st day ofmenses Cthroughout thecycle.

(ral contraceptive.

Althea is a combined low-dose oral contraceptivepill with antiandrogenic

properties. >ach tabletcontains cyproteroneacetate, a progesteronewith antiandrogenic andprogestogenic propertiesand ethinyl estradiol, anestrogen.

(ral ;ontraceptive8 Althea stops ovulation,thins the lining of theuterus and thickens thecervical mucus. !ncombination, theseactions preventpregnancy.

Antiandrogen8 Altheacontains cyproteroneacetate that works as anantiandrogen. !tcompetes at the receptorsites with androgens andreduces their effects.;yproterone acetate

GI7 5ausea,vomiting,chloasma"melasma%C other skin

or hairchanges,headache,waterretention,slight wtchange,breasttenderness,changes inlibido.

enstrualirregularitieseg spotting,breakthrough bleedingCamenorrhea.

!mpaired liverfunction orcholestasis, $ubin-


32/41

inhibits the influence ofthe androgens producedin women. Althea reducesthe development of acneand seborrhea. !t healsexisting acneefflorescence after *-months therapy. !t alsoreduces the greasiness of the hair and skin.

32


33/41


M#c-&ni ' o" Action Ad,#r #E""#ct

Contr&indic&tion Nur in( R# 1on i/i$iti#

3eneric name8K#toro$&ctro'#t-&'in#

)rand name8Tor&do$

;lassification8C#ntr&$n#ro,ou

! t#'dru(Non t#roid&$&nti3in"$&''&to!dru(

Short-termmanagementof moderatelysevere, acutepain

-*+mg !J TT

#nknown. ay inhibitprostaglandin synthesis,to produce anti-inflammatory, analgesic,and antipyretic effects.

GI7 5ausea,dyspepsia,3! pain,diarrhea,pepticulceration,vomiting,constipation,flatulence,stomatitis.

;ontraindicated inpatientshypersensitivity todrug and in thosewith active pepticulcer disease,recent 3! bleedingor perforation,advanced renalimpairement,cerebrovascularbleeding,hemorrhagicdiathesis, orincompletehemostasis andthose at risk forrenal impairmentfrom volumedepletion or at riskof bleeding.

.identify the clientcorrectly using theappropriate means ofidentification, such aschecking the identificationbracelet or asking theclient s name

0.!f the client is unfamiliarwith the medication, thenurse should explain theintended action as well asany side effect or adverseeffects that may occur.

*.;heck !J patency andobserve for complication of!v therapy such asinfiltration andextravasation phlebitis,thrombophlebitis,hematoma, and clotting ofthe needle.

.Administer drug in theprescribed dosage by theroute intended and thecorrect time.

33


34/41

6.Administer themedication slowly

/.=ecord the medicationgiven, dosage, time, anycomplaints or assessmentand your signature.

34


35/41

COURSE IN THE 6ARD

Pro(r# not# Doctor5 ord#r


36/41


37/41

FACTORS PROGNOSIS JUSTIFICATION

Medication Regimen Good The client is able tofollow the treatment

regimen that was givenby the attending

physician.Activity Good The client is able to

comply with the advise

of bed rest & no workload.

3>5>=A& '=(35(S!S8

'atient general prognosis is good since the disease of the patient could be managed through different varied

treatments with the help of her family. She has knowledge of what is medication is she taking C what it is for. She follows

religiously the attending physician s prescribed treatments and takes willingly the doctor s prescription medication. The

case of her abnormal uterine bleeding is easier to treat than any other cases of abnormal uterine bleeding.

37


38/41

HEALTH TEACHINGS

% Advised to take medicines religiously as prescribed by the doctor

0% !nstructed to avoid strenuous activities such as heavy lifting for it may aggravate

vaginal bleeding*% Advised to increase foods rich in iron

% !nstruct client to comply with the physicians advice for follow-up check-up

NURSING IMPLICATIONS

A% NURSING EDUCATION

!t helps the nursing profession gain more information regarding different

symptoms, different causes, different etiologies and different treatments and nursing

actions related to this case and to impart this information to the younger batches of

nursing students of 5otre $ame of @idapawan ;ollege.

!t also helps the nursing profession to be aware of the different terminologies

used so that it would be imparted to the future incoming nursing students. !t also helps

the nursing students of 5otre $ame of @idapawan ;ollege to be more knowledgeable in

dealing with patients who have abnormal uterine bleeding.

B% NURSING PRACTICE

!t helps the nursing profession to be more aware in dealing with this kind of cases

in different fields and hospitals.

!t also helps the nursing students of 5otre $ame of @idapawan ;ollege to be

more skillful in doing the different nursing actions to the patients in different hospitals, to

have safe and Euality nursing care that the patient needs.

!t also helps the nursing profession to prevent any clinical errors that can harm

the patient and may result to mal-practice or globally known as negligence.

38


39/41

C% NURSING RESEARCH

!t helps the nursing profession to gain more knowledge regarding this case and

to impart this data to the incoming researchers who may need the said information.

!t also helps the researchers to gather more reference to strengthen the validityof the different information of the said case. !t also helps to make the gathered

information to be more truthful in terms and learning that may found in the papers.

39


40/41

BIBLIOGRAPHY

A% Boo.

Andreasen, ;harlotte and Aris t al. P 0++/. osbys s 'ocket dictionary

of edicine, 5ursing and ?ealth 'rofessions 6 th >dition. >lsevier 'te. &td.

Singapore.

)erman, Audrey and Shirlee Synder. P 0++7. @oDier and >rb s Fundamentals of

5ursing 7 th >dition. 'earson >ducation !nc. . and ary Frances oorhouse, et al. P 0++7. 5urse s 'ocket

3uide $iagnosis, 'rioritiDed interventions and =ationales. &.A. $avis ;ompany,

'hiladelphia. Thomson &earning Asia. Singapore.

Fischbach, Frances. P 77. A manual of &aboratory diagnostic Tests * rd >dition.


41/41

http822www.medicines.org.uk2emc2medicine20 : 02S';2tranexamic10+acid10+6++mg

10+tablets10+"sandoD10+limited%2

http822www.nativeremedies.com2ailment2symptoms-of-hormone-imbalance.html

http822www.medicine.uic.edu2#serFiles2Servers2ServerM 0 * 2File2()34510+ ed

10+>d2ST#$>5TS2&ectures2>&A 10+-10+A#)10+talk.pdf

http822www.medicine.uic.edu2#serFiles2Servers2ServerM 0 * 2File2()34510+ ed

10+>d2ST#$>5TS2&ectures2>&A 10+-10+A#)10+talk.pdf

http822members.aapa.org2aapaconf0++/2syllabus2/06*Taylor$#).pdfc
http://www.medicines.org.uk/emc/medicine/21712/SPC/tranexamic%20acid%20500mg%20tablets%20(sandoz%20limited)/http://www.medicines.org.uk/emc/medicine/21712/SPC/tranexamic%20acid%20500mg%20tablets%20(sandoz%20limited)/http://www.nativeremedies.com/ailment/symptoms-of-hormone-imbalance.htmlhttp://www.medicine.uic.edu/UserFiles/Servers/Server_442934/File/OBGYN%20Med%20Ed/STUDENTS/Lectures/ELAM%20-%20AUB%20talk.pdfhttp://www.medicine.uic.edu/UserFiles/Servers/Server_442934/File/OBGYN%20Med%20Ed/STUDENTS/Lectures/ELAM%20-%20AUB%20talk.pdfhttp://www.medicine.uic.edu/UserFiles/Servers/Server_442934/File/OBGYN%20Med%20Ed/STUDENTS/Lectures/ELAM%20-%20AUB%20talk.pdfhttp://www.medicine.uic.edu/UserFiles/Servers/Server_442934/File/OBGYN%20Med%20Ed/STUDENTS/Lectures/ELAM%20-%20AUB%20talk.pdfhttp://members.aapa.org/aapaconf2006/syllabus/6253TaylorDUB.pdfchttp://www.medicines.org.uk/emc/medicine/21712/SPC/tranexamic%20acid%20500mg%20tablets%20(sandoz%20limited)/http://www.medicines.org.uk/emc/medicine/21712/SPC/tranexamic%20acid%20500mg%20tablets%20(sandoz%20limited)/http://www.nativeremedies.com/ailment/symptoms-of-hormone-imbalance.htmlhttp://www.medicine.uic.edu/UserFiles/Servers/Server_442934/File/OBGYN%20Med%20Ed/STUDENTS/Lectures/ELAM%20-%20AUB%20talk.pdfhttp://www.medicine.uic.edu/UserFiles/Servers/Server_442934/File/OBGYN%20Med%20Ed/STUDENTS/Lectures/ELAM%20-%20AUB%20talk.pdfhttp://www.medicine.uic.edu/UserFiles/Servers/Server_442934/File/OBGYN%20Med%20Ed/STUDENTS/Lectures/ELAM%20-%20AUB%20talk.pdfhttp://www.medicine.uic.edu/UserFiles/Servers/Server_442934/File/OBGYN%20Med%20Ed/STUDENTS/Lectures/ELAM%20-%20AUB%20talk.pdfhttp://members.aapa.org/aapaconf2006/syllabus/6253TaylorDUB.pdfc

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