Transcript A New Life

1. DEMOGRAPHIC DATA
Case number: 187***
Age: 24 Y/O
Sex: Female
Diagnosis: G1 P0 11 weeks
and 6 days AOG;
Incomplete Abortion
2. PHYSICAL ASSESSMENT
GENERAL
Ambulatory
Conscious and coherent
Slightly weak
(+) dizziness
Active vaginal bleeding
In pain; presented by grimaced face and
guarding the abdominal area.
Vital signs:
B/P= 90/60mmHg PR= 90 bpm
T= 36. 5 C
RR= 22 bpm
INTEGUMENTARY
Pale in appearance
Cold and clammy skin
Nail beds slightly bluish
in color
HEAD AND NECK
Facial symmetry
No lesions nor masses palpated
No deformity noted
No palpable lymph nodes noted
No nasal flaring, congestion or
drainages noted
Pale conjunctiva noted
Dry and pale lips also noted
BODY AND UPPER/LOWER extremities
No physical deformities,
contractures nor paralysis
noted.
Good range of motion.
GENITOURINARY
 Profuse vaginal bleeding with
soaked pads.
With minimal blood clots.
Cervix closed upon vaginal
examination by SOD.
Able to void freely in adequate
amount.
No painful sensation during
urination as reported.
NEUROLOGIC
Slightly anxious.
Uncooperative in internal
examination.
Oriented to time, place
and person.
3. PATIENT HISTORY
PAST HISTORY
Consultation done at DAAH
under Dra. Sofia dated 17/10/12,
investigations done as follows:
LMP: not sure
SERUM B-HCG (QUANTITATIVE) RESULT
58,598 mIU/ ml
Transvaginal Ultrasound
Impression:
•Anembryonic pregnancy
6 weeks and 5 days AOG by MSD
•No embryonic pole seen
•No yolk sac
•Irregularly shaped gestational sac
•Normal ovaries with corpus luteum
on the right
1 day prior to
admission (03/11/12)
(+) vaginal
spotting
Hypogastric pain
PRESENT HISTORY
G1 P0 11 weeks and 6 days by
UTZ
Complaint of:
Profuse vaginal bleeding
Hypogastric pain
Dizziness
Quick scan with UTZ revealed
gestational sac at the lower
uterine segment.
4. TOPIC PRESENTATION
ABORTION
Is the spontaneous or induced loss of an
early pregnancy.
Any interruption of pregnancy before a
fetus is viable or that is less than 20
weeks age of gestation (AOG), or that
which weighs less than 500g.
The term miscarriage is used often in
the lay language and refers to
spontaneous abortion.
TYPES OF SPONTANEOUS ABORTION
1.Threatened Abortion
Consists of any vaginal bleeding during
early pregnancy without cervical dilatation
or change in cervical consistency.
Usually, no significant pain exists,
although mild cramps may occur. More
severe cramps may lead to an inevitable
abortion.
Very common in the first trimester; about 2530% of all pregnancies have some bleeding
during the pregnancy.
Less than one half proceed to a complete
abortion.
On examination: blood or brownish
discharge may be present in the vagina. The
cervix is not tender, and the cervical os is
closed. No fetal tissue or membranes have
passed.
The ultrasound shows a continuing
intrauterine pregnancy.
2. Inevitable Abortion
An early pregnancy with vaginal
bleeding and dilatation of the cervix.
Typically, the vaginal bleeding is worse
than with a threatened abortion, and more
cramping is present.
No tissue has passed yet.
On ultrasound, the products of
conception are located in the lower uterine
segment or the cervical canal.
3. Incomplete Abortion
A pregnancy that is associated with
vaginal bleeding, dilatation of the cervical
canal, and passage of products of
conception.
Usually, the cramps are intense, and the
vaginal bleeding is heavy.
With passage of tissue within the vagina.
Ultrasound may show that some of the
products of conception are still present in
the uterus.
4. Complete Abortion
A history of vaginal bleeding, abdominal
pain, and passage of tissue exists.
After the tissue passes, the patient notes
that the pain subsides and the vaginal
bleeding significantly diminishes.
The examination reveals some blood in the
vaginal vault; a closed cervical os; and no
tenderness of the cervix, uterus, adnexa, or
abdomen.
The ultrasound demonstrates an empty
uterus.
Anembryonic gestation
(also known as a blighted ovum) is a
pregnancy in which the very early pregnancy
appears normal on an ultrasound scan, but as the
pregnancy progresses a visible embryo never
develops. In a normal pregnancy, an embryo
would be visible on an ultrasound by six weeks
after the woman's last menstrual period.
Anembryonic gestation is one of the
causes of miscarriage of a pregnancy.
5. ANATOMY AND PHYSIOLOGY
EARLY PREGNANCY
RISK FACTORS
MATERNAL/
PARENTAL
FACTORS
*AGE
*POOR NUTRITIONAL
STATUS
*POOR IMMUNE SYSTEM
*W/ UNDERLYING
DISEASE OR CONDITION
AUTOIMMUNE (APAS)
ENVIRONMENTAL
FACTORS
*EXPOSURE TO
RADIATION
*TERATOGENS
LIFESTYLE
*USE OF ALCOHOL
*PROHIBITED
DRUGS
*SMOKING
CHROMOSOMAL
ABNORMALITIES
INFECTION
HIGH RISK
PREGNANCY
MISCARRIAGE
SIGNS &
SYMPTOMS:
*LOWER BACK
PAIN
*VAGINAL
BLEEDING
*ABDOMINAL
CRAMPS
7. SIGNS AND SYMPTOMS
UTERINE CRAMPING
LOWER BACK PAIN
VAGINAL BLEEDING
8. NURSING
INTERVENTIONS
Monitor vital signs.
Monitor vaginal bleeding through pad count.
Promote bed rest.
Provide fluid resuscitation.
If considerable amount of blood loss has
occurred, aggressive hydration, iron therapy
or transfusions may be indicated.
Prevent infection.
Provide emotional support.
9. TREATMENT
MEDICAL
COMPLETE ABORTION usually needs no further treatment,
medically or surgically.
THREATENED ABORTION- use of progestogen.
MISOPROSTOL is an effective medical therapy. It increase
uterine smooth muscle contractions and soften the cervix to
allow passage of products of conception from missed
abortion, inevitable abortion, or incomplete abortion.
Risks for medical therapy include bleeding, infection,
possible incomplete abortion, and possible failure of the
medication to work.
SURGICAL
Inevitable and incomplete abortions are
typically treated surgically with D&C.
Methylergonovine maleate (Methergine)
(0.2 mg IM)- given after D&C to contract the uterus.
This will also decrease the likelihood that clots will
be retained in the uterus.
Risks of a D&C include bleeding, infection,
possible perforation of the uterus, and possible
Asherman syndrome after the procedure.
10. COMPLICATIONS
Hemorrhage
High fever due to infection.
Maternal mortality.
Accumulation of clot in the uterine
cavity without expulsion due to
uterine atony.
11. PRIORITIZATION OF NURSING PROBLEMS
A. Fluid volume deficit related to profuse vaginal
bleeding secondary to incomplete abortion.
B. Acute pain related to uterine cramping secondary
to expulsion of some products of conception.
C. Anticipatory grieving related to loss of
pregnancy.
D. Risk for infection related to dilated cervix and
open uterine vessels.
12. NURSING CARE PLAN
ASSESSMENT
CUES/ EVIDENCE
SUBJECTIVE:
“I felt dizzy and I
consumed 5-6 pads
today and it’s fully
soaked.”
OBJECTIVE:
*Profuse vaginal
bleeding with soaked
pad and with minimal
blood clots.
NURSING
DIAGNOSIS
Fluid volume
deficit related to
profuse vaginal
bleeding secondary
to incomplete
abortion.
PLANNING
IMPLEMENTATION
GOALS AND
DESIRED OUTCOME
NURSING
INTERVENTIONs
RATIONALE FOR
INTERVENTION
After 6-8 hours of
INDEPENDENT:
nursing intervention

Assessed the stability 
the patient will be
of the patient
able to demonstrate
through monitoring
improve fluid balance
vital signs.
as evidence by minimal
vaginal bleeding, good 
Inserted gauge 18 of 
skin turgor, diminish
cannula at the left
pallor.
metacarpal vein.

Instructed the
patient to do pad
counts.

Maintained bed rest

and assisted in ADL.
Schedule activities to
undisturbed rest
periods.
*Skin pallor noted.

*Bluish nail beds.
*Cold and clammy skin.
*Dry oral mucous
membranes.
EVALUATION
Provide baseline
data regarding
patient’s condition.
IV line is needed
for the hydration
of the patient to
replace the blood
loss.
After 6-8 hours of
nursing interventions
the goals were met as
evidenced by:

Scanty vaginal
bleeding.

Good skin turgor
and color.

Fast capillary
refill <2 sec
To monitor the
bleeding and able

V/S stable:
to assess the blood
loss.
BP- 110/70mmHg
T- 36. 9 C
Activity increases
PR- 80 bpm
intra-abdominal
RR- 20 bpm
pressure that may
cause further
bleeding and also
to promote fast
recovery.
*V/S as follows:
DEPENDENT:
BP- 90/60mmHg
T- 36. 5 C
PR- 90, bpm
RR- 22 bpm

Administered fluids as 
ordered.
To replace fluid
loss and aids in
fast recovery.

Hgb, Hct, RBC
monitored.
Through laboratory
results we can see
the effectiveness
of the theraphy.

EVALUATION
13. NURSING HEALTH TEACHING
Explained to the patient the need to wait for at
least 3-6 months before attempting another
pregnancy.
Reinforced or discussed with the couple the
methods of contraception to be used.
Instructed the couple to observe for signs of
infection such as fever, pelvic pain, and change in
character or amount of vaginal discharge and
advise to report them immediately.
Explained to the patient the importance of follow
up check-up to monitor the presence of bleeding
and contraction of the uterus after D&C.
Emphasized the importance of take home
medications prescribed by the physician.
14. CONCLUSION
First Trimester/early pregnancy is the
most crucial stage of pregnancy in which
the mother must have a closed watch or
gives much attention to. Therefore I
conclude that Antenatal check-up during
pregnancy is important to monitor the
status of the fetus and the mother. Any
presence of unusual signs and symptoms
must be reported immediately.
 If in any case pregnancy loss is inevitable
immediate action is needed, any delay may result to
infection or further complications to mother.
 As a nurse, we need to encourage pregnant women
to have their routine check-ups to prevent any
complications during or throughout their pregnancy.
Importance of vitamins and other pregnancy
supplements should be emphasized. Medical team
stands an important role in human well-being. The
role of a healthcare provider must not just within the
hospital but also in the home wherein provided health
teachings must be implemented.
15. BIBLIOGRAPHY
1. Philippine Obstetrical and Gynecological Society (Foundation), Inc.
Clinical Practice Guidelines on Abortion (November 2010)
Pages 1-15
2. Lippincott Manual of Nursing Practice 9th Edition; pages 1316, 1317, 1318
3. Maternal and Child Health Nursing by Adele Pillitteri 5th Edition; pages 400409
4. http://www.scribd.com/doc/15991947/Nursingcribcom-SpontaneousAbortion
5. http://nursingcrib.com/nursing-notes-reviewer/maternal-childhealth/spontaneous-abortion/
6.http://nursingcrib.com/nursing-notes-reviewer/fundamentals-ofnursing/nursing-diagnosis-for-female-reproductive-diseasesdisorders/
7. http://nursingcrib.com/nursing-care-plan/nursing-careplan-dilatation-and-curettage-d-c/
8. http://emedicine.medscape.com/article/795085-overview
9. http://emedicine.medscape.com/article/795085-clinical
10.http://www.rightdiagnosis.com/m/miscarriage/complic.htm
11. http://arispestanyo.hubpages.com/hub/nursing-care-planabortion
12. http://www.healthplus24.com/womenshealth/miscarriage.aspx