Anda di halaman 1dari 58

ST.

PAUL UNIVERSITY DUMAGUETE


ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

CHAPTER I

Introduction
Abnormal uterine bleeding is defined as bleeding between monthly periods,
prolonged bleeding or an extremely heavy flow or also called as condition
of DUB (dysfunctional uterine bleeding. Results in irregular shedding of
endometrium lining. AUB and its sub group, heavy menstrual bleeding (HMB),
are common conditions affecting 14–25% of women of reproductive age and
may have a significant impact on their physical, social, emotional and
material quality of life.

It can occur at any time during your monthly cycle, including during normal
menstrual period. There is a wide range of normal when talking about
menstrual period but it shouldn’t be a problem for you time after time.
If it keeps you from doing your daily activities or makes you miss work
or school, it may be worth going to the doctor and get it checked out.
Menstrual cycle should be fairly regular. The length of each cycle should
not change more than a week meaning it should not be less than 3 weeks and
more than 5 weeks per cycle. Another sign of abnormal uterine bleeding is
the length of your menstrual cycle.

If it last less than 2 days or lasts more than a week indicates it is abnormal.
Another way to tell if you have abnormal bleeding is if the amount of blood
is more than 5 tablespoon. Usually women lose about 2 tablespoons of blood
each period. Another way to check for abnormalities is you have spotting
between periods or bleeding after having sex (assuming his penis is not
too big). There is no definite statistical prevalence data worldwide. But
on a study at Beijing Shijitan Hospital there is a total of 1053 women aged
15 to 55 years of age with chronic abnormal uterine bleeding were evaluated
between November 2016 and May 2017. This statistical data tackles the causes
of those abnormal uterine bleeding cases.

Ovulatory dysfunction was the most frequent finding in women with chronic
AUB accounting for 608 (57.7%) cases. Polyp was found in 171 (16.2%) cases,
Leiomyoma was found in 130 (12%) women, Adenomyosis is found in 52 (4.94%)
women, Endometrial cause found in 28 (2%) women, Latrogenic is found in
23 (2%) women, Malignancy and Hyperplasia is found in 20 (1.9%) women,
Coagulapathis found in 10 (1%) women and Not yet classified in 10 (0.9%)
women.

M.B. is a 44 year old woman who just got married and had abnormal uterine
bleeding for 10 years. She has been advised to get check up on a doctor
but she doesn’t want to because she is afraid to know her problem. Two weeks

1
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

prior to admission, she had an onset of vaginal spotting and hypogastric


pain. Since she doesn’t want to go to the doctor she tolerated her condition.
More than a week later the pain is still there so she went to the local
hospital to consult her condition. CBC was done which showed that her
hemoglobin of 3.2 g/dl thus she referred to the NOPH.

Vaginal bleeding still persisted to the point that she have to use 3-5
perineal pads per day. Sometimes she uses diapers to keep it from leaking
at night.

We group two chose this case because we observed that this case will
improved our understanding on the patient and further enhanced our nursing
care services in accordance to patient’s wellness and well-being.

M.B. is a 44 year old woman who just got married and had abnormal uterine
bleeding for 10 years. She has been advised to get check up on a doctor
but she doesn’t want to because she is afraid to know her problem. Two weeks
prior to admission, she had an onset of vaginal spotting and hypogastric
pain. Since she doesn’t want to go to the doctor she tolerated her condition.
More than a week later the pain is still there so she went to the local
hospital to consult her condition. CBC was done which showed that her
hemoglobin of 3.2 g/dl thus she referred to the NOPH.

Vaginal bleeding still persisted to the point that she have to use 3-5
perineal pads per day. Sometimes she uses diapers to keep it from leaking
at night.

We group two chose this case because we observed that this case will
improved our understanding on the patient and further enhanced our nursing
care services in accordance to patient’s wellness and well-being.

2
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

OBJECTIVES

General aim of the study:

To further understand, learn and gain more information about the dengue
fever. This study accomplished and created for a comprehensive analysis
related to a specific illness/disease.

Specific learning objectives:

Knowledge:

1. Analyze the disease or disorder of the patient.

2. To identify the history of the illness on its concept and mechanism


including its risk factors and signs and symptoms.

3. Conduct a thorough study regarding the normal structure and function


of the human body system affected specifically reproductive system and
how it is altered when the disease process occurs.

4. discuss and to intervene with the different assessment and diagnostic


findings that will be evident and deem relevant to the patient’s case.

5. formulate drug study with regards to the disease.

6. formulate and implement an appropriate nursing care plan that will


effectively facilitate in the recovery and restoration of the patient
health status.

Skills :

1. Assess the general health status of the patient and gather data needed
for care.

2. Apply appropriate nursing intervention for the patient.

3. Discuss and to intervene with the different assessment and diagnostic


findings that will be evident and deem relevant to the patient’s case.

4. Apply the knowledge, skills and attitude we learned from our Clinical
Instructor and experience to the nursing field in providing health care
and wellness for the patient.

5. Formulate medical management for abnormal uterine bleeding.

3
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

Attitude:

1. Practice professionalism in dealing with the patient, to the members


of the health care them.

2. Establish rapport and harmonious patient-SN relationship as well as


further total patient care in actual nursing field.

3. Build harmonious working relationship and cooperation among the team.

Scope

Abnormal uterine bleeding is defined as bleeding between monthly periods,


prolonged bleeding or an extremely heavy flow or also called as condition
of DUB (dysfunctional uterine bleeding. Results in irregular shedding of
endometrium lining. AUB and its sub group, heavy menstrual bleeding (HMB),
are common conditions affecting 14–25% of women of reproductive age and
may have a significant impact on their physical, social, emotional and
material quality of life.

In this study we are tackling about the biographical data to know personal
information of the patient. Nursing history that aid to gather data about
her past, present and family illnesses. Physical assessment that aid to
assess the general condition and possible manifestation related to the
condition of the patient. Functional health pattern that aid to trace or
to know the way of living of the patient with regards about the religion
and culture. Diagnostic test and lab results to determine or help the patient
and health care provider understand and analyze the condition of the
patient.Nursing care plan provides direction on the type of nursing care
the patient may need. To facilitate standardized, evidence-based and
holistic care.

Limitation

In the study there are different circumstances that we are dealing. The
hindrances that we encountered during this case study is limited patient
since other patients are not related in Ob-gyn case. Also due to schedule
of clinical duty. Sometimes the patient don’t have enough diagnostic and
lab results that may interfere in tracing the pathophysiology of the
condition of the patient to go deep what is really the cause of the condition.

4
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

Patient’s Biographical Data

Name: M.B

Nick-name: Lyn2x

Address:Tayasan Neg. Oriental

Phone#: 093671022317

Blood type: AB+

Age : 44 yrs old

Birthdate: June 26, 1974

Birth place : Tayasan

Sex: Female

Citizenship: Filipino Race:Filipino

Marital Status : Married

Religion: S.D.A

Educational Attainment: Elementary

Occupation: House wife

Spouse: F.B

Contact: E.B

Relationship: Employer

Date of Admission: 2/24/ 2019

Usual Source of Medical Care: Health Center

Health Care: Malasakit

OB-Gyne/Physician:Dr. C.A.C

Admitting Diagnosis: Severe Anemia, Abnormal Uterine Bleeding

Source of information:

Client - 60%

Sister - 10%

Husband -10%

Chart - 20%

5
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

Health History

Chief Complaint

“Gihilantan ko mawala dayon mubalik dayon ga-ubo pud ko” as verbalized by


the patient.

History of Present Illness

Patient had an onset of fever and productive cough 4 days prior to admission.
Patient looks fatigue, sleepy and tired. Because of his cough he cant sleep
well and every cough there’s a presence of pain in his upper quadrant of
abdomen with a pain scale of 5/10(average). And got his CBC result his
platelet is 60 thus the physician’s admitting impression is dengue fever
without warning signs; URTI.

Past Medical History

Base on her medical history,he was admitted in the same hospital and
diagnosed as pneumonia when he was 5 months old. Prior to admission he was
experiencing fever and cough so he took paracetamol and

Family Medical History

Her parents and siblings had no history of Hypertension, diabetes


mellitus,blood Alcohol,cancer or other kinds of illness,her family also
doesn't have smoking and alcoholic problems. Her mom died while she was
young with an unknown cause. And her dad died at the age of 63 years old
with a kidney problem.

Gynecology History

She started her first menstruation at the age of 15 years old,with a regular
interval every month that lasted usually for 8 - 10 days,in a moderate flow
with dysmenorrhea every month. Recently her last menstrual period was Feb.
9, 2019 and still persisted to weeks after.

FUNCTIONAL HEALTH PATTERNS

1.Health Perception and Health Management

Prior to admission: patient stated that general health has been OK. No colds
noted in the past few years. Patient said that to keep her body healthy,
she always eats nutritious foods and stated that no time for exercise because

6
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

she’s a domestic helper. Not using any cigarettes, alcohol and drugs. No
accidents noted. Hard for her to follow the doctor’s order just like in
getting an ultrasound. She thinks that she’s in menopausal stage that’s
why she had bleeding. 10 years ago, she started to have dysmenorrhea, heavy
bleeding and longer periods of menstruation for 8- 10 days. No actions taken
when symptoms perceived.

During hospitalization: She’s afraid in getting an ultrasound because of


ignorance that she might find out the cause of her hospitalization. She’s
very dependent in the health care team in terms of administering medications
and blood transfusion. She’s looks tired, lips and hands are pale.

2.Nutritional- Metabolic Pattern

Prior to admission- Daily food intake depends on what her employer wants
to eat but usually her breakfast is egg with coffee. During lunch they always
eat foods that has soup especially “tinola” because that’s the favorite
food of her employer. Snacks is usually fried banana and “balanghoy.” Meat
is restricted on her religion. She drinks a lot of water with a maximum
of 12 glasses per day. Weight is 56 kg and no weight gain nor weight loss,
height is 5’1. Appetite is good no discomforts in swallowing and no diet
restrictions. Wound healing is fast. Skin is dry with no lesions and exposed
areas are darker than the unexposed ones. Mole is present in the face. There
are 30 teeth and 2 are missing, no dentures, dental carries are noted as
well as plaques.

During hospitalization: Diet is as tolerated. She usually eats fish during


meals and in between are biscuits. Fluid intake is water and IVF only. Drinks
lot of water for a maximum of 8 glasses per day. Appetite is good, no
discomforts in swallowing. Lips are dry and pale as well as her nails.

3.Elimination Pattern

Prior to admission: Defecates for at least twice a day. The color depends
on the food that she ate on that day as well as the consistency but usually
it is yellowish with a little brown on it and stool is soft with no difficulty
in defecating. Not using any laxatives and there’s no problem in controlling.
Urinates for at least 6 times in a day with no pain and problem in controlling.
Yellowish in color. No excessive perspiration because house is well
ventilated.

During hospitalization: Defecates for at least once a day. Color is brownish


and consistency is soft without problem in controlling and pain. Eliminates
for at least 6 times a day and color are yellowish measuring half of the

7
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

glass. Sweats a lot because of poor ventilation and room is crowded. Body
odor is present also.

4.Activity- Exercise Pattern

Prior to admission: Energy is more than enough for desired and required
activities. No exercise because of the type of her work. Spends her
spare-time in watching television and sometimes if she feels going out,
she’ll watch basketball and socialized with her friends. She can take care
of herself fully like in feeding, bathing, toileting, dressing, grooming,
cooking, shopping, bed mobility, home maintenance and general mobility.

During hospitalization: She likes to lie in bed the whole day and sleeps
whenever she wants to. Stands only when urged to urinate or defecate. Sits
on bed when eating and drinking. No exercise and if she’s awake she prefers
to have her phone with her to do things like games and watching videos on
YouTube. She requires assistance or supervision from others in feeding,
bathing, toileting, bed mobility, dressing, grooming, and general mobility.
Pulse rate is 84 bpm and regular, respiratory rate is 18 cpm and regular,
blood pressure is 110/70 mmHg. Patient is not well groomed, poor hygiene
and energy level is low.

5.Sleep- Rest pattern

Prior to admission: Usually sleeps at 8 pm in the evening and wakes up at


5:30 in the morning. She has more energy in the day in doing household chores.
Naps every noon time for at least 2 hours and resume to work. No problems
in sleeping and not taking any medications like sleeping pills. Sometimes
she wakes up at the middle of the night to urinate and if she has nightmares.

During hospitalization: Patient said that she has nothing to do in the


hospital except for sleeping, eating and eliminating. Sleeping pattern is
very disturbed because of medical procedures.

6.Cognitive-Perceptual Pattern

Prior to admission: No hearing difficulty and not using any hearing aids.
Vision is good, not wearing any glasses and haven’t had her first check
up on her eyes. No changes in memory noted. She stated that in terms of
making important decisions, she thinks of it overnight and found it hard
for her. To learn new things, she prefers to watch it first and then do
it the next time. She complains of dysmenorrhea and heavy bleeding every
menstruation without taking any actions on it. The daughter of her employer
is a nurse and advised her to take Ferrous because she looks so pale already.

8
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

During hospitalization: Patient is well oriented. Hearing and vision are


good. Attention span is short and eagers to ask questions and open for new
ideas and suggestions. She speaks Cebuano and understands a little of
English. She speaks freely without limitations and restrictions.

7.Self-Perception/ Self-Concept Pattern

Prior to admission: Describes self as a blessing from above and she feels
good about it. 10 years ago, her menstrual pattern was changed. She started
experiencing dysmenorrhea, heavy bleeding and long periods of menstruation
that will last for 10 days and more. She said that whenever her menstruation
is fast approaching, she gets annoyed easily and gets mad after all. This
triggers when her boyfriend which is now her husband teases her for simple
things or if he has done something that makes her mad. She’s afraid of having
check ups because of the possible outcomes. She doesn’t feel in losing hope
because her employer is very supportive because she has been living with
them for 28 years already as well as her husband.

During hospitalization: Describes self as a burden and gets annoyed easily


because of the environment which is very hot and the condition she is
experiencing also. She doesn’t feel to lose hope because she thinks of the
people who wishes for her fast recovery. Maintains eye contact and short
attention span. Voice and speech pattern are good, she answered questions
with relevance.

8.Roles- Relationship Pattern

Prior to admission: She lives with her employer in Tayasan for 28 years
but now she’s married, she’s living now in Jimalalud with the sons and
daughters of her husband. She’s having difficulty in adjusting to a new
environment and there are conflicts between them and the children. No one
is depending on her but now she depends on her husband’s salary because
she’s out of work already. She has close friends and socialized with them
for once in a while. She doesn’t feel any loneliness or emptiness at all.
She said that everything is going well. Income is sufficient for daily needs.

During hospitalization: Patient’s husband and sister took turns in taking


care of her in the hospital. She has a good relationship with them. They
cheered her up and assisted her in everything she does.

9.Sexuality- Reproductive Pattern

Prior to admission: Patient said that sexual relationship with husband is


satisfying and added that in one week they can have an intercourse for at

9
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

least twice. On their first intercourse, she said that she felt pain and
it bleeds a little but was gone the next time they had their intercourse
without the use of contraceptives. Menstruation started at the age of 15
and having no problems with it but 10 years ago, she started to have problems
in menstruation like heavy bleeding that she was able to consume 3-5 pads
per day and sometimes uses diaper.

During admission: Heavy bleeding was noted and did pelvic examination in
the delivery room.

10.Coping- Stress tolerance Pattern

Prior to admission: The only change that happened on her is marriage. Her
husband is always there for her in everything she does and supports in doing
big and important decisions. She’s always relaxed and if tense she breathes
in and out to relax without the use of medicines, drugs and alcohol. If
there are big problems that will happen to her, she doesn’t lose hope and
will do everything to handle it well and of course with the grace and guidance
of God. So far, she’s making good decisions.

During hospitalization: it’s her first time being admitted that’s why she
was afraid of what will happen to her but luckily her husband was always
there to support. She said that she always prays to God for her fast recovery.

11.Values- Beliefs Pattern

Prior to admission: Patient said that it’s hard for her to get things from
life easily because of her educational attainment but she added that as
long as she’s happy as well as the people around her makes her realized
that she’s contented already. She has plans on conceiving a child someday.
Religion is very important for her and always go to church every Saturday.
She said that their Pastor will give advises on her.

During admission: Patient said that despite everything that happened on


her she doesn’t forget to pray and seek for help in the Lord. Her religion
practices do not interfere in her well-being.

GENERAL CONDITION

Mrs. M. B., is our patient, a 44-year-old and a residence of Tayasan, Negros


Oriental. She lives with her husband and together with them are the children
of her husband. She was confined in the hospital with a chief complaint

10
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

of “February 9 gasugod akong regla wala pa gihapon siya niundang ug 2 ka


semana, natingala naman ko munang nag pa check-up nalang ko.” She said that
this is her first time being hospitalized. She was transfused with 3 bags
of blood during her admission because of low hemoglobin level. Received
patient lying on bed with IVF, PNSS 480 mL at 20 gtss/min. Patient is awake
and looks tired.

Review of System

A.Baseline Height/Weight: 5’1 and 56 kg

B.Assessment of Systems:

1.General appearance and Mental Status:

Received patient lying on bed with IVF, PNSS 480 mL at 20 gtts/min to be


consumed in 8 hours, awake, looks tired, cooperative. Alert and oriented
to what is happening at the time of the interview and physical assessment
and responds to questions and interacts appropriately. Facial features are
symmetric with movement and establishes good eye contact when conversing.
Speech is clear, moderately paced, and culturally appropriate. Grooming
is very poor like hair is very messy and body odor is noted. Body build
is proportionate in her age and no deformities noted.

A.Vital sign measurement:

Temperature: 35.8 C

Pulse Rate: 84 bpm

Respiratory Rate: 18 cpm

Blood Pressure: 110/70 mmHg

1. Integumentary System:
Skin color is brownish; darker on the exposed areas and lighter
on the unexposed ones, warm with no lesions, no contractures and
skin breakdowns noted. Skin is smooth, dry and even. Calluses are

11
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

present in palms ang soles of feet. Skin turgor is poor, no edema


and elastic.
Hair is black, arm length, clean and dry. Scalp is also clean and
dry. Normal distribution of hair on scalp and perineum. Hair in
legs is abundant as well as in the axillae. Nails are short and
forms 160-degree angle at base. Nailbeds are pale without
clubbing. It is hard, smooth, and immobile. Cuticles smooth, no
detachment of nail plate.

2. Head, Face and Neck:


Head: The head is symmetric, round, erect and in the midline. One
mole is present. No involuntary movements. Hard and smooth without
lesions.
Face: Face is symmetric with an oval appearance. No abnormal
movements noted. Facial wrinkles are prominent. Temporal artery
is elastic and not tender. Temperommandibular joint has no
swelling, tenderness or crepitation with movement. Mouth opens and
closes fully. Lower jaw moves laterally.
Neck: Neck is symmetric with head centered and without bulging
masses. The thyroid cartilage, cricoid cartilage and thyroid gland
move upward symmetrically as she swallows. Neck movement is smooth
and controlled. Trachea is in the midline. No swelling or
enlargement and tenderness of the lymph nodes.

3. Eyes, Ears, Nose, Mouth, and Throat


Eyes: Upper lid margin is in between the upper margin of the iris
and the upper margin of the pupil. The lower lid margin rests on
the lower border of the iris. No white sclera is seen above or below
the iris. Upper and lower lids close easily and meet completely
when closed. Lower eyelid is upright with no inward or outward
turning. Eyelashes are evenly distributed and curve outward along
the lid margins. Skin on both eyelids is without redness, swelling,
or lesions. Eyeballs are symmetrically aligned in sockets without
protruding or sinking. Bulbar conjunctiva is clear, moist, and
smooth. Sclera is white. The lower and upper palpebral conjunctivae
are clear and free of swelling or lesions. No swelling or redness
appeared over the areas of lacrimal gland. No drainage was noted.
The cornea is transparent. Iris is round and flat. Pupil is centered
in the iris having the same size. Pupil constricts when there is
direct light

12
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

Ears: Ears are equal in size bilaterally. The auricle aligns with
the corner of each eye. Earlobes are attached to the sin with no
apparent lobe. Skin is smooth without lesions, lumps, or nodules.
Color is consistent with facial color. No discharges noted. A small
amount of odorless cerumen is the only discharge present which has
a color of yellow and is soft. Canal walls are pink and smooth without
nodules. Tympanic membrane has no bulging or retraction
Nose: Color is the same as the rest of the face, nasal structure
is smooth and symmetric, and no tenderness. Able to sniff through
each nostril. Nasal mucosa is dark pink, moist and free of exudate.
Nasal septum is intact and free of ulcers or perforations.
Sinuses: Frontal and maxillary sinuses are non-tender to palpation,
and no crepitus is evident.
Mouth and Throat: Lips are smooth, and dry without lesions or
swelling. There are 30 teeth and 2 are missing, no dentures, dental
carries are noted as well as plaques. Buccal mucosa is pinkish, smooth
and moist without lesions. Tongue is pink, moist and moderate size
with papillae present. The tongue’s ventral surface is smooth and shiny
with visible veins and no lesions noted. Frenulum is in the midline.
Sides of the tongue has no lesions, ulcers or nodules. It has strong
resistance and can distinguish between sweet and salty. Hard palate
is pale. No unusual odor is noted. Uvula is in the midline with no
redness of or exudate from uvula or soft palate. Tonsils are present.
They are pinkish and symmetric with no exudate, swelling or lesions.
Throat is pinkish without exudate or lesions.

4. Respiratory System (Thorax and Lungs)


Nasal flaring is not observed. There is outward expansion of
the abdomen and lower ribs on inspiration and return to resting
position on expiration. Patient has evenly colored skin tone
without unusual or prominent discoloration. Nailbeds are pale
having a 160-degree angle between the nail base and the skin.
Posterior thorax: Scapulae are symmetric and non-protruding.
Shoulders and scapulae are at equal horizontal positions. The ratio
of anteroposterior to transverse diameters is 1:2. Spinous
processes appear straight, and thorax appears symmetric with ribs
sloping downward. The patient does not use accessory muscles to
assist breathing. There is expansion of lower chest during
inspiration. Upon palpation, patient reports no tenderness, pain
or unusual sensations. Temperature is equal bilaterally. No
palpable crepitus noted. Skin and subcutaneous tissue are free of

13
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

lesions and masses. Fremitus is symmetric and easily identified


in the upper regions of the lungs and when she breathes my thumb
moves apart symmetrically. Upon percussion of the lungs, resonance
tone was elicited. No adventitious sounds, such as crackles or
wheezes are auscultated.
Anterior thorax: The anteroposterior diameter is less than the
transverse diameter with a ratio of 1:2. Sternum is positioned at
midline and straight. Retractions not noted. Ribs slope downward
with symmetric intercostal spaces. Respirations are relaxed,
effortless, and quiet. They are of regular rhythm and normal depth
at a rate of 18 per minute. no retractions or bulging of intercostal
spaces. Use of accessory muscles is not seen with normal respiratory
effort. No tenderness or pain is palpated over the lung area with
respirations. No crepitus, masses and lesions. Lung tissue is
resonant and dullness over breast tissue, heart and the liver.
Tympany is detected over the stomach, and flatness is detected over
the muscles and bones.

5. Cardiovascular System:
Jugular vein is not distended, bulging or protruding. No blowing
or swishing or other sounds are heard. Apical impulse is not visible
and palpated in the mitral area. No pulsations or vibrations are
palpated in the areas of the apex, left sternal border, or base.
Rate is at 89 bpm with a regular rhythm. Radial and apical pulse
rates are identical. S1 corresponds with each carotid pulsation
and is loudest at the apex of the heart. S2 immediately follows
after S1 and is loudest at the base of the heart. No extra sounds
are heard. No murmurs are heard. S1 and S2 heart sounds is present.

6. Peripheral and Lymphatic System


Arms are bilaterally symmetric with no edema or prominent venous
patterning. Color is the same bilaterally. Skin is warm to touch
bilaterally from fingertips to upper arms. Poor capillary refill
more than 3 seconds in both left and right fingers. Radial and
brachial pulses have equal strength bilaterally (2+). Epitrochlear
lymph nodes are not palpable. Color of legs are the same with body’s
color. Minimal hair covers the skin on the legs with free from
lesions or ulcerations. Identical size and shape bilaterally
without swelling or atrophy. No edema present and toes, feet and
legs are equally warm bilaterally. Inguinal lymph nodes are

14
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

non-tender. Femoral pulses, dorsalis pedis, posterior tibial are


strong and equal bilaterally. Veins are flat and barely seen under
the surface of the skin. Homan’s sign is negative.

7. Breast and Axillae


Breast color is lighter than the exposed ones. It is round and
pendulous. Right breast is larger than the other. Areolas are dark
brown. Nipples are nearly equal bilaterally in size and are in the
same location on each breast and is everted without discharges.
Rose symmetrically with no sign of dimpling or retractions. Breasts
hangs freely and symmetrically. Texture is smooth with no edema,
firm and elastic with a normal body temperature. No masses were
palpated. Axillae has no rash or infection noted and no palpable
nodes in the central area.

8. Abdomen
Abdomen is lighter in color than the exposed ones. Free from lesions
or rashes. Umbilical skin tones are similar to surrounding
abdominal skin tones. Located in the midline at lateral line. It
is inverted and is round. Abdomen is rounded and symmetric. It does
not bulge when patient raises head. Soft clicks are heard at a rate
of 20 per minute. No bruit sounds were heard. No friction rub over
liver or spleen is present. Tympanic sound predominates over the
abdomen and dullness is heard over the liver and spleen.

9. Genitourinary System
Patient voids 6 times in a day with a yellow color of the urine.
Doesn’t have any discharges as claimed by the patient. No pain noted
upon urinating. Pubic hair is distributed in an inverted triangular
pattern without signs of infestation. No enlargement or swelling
of lymph nodes. Labia majora are equal in size and free of lesions,
swelling, and excoriation. Labia minora appear symmetric, dark pink
and moist. Vaginal opening is positioned below the urethral meatus.
Blood is present due to bleeding.

10. Motor and Musculoskeletal System


Muscles are fully developed and symmetric in size. Relaxed muscles
contract voluntarily and show mild, smooth resistance to passive
movement. All muscle groups equally strong against resistance,
without flaccidity, spasticity or rigidity. No involuntary
movements noted. Gait is steady and maintains balance. Client

15
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

touches finger to nose with accurate movements. Turns palms up and


down.

11. Sensory -Neurologic System:


Patient is alert, conscious, oriented to time, place, and setting.
Cooperative and expresses situations to feelings and able to recall
past events. Identifies light touch, differentiates between dull
and sharp sensations hot and cold temperatures over various body
parts. Reflexes are present. Identifies scent presented to each
nostril, able to read, eyes move in a smooth, coordinated motion
in all directions. Temporal and masseter muscles contract
bilaterally and can smile, frowns, wrinkles forehead, shows teeth,
puffs out cheeks, purses lips, raises eyebrow and closes eye against
resistance and movements are symmetrical. Gag reflex present,
swallows without difficulty. There is symmetric, strong
contraction of the trapezius muscles.

Genogram Interpretation

16
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

The patient has insufficient knowledge about most of family


members. Her mother died at a young age without her knowing the
cause she has no idea about her maternal sides health status, she
can only recall that her mother had six other siblings. On her
paternal side she know both her grandparents are already deceased
but does not know the cause of their deaths, she has one aunt and
one uncle who she claims to be alive and well but does not know
their respective ages. Her father died due to a kidney related
problem at the age of 63. The patient has two younger sisters, who
are 40 and 42 years old with no disorders that she knows of. The
patient has a chance of developing kidney problems as her father
did, no other problems could be related to the patient because of
insufficient knowledge.

17
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

Examination Results Units Normal Values Remarks

Laboratory Examinations

Complete blood count (CBC) is a blood test used to evaluate your overall
health and detect a wide range of disorders, including anemia, infection
and leukemia.
A complete blood count test measures several components and features of
your blood, including:
 Red blood cells, which carry oxygen
 White blood cells, which fight infection
 Hemoglobin, the oxygen-carrying protein in red blood cells
 Hematocrit, the proportion of red blood cells to the fluid component,
or plasma, in your blood
 Platelets, which help with blood clotting.

Date: February 24,2019

18
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

WBC 11.3 10^3/mm3 4.0-11.0 HIGH

RBC 2.08 10^6/mm3 4.50-6.50 LOW

Hgb 3.3 g/dL 13.0-18.0 LOW

HCT 13 % 40.0-50.0 LOW

MCV 95 Um3 76-96 NORMAL

MCH 30.0 pg 27.0-32.0 NORMAL

MCHC 31.0 g/dL 30.0-35.0 NORMAL

RDW 15.1 % 11.0-16.0 NORMAL

PLT 1,037 10^3/mm3 150-450 HIGH

MPV 8.4 Um3 8.0-12.0 NORMAL

PCT 0.428 % 0.100-0.500 NORMAL

PDW 12.3 % 8.0-18.0 NORMAL

Neutrophils 73 10^3/mm3 40-75 NORMAL

Lymphocytes 19 10^3/mm3 20-45 NORMAL

Monocytes 6 10^3/mm3 0-10 NORMAL

Basophils 1 10^3/mm3 0-3 NORMAL

Interpretation: CBC noted that WBC is high may indicate that the immune
system is working to destroy an infection. While RBC is lower than normal
range that could lead to symptoms or complications like pale skin, fatigue,
dizziness and etc. And with very low levels of haemoglobin can also be due
to blood loss, which can occur because of Menorrhagia (heavy menstrual
bleeding) and hematocrit low another term for low hematocrit is anemia due
to bleeding (ulcers, trauma, colon cancer, internal bleeding).High platelet
count infections are the most common cause of an elevated platelet count.
This elevation can be extreme, with platelet counts greater than one million
cells per micro-liter.

Date: February 26,2019

Examination Results Units Normal Values Remarks

WBC 11.0 10^3/mm3 4.0-11.0 NORMAL

RBC 3.3 10^6/mm3 4.50-6.50 LOW

Hgb 4.7 g/dL 13.0-18.0 LOW

HCT 17 % 40.0-50.0 LOW

MCV 95 Um3 76-96 NORMAL

19
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

MCH 30.0 pg 27.0-32.0 NORMAL

MCHC 31.0 g/dL 30.0-35.0 NORMAL

RDW 15.1 % 11.0-16.0 NORMAL

PLT 697 10^3/mm3 150-450 HIGH

MPV 8.5 Um3 8.0-12.0 NORMAL

PCT 0.430 % 0.100-0.500 NORMAL

PDW 12.5 % 8.0-18.0 NORMAL

Neutrophils 78 10^3/mm3 40-75 NORMAL

Lymphocytes 46 10^3/mm3 20-45 NORMAL

Monocytes 13 10^3/mm3 0-10 NORMAL

Basophils 1 10^3/mm3 0-3 NORMAL

Interpretation: CBC noted normal findings of WBC and very low levels of
RBC, hemoglobin and hematocrit with high platelet count.

Urinalysis Results
Date: February 24, 2019
A urinalysis is a test of your urine. A urinalysis is used to detect and
manage a wide range of disorders, such as urinary tract infections, kidney
disease and diabetes.
A urinalysis involves checking the appearance, concentration and content
of urine. Abnormal urinalysis results may point to a disease or illness.

Urinalysis Parameter Results Normal Value

Transparancy Slightly turbid Pale yellow-yellow

Leukocyte ++ -

Nitrite - -

Urobilingen - -

Protein + -

pH 6.5 6.0-7.5

Blood +++ -

20
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

Specific gravity 1.005 1010-1030

Ketonuria - -

Billirubin - -

Glucose - -

Pus cell 8-12 0-4 p.v.f

RBC TNTC 0-5 hpf

Epithelial abundant 0-4 p.v.f

Crystal - No abnormal crystal present

Casts - 0-2 -

Mucus thread moderate No/some

Amorphous material moderate few

Bacteria moderate -
Interpretation: slightly turbid transparency of urine can occasionally
occur as a result of mild dehydration, which is determined in the absence
of other symptoms. This type of turbid urine goes away rapidly without
significant complications or consequences. The turbidity, which can vary
more or less depending on the case and on the patient, is usually due to
the presence of pus, crystals, bacteria, blood or lipid material in the
urine that cause the urine to appear persistently cloudy or foamy. Positive
leukocytes may occur cause of bladder infection, UTI, kidney stones,and
holding in urine.

Date: February 26, 2019

Urinalysis Parameter Results Normal Value

Transparancy Slightly turbid Pale yellow-yellow

Leukocyte ++ -

Nitrite - -

Urobilingen - -

Protein - -

pH 6.0 6.0-7.5

Blood +++ -

Specific gravity 1.020 1010-1030

Ketonuria - -

Billirubin - -

21
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

Glucose - -

Pus cell TNTC 0-4 p.v.f

RBC 12.16 0-5 hpf

Epithelial abundant 0-4 p.v.f

Crystal - No abnormal crystal present

Casts - 0-2 -

Mucus thread negative No/some

Amorphous material negative few

Bacteria negative -

Interpretation: Urinalysis results it is still slightly turbid,(+)


leukocytes,(+) blood and abundant epithelial epithelial cells in
the urine increases when someone has a urinary tract infection or some
other cause of inflammation.Some of the causes of high RBC’s in urine may
be acute. This means they’re temporary conditions that only last for a short
period of time.

Blood Typing

Blood typing is a method to tell what type of blood you have. Blood typing
is done so you can safely donate your blood or receive a blood transfusion.
It is also done to see if you have a substance called Rh factor on the surface
of your red blood cells.

Date submitted: February 24, 2019

Blood type: AB
Rh: Positive (+)

Interpretation: Blood type AB red blood cells have both A and B


antigens.Rh-positive blood have Rh antigens on the surface of the red blood
cells.
Ultrasound results
Transvaginal/Transabdominal:

22
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

The uterus is anteverted with regular contour and heterogenous echopattern


measuring approximately 20.2 x 14.14 x 9.4 cm. ( Cervix measures 3.6 x
2.5 cm.)The endometrium is hyperechoic measuring 1.3 cm. thick with
intact subendometrial halo.
There is a well- circumscribed heterogenous mass seen measuring 14.3 x 11.0
x 7.2 cm. Posterior midcorpus, intramural.
At the posterior cul de sac is a unilocular cystic mass measuring 6.1 x
5.4 x 4.4 cm. With medium level echo fluid and with echogenic stipplings
within. There is echogenic core measuring 3.3 x 2.3 x 3.6 cm. Casting
posterior acoustic shadows.
Superior and to the right of the uterus is a unilocular cyst measuring 12.3
x 11.8 x 7.4 cm. With diffuse low level echo fluid within. The capsule measures
0.4 cm. There is no free fluid in the cul de sac.
Impression:
Myoma Uteri (Intramural)
Posterior culdesac mass, consider Ovarian New Growth.Probably Dermoid
Cyst:
Right Adnexal Mass, consider endometriotic cyst vs. Dermoid Cyst
thickened endometrium, consider endometrial pathology.
 The above described results are based on sonologic findings and
should be correlated with other clinical and ancillary exams.

Chapter III
Normal anatomy and physiology:

The reproductive system or genital system is a system of sex organs within


an organism which work together for the purpose of sexual reproduction.
Many non-living substances such as fluids, hormones, and pheromones are
also important accessories to the reproductive system. The female
reproductive system is made up of the internal and external sex organs that
function in reproduction of new offspring. the human the female reproductive
system is immature at birth and develops to maturity at puberty to be able
to produce gametes, and to carry a foetus to full term. The structures that
form the female external genitalia are termed the vulva.

23
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

The female

external structures:

The Mons Verines or commonly called as the Mons Pubis is a pad of adipose
tissue located over the symphysis pubis, the pubic joint. It is covered
by a triangle of coarse and curly hairs. The purpose of the Mons pubis is
to protect the junction of the pubic bone from trauma.

The labia majora are relatively large, fleshy folds of tissue that enclose
and protect the other external genital organs. They are comparable to the
scrotum in males. The labia majora contain sweat and sebaceous glands, which
produce lubricating secretions. During puberty, hair appears on the labia
majora.

The labia minora can be very small or up to 2 inches wide. The labia minora
lie just inside the labia majora and surround the openings to the vagina
and urethra. A rich supply of blood vessels gives the labia minora a pink
color. During sexual stimulation, these blood vessels become engorged with
blood, causing the labia minora to swell and become more sensitive to
stimulation.

24
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

The Vulval vestibule is a part of the vulva between the labia minora into
which the urinary meatus (urethral opening) and the vaginal opening open.
Its edge is marked by Hart's line. It represents the distal end of the
urogenital sinus of the embryo.
The clitoris, located between the labia minora at their upper end, is a
small rounded organ of erectile tissue at the forward junction of the labia
minora. Its covered by a fold of skin, the prepuce. Which is sensitive to
touch and temperature and is the center of sexual arousal and orgasm in
women.
The Skene's glands are glands located on the anterior wall of the vagina,
around the lower end of the urethra. They secrete a fluid that helps lubricate
the urethral opening, and are surrounded with tissue that swell with blood
during sexual arousal.
The Bartholin's glands or also called as the greater vestibular glands are
two pea sized compound alveolar glands located slightly posterior and to
the left and right of the opening of the vagina. They secrete mucus to
lubricate the vagina
The fourchette is the ridge of tissue formed by the posterior joinng of
the labia minora and the laba majora. This structure is prone to lacerations
and is where episiotomy is performed at child birth.
The hymen is a tough but elastic semicircle of tissue that covers the opening
to the vagina during childhood. It is usually torn during the first sexual
intercourse.
The vulvar blood supply, The blood supply of female external genitalia is
mainly from the pudendal artery and a portion is from the inferior rectus
artery.

25
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

The vulvar nerve supply, The anterior portion of the vulva derives its nerves
supply from the ilioinguinal and genitofemoral nerves (L1 level). The
posterior portions and the vagina are supplied by the pudendal nerve (S3
level) such a rich nerve supply makes the area extremely sensitive to touch,
pressure, pain and temperature.

The female internal structures:


Female internal reproductive organs play a vital role in human reproduction.
These organs are the ovaries, the fallopian tubes, the uterus and the vagina.
The ovaries are approximately 3 cm long by 2 cm in diameter and are 1.5
cm thick, or the sixe and shape of almonds. they are grayish-white and appear
pitted, with minute indentions on the surface. These are located close to
and on both sides of the uterus. The function of the ovaries is to produce,
mature and discharge ova or the egg cells. The ovaries also secrete hormones
that play a role in the menstrual cycle and fertility. The ovary progresses
through many stages beginning in the prenatal period through menopause.
It is also an endocrine gland because of the various hormones that it
secretes.
The fallopian tubes, also known as oviducts, uterine tubes, or salpinges
are uterine appendages lined from inside with ciliated simple columnar
epithelium, leading from the ovaries the uterus, via the uterotubal
junction. They enable the passage of egg cells from the ovaries to the uterus
The uterus or womb is a major female hormone-responsive secondary sex organ
of the reproductive system in humans and most other mammals. the lower end
of the uterus known as the cervix, opens into the vagina, while the upper
end, the fundus, is connected to the fallopian tubes. It is within the uterus
that the fetus develops during gestation. The uterus is suspended in the
pelvic cavity by a number of ligaments that also help support the bladder,
it is also supported by a combination of fascia and muscle.

26
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

The vagina is the elastic, muscular part of the female genital tract. It
extends from the vulva to the cervix. The outer vaginal opening is normally
partly covered by a membrane called the hymen. At the deep end, the cervix
bulges into the vagina. The vagina allows for sexual intercourse and birth.
It also channels menstrual flow.
The uterine blood supply, the
uterine artery arises from the
anterior division of the
internal iliac artery. It crosses
above the ureter on its course to
the uterus. The uterine artery
commonly anastomoses with
the vaginal and ovarian
artieries. The uterine artery is
the main blood supply to the
uterus and it enlarges
significantly in pregnancy.
lymphatic drainage of the uterus is via the iliac, sacral, aortic and
inguinal lymph nodes.
The uterine nerve supply, The uterus is supplied by both efferent and
afferent nerves. The efferent nerves arise from the T5 through T10 T10 spina
ganglia, the afferent nerves joins the hypogastric plexus and enter the
spinal column at T11 and T12.
Menstruation
A menstrual cycle or the female reproductive cycle is episodic uterine
bleeding in response to cyclic hormonal changes. The purpose of menstrual
cycle is to bring an ovum to maturity and renew
a uterine tissue bed that will be necessary for
the ova’s growth should it be fertilized.

The Physiology of Menstruation


Four body structures are involved in the
physiology of the menstrual cycle: the
hypothalamus¸ the pituitary gland, the ovaries,
and the uterus. For menstrual cycle to be complete
all four organs must contribute their part; in
activity of any part results in an incomplete or
ineffective cycle.

The hypothalamus, the release of GnRH also called


the luteinizing hormone-realising hormone (LHRH) from the hypothalamus

27
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

initiates the menstrual cycle. GnRH then stimulates the pituitary gland
to send gonadotropic hormone to the ovaries to produce estrogen.

The Pituitary Gland, under the influence of GnRH, the anterior lobe of the
pituitary gland or the adenohypophysis produces two hormones:
 FSH, a hormone active early in the cycle that is responsible for
maturation of the ovum.
 LH, a hormone that becomes most active at the midpoint of the cycle
and is responsible for ovulation or release of the mature egg cell
from the ovary. It also stimulates growth of the uterine lining
during the second half of the menstrual cycle.
The Ovaries, FSH and LH are called gonadotropic hormones because they cause
growth in the gonads or the ovaries. Every month during the fertile period
of a woman’s life from menarche to menopause, one of the ovary’s oocytes
is activated by FSH to begin to grow and mature.
As the oocyte grows, its cells produce a clear
fluid called follicular fluid that contains a
high a high degree of estrogen and some
progesterone. As the follicle surrounding the
oocyte grows, it is propelled toward the
surface of the ovary. At full maturity, the
follicle is visible on the surface of the ovary
as a clear blister approximately 0.25 to 0.5
inches across. At this stage of maturation, the
small ovum which is about the size of a printed
period, with its surrounding follicular
membrane and fluid is termed as graafian
follicle.

The Uterus,
The first phase of the menstrual cycle
(proliferative) Immediately after a menstrual
flow (which occurs during the first 4 or 5 days
of a cycle), the endometrium, or lining of the
uterus, is very thin, approximately once cell
layer in depth. As the ovary begins to produce
(in the follicular fluid, under the direction
Above is a Illustration of uterine changes of the pituitary FSH) the endometrium begins to
that occur monthly as a result of stimulation
from estrogen and progesterone produced
proliferate so rapidly the thickness of the
by the ovaries

28
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

endometrium begins to proliferate so rapidly the thickness of the


endometrium increases as much as eightfold from day 5 to day 14.
The second phase of menstrual cycle(secretory) after ovulation, the
formation of progesterone in the corpus luteum under the direction of LH
causes the glands of the uterine endoterium to become corkscrew and twisted
in appearance and dilated with quantities og glycogen and mucin. It takes
the appearance of rich, spongy velvet.
The third phase of menstrual period(ischemic) if fertilization does not
occur, the corpus leteum in the ovary begins to regress after 8 to 10 days,
the production of progesterone decreases. With the withdrawal of
progesterone the endometrium of the uterus begins to degenerate at about
the 24th or 25th day of cycle . the capillaries rupture, with minute
haemorrhages, and the endometrium sloughs off.
The fourth phase of menstrual cycle (menses) menses, or a menstrual flow
is composed of a mixture of blood from the raptured capillaries, mucin,
fragments of endometrial tissue and the microscopic atrophied and
unfertilized ovum.
Menses is actually the end of an arbitrarily defined menstrual cycle. Because
it is the only external marker of the cycle, the first day of an menstrual
cycle is marked as the beginning of a new cycle.
Cervical changes
The mucus of the uterine cervix also changes in structure and consistency
each month during a menstrual cycle. At the beginning of each cycle, when
estrogen secretion from the ovary is low, cervical mucus is thick and scant.
At the time of time ovulation, when the estrogen level has risen to a high
point, cervical mucus becomes thin, stretchy (Spinnbarkeit) and copious.
Making sperm survival and penetration excellent.

THEORETICAL BACKGROUND

Name of the disease: Abnormal Uterine Bleeding

Definition: Abnormal uterine bleeding is defined as bleeding between monthly


periods, prolonged bleeding or an extremely heavy flow. or also called as
condition of DUB (dysfunctional uterine bleeding. results in irregular
shedding of endometrium lining.

AUB and its sub group, heavy menstrual bleeding (HMB), are common conditions
affecting 14–25% of women of reproductive age and may have a significant
impact on their physical, social, emotional and material quality of life.

Etiology: Pregnancy is a common cause of abnormal uterine bleeding. Polyps


or fibroid (small and large growths) in the uterus can also cause bleeding.

29
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

Structural Causes:Polyps, Adenomyosis, Leiomyoma ,Malignancy and


Hyperplasia

Nonstructural Causes:

 Coagulopathy - abnormal bleeding due to an underlying bleeding


condition.

 Ovulatory dysfunction - abnormal bleeding because you are not ovulating


regularly.

 Endometrial: abnormal bleeding because of a problem with the lining of


your uterus like an infection.

 Iatrogenic: abnormal bleeding because of a medication you are taking.

Outdated Terminology for Abnormal Uterine Bleeding

 Menorrahgia - a period of a heavier flow than normal, more than 80 ml


of menstrual blood loss.

 Metrorrhagia - any irregular, non menstrual bleeding as in bleeding which


occurs between menstrual period.

 Menometrorrhagia - combination of heavy periods and bleeding between


periods.

Terms describe the frequency of your bleeding

 Polymenorrhea: This term describes a period that comes more frequently


than every 21 days.

 Oligomenorrhea: This term describes a period that comes at intervals


greater than every 35 days.

Clinical Manifestation:

 Bleeding or spotting from vagina between periods

 Periods that occur less than 28 days apart or more than 35 days apart

 heavier bleeding such as passing of large clots, soaking through a


sanitary pad or tampon every 2 to 3 hours in a row.

 Bleeding that lasts for more days than normal or for more than 7 days.

30
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

Management

Medical Management

 Conjugated equine estrogen- menopausal hormone therapy used in symptoms


of menopause

Suggested Dose: 25 mg IV

Dose Schedule: Every 4–6 hours for 24 hours

 Combined oral contraceptives - medroxyprogesterone acetate and


combinationoral contraceptives for acute uterine bleeding

Dose: 35 micrograms of ethinyl estradiol

Dose Schedule: Three times per day for 7 day

 Medroxypro-gesterone acetate - medroxyprogesterone acetate and


combination oral contraceptives for acute uterine bleeding

Dose: 20 mg orally

Dose schedule: Three times per day for 7 days

 Tranexamic acid - prevent or excessive blood loss

Dose: 1.3 g orally or 10 mg/kg IV (maximum 600 mg/dose

Dose schedule: Three times per day for 5 days (every 8 hours)

Patient medical management

Multi vitamins + iron1 tab BID (twice a day)per oral

Cefuroxime- 500 mg 1 tab BID per oral x 7 days - antibiotic used to treat
certain infections caused by bacteria

Mefenamic acid- 500 mg 1 tab q 6 hours PRN - for pain management

Tranexamic Acid - 500 mg 1 tab TID per oral for x3 days - to prevent or
stop blood loss.

Pharmacologic Management

1. Name of drug : Cefuroxime

Generic name: cefuroxime

Brand name: Zoltax

Patient dose: 500 mg

31
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

Minimum dose: 250 mg , 500 mg

Maximum dose: 1000 mg

Route: PO

Classification: Pharmacologic

After oral administration, Zoltax (Cefuroxime Axetil) is absorbed from the


gastrointestinal tract and rapidly hydrolyzed by nonspecific esterases in
the intestinal mucosa and blood to cefuroxime

Mechanism of action

Second-generation cephalosporin that inhibits cell-wall synthesis,


promotingosmotic instability; usually bactericidal.

Indication

Treatment of susceptible infections which include bone and joint infections,


bronchitis (and other lower respiratory tract infections), gonorrhea,
meningitis (although treatment failures have been reported in Haemophilus
influenzae meningitis), otitis media, peritonitis, pharyngitis, sinusitis,
skin infections (including soft tissue infection) and UTI.

Cefuroxime is also used for surgical prophylaxis

Contraindications

Contraindicated in patients hypersensitive to drug.* Use cautiously in


patients hypersensitive to penicillin because of possibility of
cross-sensitivity with other beta-lactam antibiotics.* Use with caution
in breast-feeding women and inpatients with history of colitisor renal
sufficiency.

Adverese effect

Body as a Whole:Thrombophlebitis IV site;pain,burning, cellulitis

IM site: superinfections,positive Coombs'test

GI: Diarrhea,nausea, antibiotic-associated colitis.

Skin: Rash, pruritus, urticaria.

Urogenital:Increased serum cretonne and BUN, decreased creatinine


clearance

32
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

Nursing Responsibilities

- Determine history of hypersensitivityreactions


tocephalosphorins,penicillins and historyof allergiesparticularly to
drugsbefore therapy isinitiated.

- Report onselt of loose stool.

-Absorption of cefuroxime isenhanced by food.

-Notify prescriberabout rashes orsuperinfections.

2. Name of drug : Mefenamic

Generic name: Mefenamic

Brand name:Ponstan

Patient dose: 500mg

Minimum dose: 250 mg

Maximum dose:500 mg

Route: Oral

Classification: Pharmacologic

Mefenamic acid, an anthranilic acid derivative, is a member of the fenamate


group of nonsteroidal anti-inflammatory drugs (NSAIDs). It exhibits
anti-inflammatory, analgesic, and antipyretic activities. Similar to other
NSAIDs, mefenamic acid inhibits prostaglandin synthetase.

Mechanism of action

Mefenamic acid binds the prostaglandin synthetase receptors COX-1 and COX-2,
inhibiting the action of prostaglandin synthetase. As these receptors have
a role as a major mediator of inflammation and/or a role for prostanoid
signaling in activity-dependent plasticity, the symptoms of pain are
temporarily reduced.

Indication

For the treatment of rheumatoid arthritis, osteoarthritis, dysmenorrhea,


and mild to moderate pain, inflammation, and fever.

Contraindication

PONSTEL (mefenamic acid) is contraindicated in patients with known


hypersensitivity to mefenamic acid. PONSTEL (mefenamic acid) should not

33
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

be given to patients who have experienced asthma, urticaria, or


allergic-type reactions after taking aspirin or other NSAIDs.

Adverse Effect

Body as a whole - fever, infection, sepsis

Cardiovascular system - congestive heart failure, hypertension,

Digestive system - dry mouth, esophagitis,

Hemic and lymphatic system - ecchymosis, eosinophilia,

Metabolic and nutritional - weight changes

Nervous system - anxiety, asthenia, confusion, depression,

Respiratory system - asthma, dyspnea

Skin and appendages - alopecia, photosensitivity, pruritus, sweat

Special senses - blurred vision

Urogenital system - cystitis, dysuria, hematuria, interstitial nephritis,


oliguria/polyuria, proteinuria, renal failure.

Nursing Responsibility

-Assess patients who developsevere diarrhea and vomiting fordehydration


and electrolyteimbalance

-GI discomfort, sore throat, fever, ormalaise occur.

-Do not drive or engage inpotentially hazardous activities until response


to drug is known. It may cause dizziness anddrowsiness.

-Monitor blood glucose for loss of glycemic control if diabetic.

3. Name of the drug: Multivitamins

Generic name: Multivitamins

Brand name: Feosol

Patient dose: 1tab

Minimum dose: 125 mg

Maximum dose:750 mg

Route: Oral

Classification: Pharmacologic - water soluble vitamins iron supplements

34
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

Therapeutic: Vitamins, Minerals and antianemics

Mechanism of action

An essential mineral found in hemoglobin, myoglobin, and many enzymes.Enters


the blood- stream and is transported to the organs of the
reticulo-endothelial system (liver, spleen, bone marrow), where it is
separated out and becomes part of iron stores. Therapeutic Effects:
Prevention/treatment of iron deficiency.

Indication

PO: Prevention/treatment of iron-deficiency anemia.

IM, IV: Iron dextran

Treatment of iron-deficiency anemia in patients who cannot tolerate or


receive oral iron. Sodium ferric gluconate complex.

Contraindication

Hemochromatosis, hemosiderosis, or other evidence of iron overload; Anemias


not due to iron deficiency. Some products contain alcohol, tartrazine, or
sulfites and should be avoided in patients with known intolerance or
hypersensitivity.

Adverse effect

CNS: Seizures, Dizziness, Headaches

CV: hypotension, hypertension, tachycardia

G.I: Nausea and Vomiting

Dermatologic: flushing

Respiratory: Cough, Dyspnea

Local: Pain at IM site

Nursing Responsibilities

Before:

-Monitor blood studies of patient

-Observe proper dossage of medication

-Note other drug patient is taking

-Verify patient identity

35
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

During:

-Most effective if administered 1 or 2 hours before meal

-Take with full glass of water

-Do not chew or crush

-Encourage patient to avoid using antacids, coffee,tea,dairy products


within 1 hour after taking

-Inform patient about black/dark stool to avoid panic

After:

-Monitor pt. blood

-Inform patient about possible adverse effect

-Assess bowel function for constipation and diarrhea

-Document patient response

4. Name of the Drug: Tranexamic

Generic name: Tranexamic

Brand name: Hemostan

Patient dose: 500 mg

Minimum dose: 250 mg

Maximum dose: 500 mg

Route: Oral

Classification: Pharmacologic

For use in patients with hemophilia for short term use (two to eight days)
to reduce or prevent hemorrhage and reduce the need for replacement therapy
during and following tooth extraction. It can also be used for excessive
bleeding in menstruation, surgery, or trauma cases.

Mechanism of action

forms a reversible complex that displaces plasminogen from fibrin resulting


in inhibition of fibrinolysis, it also inhibits the proteolytic activity
of plasmin.

36
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

Indications

antihemorrhagic and antifibrinolytic for effective hemostasis in various


surgical and clinical cases, in traumatic injuries, post-tooth extraction
and other dental procedures.

Contraindication

Active intravascular clotting (contraindicated)

Subarachnoid hemorrhage, (may increase cerebral ischaemic complications)

Hypersensitivity to tranexamic acid

Upper renal tract bleeding,(relatively contraindicated due to the


possibility of clot retention).

Adverse effect

- increased risk of blood clotting

- fluid accumulation in the brain

- retinal thrombosis

- heart attack

- Acute Blood Clot in a Blood Vessel Supplying the Lungs

- heart valve disease

- subarachnoid intracranial hemorrhage

- blood clot in the brain

- stroke

- obstruction of a blood vessel by a blood clot

- blood clot

- blood clot in a deep vein of the extremities

- moderate to severe kidney impairment

- Chronic Degenerative Conjunctivitis with Fibrin Deposits

Nursing Responsibilities

-Unusual change in bleeding pattern should be immediately reported to


thephysician

- the medication should only be taken during the menstrual period

-Tranexamic Acid should be used with extreme caution

37
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

-The medication can be taken !ith or !ithout meals

-if you miss a dose of Tranexamic Acid, take it !hen you remember, then
take your next dose at least 6 hours later. do not take doses at once.

Surgical Management

 Endometrial ablation - destroys the lining of the uterus. It stops or


reduces the total amount of bleeding.

 Uterine artery embolization - This procedure blocks the blood vessels


to the uterus, which in turn stops the blood flow that fibroids need
to grow.

 Myomectomy - removes the fibroids but not the uterus

 Hysterectomy - the surgical removal of the uterus, is used to treat some


conditions or when other treatments have failed.

Nursing Management

 Encourage patient to comply the medication to reduce discomfort and pain

 Explain the importance of iron-rich foods to supplement

 Explain methods of quantfying blood loss and reporting to healthcare


provider

 Assist in and teach patient relieving techniques to promote self


sufficiency in managing pain

 Assess meaning of dysfunction for patient to explore self concept issues

 Encourage patient to express her feelings to increase understanding of


individual coping style.

38
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

CHAPTER IV

Pathophysiology

Precipitating factors
• Abdominal enlargement Predisposing factors:
• (+) mayoma • Age
• (+) ovarian cyst • Sex
• (+) ovarian new growth
• Lifestlye
• environment

SIGNS AND SYMPTOMS ORGAN INVOLVED: COMPLICATION:


 Heavy bleeding Reproductive system SEVERE ANEMIA
 Abdominal pain BLEEDING
 Abdomen distended
 Pale
 Poor capillary
refill
 fatigue
DIAGNOSIS
Ultrasond
CBC
Urinalysis

Treatment: Nursing interventions:


NURSING DIAGNOSIS
• Medication Independent:
 Ineffective
peripheral tissue
perfusion related to  Note current
decrease hemoglobin situation or
count secondary to presence of
anemia. condition that can
 Risk for infection affect perfusion to
related to uterine all body systems.
bleeding as evidence
by excessive blood  Assess and monitor
loss. vital signs , pallor,
 Fear related to threat capillary refill
of death to self
 Measure Capillary
refill

 Assess lower
extremities for skin
texture , edema and
39 ulceration.

 Note client’s
nutritional and
fluid status
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

 Determine pulse equality as well intensity


 Dependent:

 Assess for optimal fluid balance

 Administer medications such as anti platelet agents,


thrombolytics, antibiotics

 Administer Fluids, electrolytes, nutrients, and oxygen as


indicated
Collaborative:

 Monitor laboratory examinations such as RBC, hemoglobin,


hematocrit and platelet.

40
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

41
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

42
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

43
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

44
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

45
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

46
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

47
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

48
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

Progress Notes

Admission: Referred and -Seen and -Monitor Vital Signs


February Admitted with examined by Vital signs BP : 90/60
24,2019 the chief Dr. Cabano, with BP every PR : 70bpm
6:15am complaint of “ made pt. 2-3 hours. RR: 16cpm
feb 9 akong comfortable -monitor Temp : 36
last regla wla in DR bed for status of
pa japon sia pelvic exam. patient. - CBC test
ni undang ni - -Assess taken with
about nalang Examined for amount of results of
ug duha ka Na+ and K+ bleeding WBC 11.3
semana nia na levels. -labs RBC – 2.08
tingala man ko -Requested requested HgB - 3.3
so nagpa check for CBC test. -Diet g/hdl
up nlang ko.” -Start instructed Hct – 13
As verbalized bloodline -IVF Plt- 1,037
by the with PNSS 1L started.

49
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

patient. at 20 gtt/min - Blood bank


- Hgb count - secure 6 available
of 3.2 units of FWB/ AB+ RH group
RBC of pt. positive
blood type. matched and
Transfuse was
once 1st unit transfused.
is available
-
Medications
given are
> MV + iron 1
tab BID oral
> cefuroxime
500mg 1 tab
BID oral x 7
days for
infection
> Mefenamic
500mg 1 tab
q 6 hours as
needed for
pain
> Tranexamic
acid 500 mg 1
tab TID oral
x 3 days for to
prevent blood
loss.

February 25, - ongoing IV - Vital Signs V/S


2018 therapy and BP kept BP: 110/70
PNSS @ 20 monitored PR: 78 bpm
gtt/min - regulated IV RR: 17cpm
Infusing at at 20 gtt/ min T- 36
Left Cephalic - assessed
Vein. bleeding
- ongoing -Monitored I &
with O
following
medications
given 1 tab
500 mg each.

February 26, - ongoing IV - Vital Signs V/S


and BP kept

50
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

2019 therapy PNSS @ monitored BP: 110/70


20 gtt/min - regulated IV PR: 84
infusing at at 20 gtt/min RR: 18
left cephalic - assessed T: 35.8
vein. bleeding. CBC:
- ongoing with Monitored I Hgb – 4.7
following & O g/hdl
medications HCT- 17.1
given 1 tab
500 mg.
- repeat H & H
9:15 pm per telephone
order

- medication
added NaHc03
TID x 5 days
- Received
FFUB Blood

February 27, - ongoing IV - Vital signs,


2019 BP kept V/S
therapy PNSS @
monitored. BP : 120/70
20 gtt/min @
- regulated IV PR: 88
Left Cephalic
@ 20 gtt/min. RR: 20
Vein.
- assessed T: 36
- ongoing with
following bleeding
medications - Monitor I &
O
- ongoing IV
therapy PNSS @
20 gtt/min @
left cephalic
Vein

V/S
February 28, - ongoing Vital signs ,
BP: 110/70
2019 following BP are kept
PR-77
medications monitored.
RR- 77
- Blood typing - regulated IV
T : 36.1
and @ 20 gtt/min
crossmatchin - assessed
g done. bleeding.
- Monitored I
& O

Vital signs, V/S


March 1, 2019 - ongoing IV BP : 110/70
BP are kept
therapy PNSS @ PR- 77cpm
monitored.
20 gtt/min @ RR: 22
- regulated IV
Left Cephalic T: 35.8
@ 20 gtt/min

51
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

Vein. - assessed
- ongoing with bleeding.
following - Monitored I
medications. & O

V/S
- ongoing IV Vital signs, BP : 110/70
March 2, 2019 therapy PNSS @ BP are kept PR- 87
20 gtt/min @ monitored. RR: 18
Left Cephalic - regulated IV T: 36
Vein. @ 20 gtt/min
- ongoing with - assessed
following bleeding.
medications. - Monitored I
& O

- Vital signs,
- ongoing IV BP are kept V/S
March 3, 2019 therapy PNSS @ monitored. BP : 110/70
20 gtt/min @ - regulated IV PR- 79
Left Cephalic @ 20 gtt/min RR: 17
Vein. - assessed T: 36
- ongoing with bleeding.
following - Monitored I
medications. & O

-ongoing IV Vital signs,


BP are kept V/S
March 4, 2019 therapy PNSS @
monitored. BP : 110/70
20 gtt/min @
- regulated IV PR- 79
Left Cephalic
@ 20 gtt/min RR: 17
Vein.
- assessed T: 36
- ongoing with
following bleeding.
medications. - Monitored I
& O

- ongoing IV - Vital signs,


BP are kept V/S
therapy PNSS @ BP : 12/70
March 5, 2019 20 gtt/min @ monitored.
- regulated IV PR- 72
Left Cephalic RR: 19
Vein. @ 20 gtt/min
- assessed T: 36.5
- ongoing with
following bleeding.
medications. - Monitored I
Monitor blood & O
crossmatch.

52
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

Discharge Plan

M- MEDICATION:

 Instruct the patient to continue and follow appropriately the home


medications that were prescribed by the physician. Inform patient
correctly about the drug, its use, dose, time, frequency and the side
effects of the medication.

E- Exercise:

 Advice patient to keep muscles active with through warm ups, stretching,
light exercises, low volume strength training,and yoga.

T-Treatment:

 Hydrate

 Consume a well balanced diet

 Consume garlic reduces discomfort or pain

 Consume fruits rich in vitamin C on a daily basis.

 Increase iron intake foods rich in iron

H- Health Teaching

 Use Garlic is considered to be one of the most efficient home remedies


for dysfunctional uterine bleeding. All you have to do is consume five
to six cloves of garlic on daily basis which will reduce the discomfort
and pain caused during heavy bleeding.

 Using Red raspberry tea can also be used to treat this problem. Consume
this tea on daily basis which will help to regulate menstrual flow by
giving strength to the wall of the uterine.

 Continue with following medication to help stop bleeding

 Eating Healthy high iron food to prevent easily of blood loss.

 Balance the intensity of you work out routine

 Stay at the right weight and level of body fat

 Get treatment for an eating disorder

 Lower your stress levels

53
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

O-Outpatient:

 Advice the patient to make a follow up visit within a week to assess.

 Seek Medical Attention if you have any following questions.

 Fever above, redness, swelling and or pain.

 Continue ongoing medication as prescribed by her doctor such as ferrous


sulfate.

 Monitor and assess if bleeding has continued.

D-Diet-

 Eat foods high in iron each day. Good sources are organ meat (such as
liver), beef, pork, poultry, and seafood.

 Leafy vegetables such as spinach, asparagus, turnip greens, and lettuce


contain large quantities of folic acid and constitute its main source.
Other sources of folate include beans, peas and lentils, liver, kidney,
and certain fruits such as orange, pineapple, and grapefruit.

S- Spiritual

 Advice the patient to continually pray and hope for the best. Tell
motivational stories

 Encourage patient to speak up thoughts and fears to assist in accepting


and coping with the current condition .

54
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

CHAPTER V

Conclusions

Therefore this study help us to learn more about the abnormal uterine
bleeding. It was successful since the objectives were met and accomplished.
We are not just learning in analyzing and comprehending the case study but
we also realized that in clinical duty it is very important that we must
integrate the Paulinian core values we have learned in the field. It is
our privilege to be a Paulinian Nurse that we may instill “Rosamonized”
we think, act, and care like Christ. We do believed and realized that we
are already “Rosamonized” because we have the compassion to give extra care
to our patient not to gather data but rather to give holistic care and promote
quality of life. In this study it was fulfilling to help others without
asking in return, the experience was meaningful and fruitful to all of us.
And we believed, to care is to touch the lives of others.

55
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

Recommendations

To the doctor of our patient, we recommend that it is very important


to think about our responsibilities in taking care of our patients. If a
personal matter other outside of work happens then it is very important
to make sure someone can work in place of you. Patients need new interventions
as soon as a problem manifest and the whole health care team needs a doctors
order for things like ultrasound exam or maybe some medication. We could
have avoided the extra hassle which is being unable to diagnosed our case
properly.

And as for the nursing administration that work for a while in the
hospital, we recommend that a new nurse should be given enough orientation
period because every hospital has different protocols in giving care. Making
them work by themselves as early as possible is just calling for disaster
like mistakes to happen.

We recommend that nursing students should not extend their service beyond
walls of the clinical area because any activities with the client outside
the are comes with liability and risks that may put the nursing students
in great trouble.

And as for the nursing staff herself who made the mistake, it is very
important to always double check our every action so we can eliminate vital
mistakes.

We also recommend the significant others together with the client and
patient to always ask about any procedure that is done and always clarify
with the nurse about specific instructions like during discharge.

56
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

References

Jhon Napier.(2007). Selfgrowth.com. Home Remedies For Dysfunctional


Uterine Bleeding That Give Amazing Results. Retrieved from
https://www.selfgrowth.com/articles/home-remedies-for-dysfunctional-ut
erine-bleeding-that-give-amazing-results

Anderson A, Forsyth A. Playing it safe: Bleeding Disorders, Sports and


Exercise. New York, NY. National Hemophilia Foundation. 2005. Retrieved
from https://www.bleedingdisorders.com/ bleeding-disorders- info/
exercising-with-a-bleeding-disorder

EBSCO DynaMed Plus website. (2000). Abnormal uterine bleeding. Retrieved


from http://www.dynamed.com/topics/dmp~AN~T361089/Abnormal-uterine -
bleeding.

Office on Women's Health website.(2018). Retrieved from


http://www.womenshealth.gov/publications/our-publications/ fact-sheet/
menstruation.html.

Elsevier B.V..(2017) . Retrieved from https://www.sciencedirect.


com/topics/ neuroscience/folic-ac

Lori Smith BSN MSN CRNP.(2018)Retrieved from https://www.medicalnewstoday.


com/articles/315133.php

Medically reviewed by Deborah Weatherspoon, PhD, RN, CRNA on April 6, 2017


— Written by Jacquelyn Cafasso and Ana Gotter. Retrieved from
https://www.healthline.com/health/rbc-count#next-steps

Mayo Foundation for Medical Education and Research (MFMER). (2016) Retrieved
from https:// www.mayoclinic.org/symptoms/low-hemoglobin/basics /causes/

sym-20050760

Charles Patrick Davis, MD, PhD.,William C. Shiel Jr., MD, FACP, FACR. (2011).
Retrieved from https://www.emedicinehealth. com/hematocrit _blood_test
/article_em.htm#what_does_a_low_hematocrit_mean
Amber Yates, MD. ( 2018). Retrieved from
https://www.verywellhealth.com/things-that-elevate-your-platelet-count
-401336

Humanitas Research Hospital. (2002). Retrieved from


https://www.humanitas.net /wiki/anatomy/turbid-urine/

57
ST. PAUL UNIVERSITY DUMAGUETE
ST. PAUL UNIVERSITY SYSTEM
COLLEGE OF NURSING
ISO 9001

John, K.A. (2017). Retrieved from https://www.google.com/search?q=


abundant+epithelial+cells+in+urine+means&oq=abundant+epithelial+in+ur&
aqs=chrome.2.69i57j0l3.14884j1j4&sourceid=chrome&ie=UTF-8

Stacy Sampson, DO., (2018). Retrieved from


https://www.medicalnewstoday.com/articles/314165.php

Deborah Weatherspoon, PhD, RN, CRNA., ( 2018 ). Retrieved from


https://www.healthline.com/health/rbc-in-urine

Doenges, M.E. , Moorhouse, M. F , & Murr, A. C (2010) Nurse’s pocket guide:


Diagnosis, prioritized , interventions and rationales. F.A. Davis.
Philadelphia

Obstetrics and Gynecology Clinics of North America., (2001). Retrieved from


https://www.sciencedirect.com/science/article/pii/S088985450080025X

Deborah Weatherspoon, PhD, MSN, RN, CRNA ., (2017) https://www.


healthline.com/health/blood-typing#types

58

Anda mungkin juga menyukai