COLLEGE OF NURSING

In Partial Fulfillment of the Requirements

in
Related Learning Experience
Case Presentation:
Threatened Abortion
Presented by:
Group 50
Leader:
TOMAS, Sarah Joy
Members:
ADVINCULA, Jessa
ALENTAJAN, Marion Jake
ALOJADO, Mae
ALUNAN, Cyrus Anthony
ARCEO, Alyssa
BACULI, Ricardo
BALTAZAR, Joyce
BAUTISTA, Roegen
DABU, Katrina
DUMAGAT, Joy
ESGUERRA, Veronika Bianca

Submitted on:
September 12, 2009

Presented to:
Ms. Rosana R. Delfonso, RN, MAN, MSN, MATNE
Clinical Instructor

1
Threatened Abortion

2
 Nursing Process

I. Assessment
A. General Data
Patient’s Initials: AVB
Address: Tondo, Manila Informant: Primary
Age: 40 Date of Admission: Sept. 1, 2009
Sex: F Order of Admission: Wheel chair
Date of Birth: August 27, 1969 No. of Days in this
Hospital: 4
Civil Status: Married
Occupation: Housewife

B. Chief complaint:
“Sumasakit tiyan ko habang dinudugo ako ng malakas na may buo-buo
pa tapos kulay dark red,” as verbalized by the client.

C. History of Present Illness

Prior to seeking care and consultation, last September 1, 2009, Tuesday,
the patient already experienced bleeding between 8:30-11:30 in the
morning, scanty in amount then afterwards progressed at heavy flow
with pain at the abdominal region till night. It was then the patient was
brought to Amisola Hospital via wheelchair.

D. Past History
1. Childhood Illness/es
• Noted none

2. Immunization
• When she was 23 years old she had a congenital eye cataract
• At about 25 years old she then had a Mitral valve prolapse

3. Immunization
• She was completely immunized.

4. Previous Immunization
• The patient has gone no previous immunization

5. Operation/s
• CS last 2005

6. Injuries
• No injuries

7. Medications taken prior to confinement

• The patient takes her medication, Amoxicillin for UTI, everyday.

8. Allergies
• No allergies

E. System Reviews (Gordon’s Eleven Functional Areas)

1. Health Perception - Health Management
"Feeling ko, ako pinakamahina samin sa pamilya," the patient stated.
She thinks that her health before was not good because she had had
a lot of problems. Recently, she had UTI. She vomits often because of
this. She went to her physician. She took antibiotic, ciprofloxacin,
prescribed by her physician. After drinking the said medications, UTI
was gone. But this UTI was an On-Off illness for her. After how many
3
 weeks, the said illness will go back again. She thinks that she got her
UTI from salty foods. "Mahilig kasi ako sa maalat," the patient stated.
This illness triggers her pregnancy; thus, she bleeds. She had
undergone several laboratory examinations. Her health is important
to her. Thus, she drinks vitamin prescribed by her physician. She
drinks it once a day. She also had a Congeniotal Cataract when she
was a Grade 1 student. Both of her eyes were operated. She also had
miscarriages for three times. Her first abortion was a complete
abortion; she doesn't know that she is pregnant. Thus, she kept on
working. Her second pregnancy was good. With her third pregnancy,
anembryonic pregnancy was experienced by her. On her 4th
pregnancy, she was at the bathroom. She slipped; thus, she bleed.
She went to her doctor to see if her pregnancy is still good. No
problem has been recognized. After a week, her bleeding was
continuous; So they went to the hospital. It was, again, an abortion.
She had undergone dilatation and curettage.

“Natatakot ako. Sabi kasi ng doctor may posibilidad na makunan ako

ulit," the patient stated. Thus, she takes care of herself by still
drinking her medication and vitamins prescribed her physician. She
now feels better than before. Upon interviewing, she feels a little
better. Her abdomen aches a little but it is tolerable. She is
cooperative and fun to talk with. “Natatakot ako. Sabi kasi ng doctor
may posibilidad na makunan ako ulit," the patient stated.

2. Nutritional Metabolic Pattern

Before getting pregnant, she eats everything she wants. When she
found out she is pregnant, "di ako kumakain ng isda at maasim dahil
siguro sa paglilihi ko," the patient stated. She vomits often because
of her UTI so she does not eat much. "Nanghihinayang kasi ako sa
pagkain kaya 'di na lang ako kumakain ng marami kasi sinusuka ko
lang," the patient stated. Whenever she has wounds, it does heal
easily. She lost 3 teeth, mandibular third molar. But this doesn't affect
her.

During hospitalization, she eats what the hospital gives her. She
wants to drink chocolates because of her “food cravings/ Food
aversions”. She doesn't want to eat fish and fruits, especially those
sour foods. She eats three meals a day plus her snacks. She did lose
weight. Her first check up, she weighed 140 lbs. When she came for
her last check up, she weighed 132 lbs.

3. Elimination Pattern
In terms of her urinary elimination, she urinates everyday. She
urinates ten times a day as she estimated it. It is color yellow orange.
She thinks it is due to her medication intake. She has discomfort in
urinating. Her abdomen aches every after she urinates. No burning
sensation is felt after urinating. As for her elimination, she eliminates
at least once a day. It was greenish and not floating. She has no
discomfort in terms of eliminating.

She still urinates and eliminates wastes everyday. Still, she has
discomfort in urinating. Her abdomen aches every after she urinates.
No burning sensation is felt after urinating. She perspires a lot
especially when the weather is warm.

4. Activity & Exercise

Her only exercise is her household chores, like cleaning the house,
washing and ironing their clothes, etc. She does not do jogging or
anything. But she feels and thinks that her energy is enough for her to
do her work. She wakes up early in the morning to prepare breakfast
4
 for her family. She cleans their house every morning. After lunch, it is
the only time she can rest and do everything she wants. She sleeps,
sometimes, watch television or read magazines. Before, she works as
a tutor in her city. But she stopped because of her pregnancy.

During hospitalization, she does nothing. Her only exercise is when

she walks around the room.

5. Cognitive – Perceptual
She has difficulty in hearing with her right ear. She doesn’t use any
hearing aids. When she was an elementary student, she had a
congenital cataract on both eyes. She thinks that this affects her
eyes. She wears eyeglasses during elementary until college. Now,
she wears eye contact lens. Her last eye check up was December
2008. The grade of her right eye is 800+. As for her left eye, 920.
When she has to make a decision, she does it with her husband. She
consults her husband in terms of decision making. The easiest way for
her to learn is by teaching her one-on-one.

During hospitalization, she still has difficulty in hearing. She can read
newsprints with the help of her contact lens.

6. Sleep/Rest
"Mahirap ako makatulog, madali akong magising," the patient stated.
She sleeps at around 8 o'clock in the evening. She can only sleep well
if the light is off and there is no noise in the environment. She doesn't
experience nightmares much. Sometimes, she experience dreams. As
estimated by her, she dreams at least four times a day. Whenever she
is tired, she easily falls asleep. She usually wakes up in the middle of
the night, around 2-3 AM. She tries to sleep again around 4-5 in the
morning.

"Kagabi maganda yung tulog ko," the patient has stated. Her sleeping
pattern is still the same like before. No change has been experienced
except for her last night's sleep.

7. Self-perception
According to the patient, she feels insecure and has low self-esteem.
"Feeling ko, ako pinakaloser sa family. Pinaparamdam nila na wala
akong mararating. Ako pa minsan ang nasisisi dahil sa miscarriages
ko," the patient stated. The reason for this is because she thinks that
she is the least among her family. She always gets sick. She had a
Congenital Cataract, 3 abortions, and a heart failure. Nevertheless,
she forgives and forgets easily. She feels good of herself when
someone had praised her. "Madali ako mag-adjust. Hindi ko na
hinihintay sila ang mag-adjust sakin, ako na agad," the patient stated.
She gets angry because of many factors like insensitive and no
initiative people. She loses hope when her family told her something
negative.

Upon hospitalization, no change in her body image has been

experienced according to her. "Hindi pa naman ako panget," the
patient stated. With her mentality, she forgets some things like when
was got to do something, she forgets it. She thinks that the reason for
this is when she had an abortion for three times and she had
undergone dilatation and curettage. She gets angry for the same
reason. Her attention span was long. She participated well and
answered our questions directly.

8. Role-Relationship

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 She has a type of nuclear family. She plays a role of being a mother.
She never leaves her family. She is satisfied in what she has though
she cannot get everything she wants unlike when she is still single
and not married. She, also, has friends in her church. When problem
arises, she tries to solve it as early as possible. Then, everything will
be okay and be back to normal. Their family's income is not enough
for their needs mostly. They use loan for their needs.

Upon hospitalization, no change has been experienced.

9. Sexuality-Reproductive
The client doesn’t have any problems when it comes to sex. She is
satisfied with her husband. We let her rate it; 1 as the lowest and 5 as
highest. She gave us an answer of 5. "Naniniwala kasi ako na
importante yan. Kaya pag hiningi ng asawa ko, binibigay ko.
Kailangan nila yan. Mas kailang yan ng lalaki kaysa sa babae," the
patient stated. She used pills as a contraceptive but she stopped
using it because she bleeds when takes it. She was satisfied on her
sexuality which is being a woman. She expresses herself as a woman
by having an opposite sex interest, wearing a woman’s clothes such
as dress, skirt, brassiere, underwear, jeans, and shirt. Her
menstruation started when she was 11 years old. Her last menstrual
period is June 21, 2009.

Upon hospitalization, no change has been experienced.

10. Coping/Stress Tolerance

There are crises or problems experienced by the family, but they
manage to solve it. They talked about the problem. She experienced
stress when she had experienced abortions. She felt she was the most
loser among her family, as stated in Self-Perception. But she manages
to cope up since she stated that she adjusts in an environment easily.
She manages her stress by sleeping and watching television.

Upon hospitalization, her family supports her.

11. Values/Beliefs
She doesn't get what she wants. She only gets what she needs. She is
a Mormon. Her religion is important to her. She always prays to God.
When difficulties arise, she comes to God.

Her health today does not interfere with religion. It makes her to be a
strong person in keeping her relationship with God.

F. Family Assessment
Name Relation Age Se Occupation Educational
x al Attainment
DSB Father 38 years old M Salesman College Graduate
AVB Mother 40 years old F Housewife Undergraduate
DAB Son 5 years old M N/A Pre-school
Student

G. Heredo – Familial Illness

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 Maternal: Diabetes Mellitus
Paternal: Asthma

Maternal
Grand Grand
father mother
-DM
CAV SAG HEP Mother BOD
-DM -DM

Paternal
CAV
Grand Grand
Father mother
-asthma -asthma
CEV TEL Father
-asthma

H. Developmental History
Theorist Age Task Patient
Description
Erikson’s eight 40 Generativity vs. The patient is
stages of Stagnation able to perform
development all her duties and
responsibilities in
the family as a
wife and mother
such as giving
care to her
family as well as
doing household
chores thereby
becoming
productive. There
are times that
she can’t
perform all her
duties because
she’s embittered
and stressed of
her past
situations
Piaget’s Phases 40 Formal regarding to her
of cognitive Operations miscarriages.
development
The patient can
mentally
manipulate
information. She
has awareness
on different
views and
understands and
recognizes
individuals
having their own
beliefs and ways
of thinking by
7
 giving respect on
Freud 40 different
Psychosexual Genital Stage personality and
lifestyle of each
person.

The patient is in
Genital stage,
where she has
already been
married for six
years. She and
her husband has
a child and the
patient
experienced
three miscarriage
40 which results
Kohlberg’s Moral Social Contract frustration and
Legalistic unsuccessfully
Orientation resolving the
problem for the
patient.

The patient has

better
understanding
about human
complexity and
individuality, that
there is no easy
solution in
overcoming
human problems
and moral
considerations.
40 She believes that
Fowler’s spiritual Pardoxical- her previous
consolidative miscarriages and
current situations
has reasons and
purpose why it
happened.

The patient is
aware in
classifying
doctrines upon
religions who and
what to believe
in or defying
others stories
against her loved
ones, etc.

I. Physical Examination

Date of Assessment: Sept. 5, 2009

Height: Actual Weight:

Vital Signs
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Temperature: 36.7oC
PR: 21
RR: 78
BP: 110 mmHg / 80 mmHg

A. Assessment of the Skull and Face

Inspection:
• Head is round in shape (normocephalic)
• Scalp is white in color
• Symmetrical facial movements
Palpation:
• Skull is smooth, uniform consistency
• Absence of nodules or masses

B. Assessment of the Eyes

Inspection:
• Eyebrows symmetrically aligned and evenly distributed; equal
movement
• Eyelashes equally distributed; curled slightly outward
• Eyelids close symmetrically
• Her eyes are symmetrical, black in color, round in shape
• Conjunctivas are pink
• Both eyes coordinated, move in unison
• Cornea is transparent and shiny
Palpation:
• No tenderness over lacrimal gland
• No tearing upon palpation on the lacrimal sac

C. Assessment of the Ears and Hearing

Inspection:
• Ears are clean and symmetrical
• Patient can hear normally when spoken softly
• The color of the ears are the same as the facial skin
Palpation:
• Mobile, firm and not tender
• Pinna recoils after it is folded

D. Assessment of the Nose

Inspection:
• Symmetric
• No discharges or flaring noted
• Uniform color
• Presence of nasal hairs
Palpation:
• Not tender

E. Assessment of the Mouth and Oropharynx

Inspection:
• Lips and bucal mucosa uniform pinkish color, moist, smooth in
texture and symmetrical
• Tongue pinkish in color and moves freely
• No dentures
• Uvula is at the midline
• No lesions on gums
• Positioned in midline of soft palete
Palpation:
• No tenderness
• No palpable masses or nodules

9
F. Assessment of the Neck
Inspection:
• Muscles are equal in size; head is centered
• Coordinated, smooth movements with no discomfort
• Thyroid gland not visible; ascends during swallowing
• Trachea placed at the midline and spaces are equal on both sides
Palpation:
• Lymph nodes not palpable
• No masses
• Symmetric pulsation over carotid arteries
Percussion:
Auscultation:

G. Assessment of the Thorax and Lungs

Inspection:
• Quiet, rhythmic and effortless respirations
• Chest is symmetric
• Full symmetric chest expansion during respiration
Auscultation:
• Bronchial, bronchovesicular, vesicular breathsounds heard over
anterior chest
• Bronchial and tubular sounds heard over trachea

H. Assessment of the Heart

Inspection:
• No visible pulsations, lifts, and heaves
• Jugular veins not visible
Palpation:
• Full pulsations on carotid artery
Auscultation:
• No sounds heard over carotid artery
• Absence of murmurs

I. Assessment of the Abdomen

Inspection:
• Uniform in color, presence of stretch marks in lower quadrant of
abdomen

J. Assessment of the Upper Extremities

Inspection:
• Skin is pinkish white in color
• Hand: Medium in size with 5 fingernails in each side
Palpation:
• Skin is smooth and moist
• Capillary refill of 1-2 seconds was noted
Percussion:
• Able to move through active ROM

K. Assessment to the Lower Extremities

Inspection:
• Presence of scars and lesions
• Complete Fingers and Toes
• Nails are clean and short
Palpation:
• No apparent pain upon movement therefore indicates negative
Homan’s sign
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 L. Assessment of the Genitourinary
*patient has refused

M. Neurological Assessment
• Behavior – Patient is in very approachable and in a good mood.
• Motor Functioning -Able to move extremities through active ROM.
Able to extend arms front and resist active as pushed down/up on
his hands.
• Reflexes - reflexes were present such as the blinking reflex and
deep tendon reflex.
• Sensory Functioning – Patient’s sensory system is intact, she was
able to distinguish touch, pain, hot and cold.

II. Personal/Social History

The patient was born on August 8, 1969 at Munoz N.E. She is a
housewife since she was married and a teacher before. The patient’s
habit includes watching television, eating, and sleeping, but usually she
was doing household chores and taking care of her child. There are times
that she is a playing cards with her family during their spare time. The
patient eats her meals at the right time.
She is non-smoker and drinks alcohol during occasions only.

III. Environmental History (living/neighborhood)

According to the client, they have a good and clean environment. They
make sure that their surrounding is clean so that they could keep
themselves free from illnesses. They don’t have much problem when it
comes to sanitation. They don’t have any problems with their neighbors;
they have a good relationship with them. The people in their
environment are well mannered and they know their responsibilities as
member of their society.

IV. OB/GYNE HISTORY

Menarche: 13 yrs old When: unrecalled
Amount and Characteristics:
unrecalled
Durations: unrecalled
Associated symptoms: Dysmenorrhea
Deliveries: G: 5 P: 1 Operation: 3
OB Score: T: 1 P: 0 A: 0 L: 0
V. Pathophysiology
A. Theoretical Based
Predisposing factor/ Non- Precipitating factors/ Modifiable
Modifiable factors factors

• Exposure to environmental
• Infection and workplace hazards
• Hormonal problems such as high levels of
• Uterine abnormalities radiation or toxic agents.
• Incompetent cervix • Lifestyle factors such as
• Disorders of the immune smoking, drinking alcohol
system or using illegal drugs.
• Age • being underweight (i.e.
• previous miscarriage having a low body mass
index) before conception
• being stressed or anxious,
experiencing stressful or
traumatic events such as
bereavement.

11
 Exposure to these has been
linked to elicit various physiologic
alterations such as

Decreased hormonal levels of

progesterone and estrogen

Making decidua (endometrium)

begin to slough

Producing dark spotting

(Vaginal bleeding) Blood irritates the peritoneum

Causing mild cramps of back and

lower abdomen
(Abdominal pain)

Indicates Conservative
management the condition patient
is highly risk for threatened
abortion

Threatened abortion
is a clinically descriptive term that applies
to women who are at less than 20 weeks'
gestation with a viable pregnancy
and have vaginal spotting or bleeding, a
closed cervical os, and, possibly, mild
uterine cramping.

12
B. Client Based

Predisposing factor/ Non- Precipitating factors/ Modifiable

Modifiable factors factors

• Infection • Exposure to environmental

• Age and workplace hazards
• previous miscarriage

• Being stressed or anxious,

experiencing stressful
events

Recurrent miscarriage the fragility of High level of stress

Lining of the urethra suggest something is developing organs and can cause fatigue,
and bladder physically different nervous system of fetus sleeplessness,
becomes inflamed about a the patient’s have been shown to anxiety, poor
and irritated. uterus in a way that exhibit sensitivity appetite or
reduces her chances making Environmental overeating,
of a successful pollutants found in air headaches and
pregnancy and water, as well as backaches.
chemicals used at
home, pose a risk

Eliciting various physiologic

alterations such as

Decreased hormonal levels of

progesterone and estrogen

Making decidua (endometrium)

begin to slough

13
Producing dark spotting Blood irritates the peritoneum
(Vaginal bleeding)

Causing mild cramps of back and

lower abdomen
( Abdominal pain)

Indicates Conservative
management since the condition
of patient is highly risk for
threatened abortion

14
VII. Laboratory Result or Findings

ULTRASOUND REPORT

Specimen no.:

Specimen: Submitted:

Test reg.:

Result verified:

Laboratory Normal Value Result Interpretations/

Examinations Significance

A structure that
Gestational sac Present develops in the
uterus early in
pregnancy,
enclosing the
developing baby
and amniotic
fluid.
Location Intrauterine Normal
pregnancy

Border regular

Fetus recognized Yes

Num Single Single gestation

Well formed Yes

Heart motion Yes (176 bpm)

Body movement Yes

CRL ( crown-rump 41mm – 47mm 44.2 Normal

length). during 11th week embryonic
growth.
AOG 11 – 12 weeks

Haemoglobin 123.00-153.00 140.00 g/L

g/L
Decreased
Hematocrit 0.36-0.45 0.42 hematocrit
indicates
decreased
production,
excessive loss, or
destruction of red
blood cells.
Segmenters 0.50 - 0.65 0.69 Increased
segmenters may
indicate viral
infection.
Lymphocyte 0.25 - 0.35 0.31

WBC 4.00-10.50 x 8.2 x 10^9/L

10^9/L

15
 PREGNANCY TEST

Specimen no.:

Specimen: Submitted: Urine

Test reg.:

Result verified:

Normal Value Resul Interpretations/

t Significance
Color Yellow to amber Yellow

Transparency Clear Hozy

Reaction 6.0
Sp Gravity 1.002 – 1.035 1.020
Sugar Positive May indicate elevated
blood glucose.
Protein 3
RBC 30-50 May indicate
Hematuria
WBC 4.00-10.50 x 8-10 x
10^9/L 10^9/L
Bacteria Moderate May indicate UTI

Epithelial cells many Squamous epithelial

cells presence
suggests
contamination. The
presence of
transitional epithelial
cells is normal. The
presence of renal
tubule cells indicates
significant renal
pathology

16
 VIII. Drug Study

Side effect/ Nursing Patient

Drugs Indication Action Adverse considerati Teachings
Reaction on
Date Sept. 1 Infections bacterici Gastrointesti Obtain Take this
Ordered: 2009 of the dal nal: Nausea, specimen medication by
Generic amoxicillin genitourina action vomiting, for culture mouth with or
Name: ry tract - against diarrhea, and without food
Brand due to E. suscepti black hairy sensitivity
Name: coli, P. ble tongue, and test before Drink plenty of
Classificati Anti- mirabilis, organis hemorrhagic/ giving first fluids.
on: infectives or E. ms pseudomemb dose
Dosage: 500 mg faecalis. during ranous take at evenly
the colitis. Before spaced intervals.
stage of giving ask
active Onset of patient Continue to take
multiplic pseudomemb about this medication
ation. It ranous colitis allergic until the full-
acts symptoms reactions to prescribed amount
through may occur penicillins is finished even if
the during or symptoms
inhibitio after May cause disappear after a
n of antibiotic diarrhea few days. Stopping
biosynth treatment. the medication too
esis of Use early may allow
cell wall Hypersensitiv cautiously in bacteria to
mucope ity Reactions: hepatically continue to grow,
ptide. Anaphylaxis impaired which may result
patients in a relapse of the
infection.

Inform your doctor

if your condition
persists or
worsens.

17
 Side effect/ Nursing Patient
Drugs Indication Action Adverse considerati Teachings
Reaction on
Date Sept. 5, Irregular orally active Breakthroug This
Ordered: 2009 duration of progestogen h bleeding. medicine
Generic duphaston cycles and which acts Altered liver should not
Name: irregular directly on the function be used if
Brand Zuellig occurrence uterus, with patient are
Name: and duration producing a asthenia or allergic to
Classificati Hormones of periods complete malaise, one or any
on: caused by secretory jaundice
Side and Nursing of its
Patient
Dosage:Drugs10 mg progesteron
Indication endometrium
Action abdominal
effect/ considerati ingredients.
Teachings
e deficiency. in an estrogen- Adverse
pain, allergic on Inform the
Combined primed uterus. Reaction
rash, doctor or
Date Sept. 5, with an
Threatened At therapeutic Hypotensio
Vasodilators pruritus, In uterine Maypharmacist
be taken
Ordered: 2009 estrogenic
abortion, levels,
and n, urticaria motility do withifmeals,
patient
Generic Isoxilan substance,
premature dydrogesteron
antihyperten tachycardi not use milkhave
or
Name: can be
labor and e has no
sive drugs a, large previously
antacids to
Brand applied
Biofemme dysmenorrh in contraceptive palpitation volume of experience
minimise GI
Name: secondary
ea effect as it s, dizziness fluid to d such an
discomfort
Classificati Genitourin amenorrhoe does not inhibitand prevent fluid allergy. If
on: ary a, or interfere flushing. overload. patient
dysfunctiona with ovulation May cause Monitor BP have
Dosage: 10 mg
l uterine or the corpus slight and heart experience
bleeding and luteum. increase in rate d an
post- Furthermore, fetal heart allergic
menopausal Duphaston is rate if used reaction,
complaints non- as IV stop using
where androgenic, infusion in this
endogenous non-estrogenic,premature medicine
progesteron non-corticoid, labor and inform
e deficiency non-anabolic your doctor
is and is not or
implicated. excreted as pharmacist
pregnanediol. immediatel
y.

IX. List of Priority Problems

1. Fear / Anxiety
2. Risk for interrupted Family Processes
3. Disturbed Sleep Pattern

X. Nursing Care Plan

18
 CUES/ NURSING RATIONALE GOALS AND INTERVENTION RATIONA
DATA DIAGNOSIS OBJECTIVES

Subjective Cue: Fear related to Fear is a After 8 hours Independent:

“ natatakot perceived strong and of nursing -acknowledge your This will valida
ako, sabi threat of unpleasant intervention awareness of the feelings the pa
kasi ng danger for the emotion the patient patient’s fear having and
doctor may baby inside caused by will be able communicate
posibilidad patient’s womb the to: acceptance of
na makunan awareness or feelings.
ako ulit,” as anticipation -implement a -maintain a calm
verbalized of danger. positive and tolerant In this way, pa
by the client The patient’s coping manner while feeling of stab
emotion is mechanism interacting with increases a ca
Objective Cue:
motivated by patient nonthreatening
Patient fear of losing -verbalize atmosphere
verbalized the baby in reduction/ -establish a
presence of her womb absence of working An ongoing rel
fear and fear of fear relationship establishes tru
having through continuity basis for
miscarriage care communicating
again. -assist patient in feelings
identifying strategies
used to deal with fears in This help patie
the past which on fear as a re
helpful or natural part of
comforting. has been and c
continue to be
-encourage patient with successfu
to have rest
periods To improve ab
cope with fear
current situatio

19
 CUES/ NURSING RATIONAL GOALS INTERVENTION RATIONA
DATA DIAGNOSIS E AND
OBJECTIVE
S
Subjective Risk for Family After 8 hours -note components -helps client
Cue: Interrupted relationships of nursing of family, caregiver kn
"Feeling Family are intervention, presence of who is availa
ko, ako Processes characterize the patient extended family, to assist wit
pinakalose related to d by an can: and others; e.g., care/ provid
r sa Situational/tr intimacy friends/neighbors respite and
family. ansitional that can -express support
Pinaparam Crises: simultaneou feelings
dam nila Miscarriage sly be freely -identify patterns -provide
na wala protective of of communication information
akong individual - in family and about
mararatin well-being demonstrate patterns of effectivenes
g. Ako pa and increase individual interaction communicat
minsan stress and involvement between family and identifie
ang conflict. in problem- members problems th
nasisisi solving may interfer
dahil sa process with family's
miscarriag directed at ability to ass
es ko," the appropriate client
patient solutions for -assess role
stated. the situation expectations of -each person
family members may see the
-encourage and encourage situation in o
and allow discussion about individual
member them manner, and
who is ill to clear
handle identification
situation in and sharing
own way these
expectations
promote
understandi

20
 CUES/ NURSING RATIONALE GOALS AND INTERVENTION RATIONAL
DATA DIAGNOSI OBJECTIVES
S
Subjective Disturbed Sleep is a After 8-48 -provide adequate -although
Cue: Sleep naturally hours of rest. restrict prolonged and
"Mahirap Pattern recurring state nursing daytime sleep as mental activit
ako related to of relatively intervention, appropriate; results in fatig
makatulog, Psychologic suspended the patient increase which can incr
madali stress sensory and can: interaction time confusion,
akong motor activity between client and programmed
magising," in animals, -establish family/staff during activity withou
the patient characterized adequate day, then reduce overstimulatio
stated. by total or sleep pattern, mental activity promotes slee
partial with late in the day
unconsciousnes wandering
s and the reduced -evaluate level of -increasing
nearly stress/orientation confusion,
complete - as day progresses disorientation
inactivity of report/appear uncooperative
voluntary rested behaviors may
muscles. In interfere with
humans, other attaining restf
mammals, and sleep pattern
a substantial
majority of -adhere to regular -reinforces tha
other animals bedtime schedule is bedtime and
that have been and rituals. Tell maintains stab
studied (such client that it is of environmen
as some time to sleep.
species of fish,
birds, ants, and -reduce fluid -decreases ne
fruit flies), intake in the get up to go to
regular sleep is evening. toilet bathroom/inco
essential for before retiring ence during th
survival. night

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XI. On Going Appraisal
40 yrs old AB was admitted on September 1, 2009. The patient came
via wheelchair. Her chief complaint was vaginal bleeding. Dra. Amisola
admitted her. Her vital signs are monitored and recorded. She was on DAT
diet and she was encouraged to have deep breathing exercises. She was
kept rested and prescribed medications are given. The doctor issued
Isoxilan 1 tab 3x/day and Duphaston 10mg.
On 2nd hospital day, the patient test for pregnancy and positive result
noted. No other complaints noted. The rest of the day remained
uneventful.
On 3rd hospital day, the patient underwent ultrasound.

XII. Discharge Plan

Medication
• Keep a list of your medicines: Keep a written list of the medicines
you take, the amounts, and when and why you take them. Bring
the list of your medicines or the pill bottles when you see your
caregivers. Do not take any medicines, over-the-counter drugs,
vitamins, herbs, or food supplements without first talking to
caregivers.
• Prenatal vitamins: Even with a healthy diet, you may not get the
amount of vitamins and minerals that your baby needs. Prenatal
vitamins can help you get the right amount of vitamins and
minerals. Prenatal vitamins may also decrease the risk of certain
birth defects. Your caregiver will suggest the right kind and
amount of prenatal vitamins for you. Take your prenatal vitamin
every day. Do not skip days because you think your diet is good
enough.
• The patient should continue taking Isoxilan tab 3x/day and
Duphaston 10mg

Exercise
• There are changes in your activity. These changes may include
resting in bed for a time. If you do not need to rest in bed, ask
caregivers what exercise
• This may be a very stressful time for you. Since it is hard to avoid
stress, learn to control it. Learn new ways to relax, such as deep
breathing, meditation, relaxing muscles, music, or biofeedback.
Talk to someone about things that upset you.

Treatment

Health Education
• Try to drink enough liquid each day, and not just when you feel
thirsty. It may be helpful to drink liquids between your meals
instead of with your meals.
• Discouraged patient to participate in strenuous activities that
might precipitate stress and trauma.
• Follow treatment regimen instructed by the physician (chemo,
ORIF)
• Instruct patient to administer medications needed at right dosage
• Instruct patient to eat healthy and nutritious foods.
• Cooperation will greatly help in the treatment process.

OPD follow-up

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 • Keep all appointments. Write down any questions you may have.
This way you will remember to ask these questions during your
next visit.
• Check-up 1-6 months(once/month), 6-8months(twice/month), 9th
month(every week)

Diet
• Eat a healthy diet: When you are going to have a baby, eating
healthy is very important. During pregnancy, you need extra
protein, vitamins, minerals, water, and calories. You need these to
help you have a healthy pregnancy and a healthy baby. Eating
healthy foods may also help you feel better and have more
energy. It is important to eat a variety of foods every day. Healthy
foods include fruits, vegetables, breads, dairy products, and
protein such as meat and beans. Dairy products include milk,
yogurt, and cheese. Avoid raw or undercooked meat and fish
• Drink plenty of liquids: Drink at least eight (8-ounce) cups of
healthy liquids each day. Healthy liquids include milk, water, or
juice. Avoid liquids that have caffeine in them such as coffee, tea,
and soda pop. Do not drink liquids that contain alcohol.
There is no known "safe" amount of alcohol that you can drink
while pregnant. You should not drink beer, wine, liquor (such as
whiskey or gin), or any other mixed drinks. Alcohol can cause
problems during your pregnancy such as a miscarriage. It can
cause your baby to be born too small and have severe, lifelong
learning problems.
• Do not smoke: You should not smoke cigarettes or anything else
during pregnancy. Your baby may weigh less at birth if you smoke
during pregnancy. Smoking increases the chance of your baby
being born too early or your baby not growing well. Second-hand
smoke (being around someone else who is smoking frequently)
may be just as dangerous.

Signs and Symptoms

• You have new or worsening vaginal bleeding, or cramping in your
abdomen (belly) or lower back.
• You have vaginal pain or itching, or an unusual vaginal discharge
that is yellow, green, or foul smelling. This may mean that you
have an infection.
• You have trouble urinating, burning when you urinate, or feel a
need to urinate often.
• You feel weak or faint.
• You have a fever (increased body temperature).
• You have vaginal bleeding that fills one large sanitary pad every
hour for three or more hours in a row.
• You pass large clots or other material that looks like tissue or
clots. Save all of the tissue that you pass in a clean container or
plastic bag. Bring it with you when you see your caregiver.

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