III-1st sem
I. Patient’s Profile
Name: G.E.M.
Age: 27 years old
Address: Brgy. Gregorio Aliang TMC
D.O.A.: 10:05 AM, September 24, 2008
Case Number: 157821
Hospital Number: 048818
Diagnosis upon Admission: G4P2 (2012) 17 4/7 weeks AOG
Threatened Abortion
Principal Diagnosis: Complete Spontaneous Abortion, Non-Septic
R.O.D.: Dr. Baby Corine S. Rodis
Present Pregnancy
LMP: May 24, 2008
EDC: March 3, 2009
AOG: 17 4/7 weeks
-experiences morning sickness
Abnormal S/Sx: Vaginal bleeding
Cervix: soft, effaced
Clinical Abstract
1 day PTC – experienced hypogastric pain & vaginal bleeding
Operation (VSD)
Time started: 12:30 PM
Time finished: 1:15 PM
Tissue removed: Placenta
A. Demographic Data
Client’s Name : G.E.M
Gender : Female
Age : 27 y.o.
Birth date : September 13, 1981
Birthplace : Bacolod
Marital Status : Married
Race : Filipino
Religion : Roman Catholic
Address : Brgy. Gregorio, TMC
Educational Background : High School graduate
Occupation : Housewife
Usual Source of Income : Husband’s monthly salary
Usual source of medical care :
The patient receives medical care from the nearby health center in the barangay whenever she gets simple illness. But if the disease needs further medical attention, she would go to the city proper and visit Korea-Philippines Friendship Project Hospital.
B. Source and Reliability of Information
The patient herself was the major source of information. She was conscious and coherent and answers our questions confidently. We also had her husband as the second source of information. He’s also conscious and coherent during the interview.
C. Reasons for Seeking Care
Abdominal pain and vaginal bleeding are the major reasons for seeking care.
D. History of Present Illness
Eleven days prior to admission, the patient experienced mild bleeding. On the same day, she went to the nearest health center in their barangay. There, she was advised to have a complete bed rest and was given 5 amp. Isoxillan.
Two days prior to admission, the patient experienced acute abdominal pain accompanied with vaginal bleeding. The patient, however, did not come to hospital right away since what she experienced was just mild spotting. But after two days, the bleeding worsens and the abdominal pain she felt became stabbing.
Upon arrival, at 10:05 Am. the patient was diagnosed with threatened abortion. She was then admitted and was immediately given needed care. The patient’s V/S and FHT was monitored and was ordered to be on a CBR.
At 7 AM, the following were observed: uterine contractions, open cervix, bag of water, profuse vaginal bleeding. The doctor then suggested the NOD to prepare the patient for VSD. At 10:00 AM, the patient was sent to DR. A live baby boy was born via normal spontaneous delivery. The baby, however, died immediately due to immaturity. The patient was then brought to RR at 1:15 PM.
E. Past Medical History/Past Health
Pediatric, Childhood and Adult Illnesses
According to the patient, since her childhood, she just experienced common illnesses like fever, cough and colds. The patient also experienced chicken pox at the age of 5 and measles at the age of 7.
Injuries
According to the patient, she didn’t experience any injury before.
Serious/Chronic Illnesses
According to the patient she doesn’t experience any serious or chronic illness before.
Hospitalization
The patient was hospitalized last December 2007 at Korea-Philippine Friendship Project Hospital because of having an imminent miscarriage on her third baby when she was 26 years old. According to her she is not aware that she is pregnant that time. She then continuously took her pills that caused her abortion. She lost her baby on the first month of her pregnancy. She had undergone Dilatation and Curettage procedure because of the tissue left in her womb or uterus.
Operation
The patient has not undergone any operation before.
Obstetric History
The patient had her menarche at the age of 11. She has an obstetric score G3P2 (T2P0A1L2). She had her first son when she was 23 and her second son when she was 24 years old. In her second pregnancy she had a threatened abortion that was recovered by 2 weeks complete bed rest. Her third pregnancy ended up into an imminent abortion.
|No. of Pregnancies |Year |Remark |
|G1 |2004 |NSD |
|G2 |2005 |NSD |
|G3 |2007 |D & C |
Family Planning
Mr. & Mrs. M. mutually decided that they would use oral pills taking as their family planning method. Mrs. G.E.M started taking pills after her second pregnancy.
Immunization
According to the patient, she could not remember what immunization she had received; though she showed a mark on her left and right arm which she said is a mark from having vaccinated which indicates that she had been given BCG.
Mrs. G.E.M has already acquired four doses of Tetanus Toxoid.
Allergies
The patient has no allergy.
Medication
The patient has taken 5 amp. Isoxilan last September 13, prescribed by the doctor on the health center, due to the mild bleeding she experienced..
Last Examination
The patient had her last examination on September 13, 2008 in a health center due to mild bleeding.
F. Family History - Genogram
1[pic]
Legend: - Female - Female-deceased - Male - Male deceased - Patient
The genogram reveals that in the mother side, one of the family members died because of Leukemia. Also, a history of asthma can be seen. The patient’s grandfather died due to senility.
The patient’s father died, together with his younger brother, due to a vehicular accident. One of the members, J.N., has hypertension.
G. Socio-economic
|NAME |OCCUPATION |MONTHLY INCOME |
|J.M. |government employee |P15, 000.00 |
|G.M. |housewife |P2, 000.00 |
Mrs. G.M’s husband is a government employee and the whole family chiefly depends on his monthly salary which amounts to P15, 000.00 a month. However, Mrs. G.M. sometimes accepts laundry from her neighbors. From here she’s also able to get some money and according to her, she earns at least P2, 000.00 a month.
Since there are 4 members in the family, and their kids are still out of school, the income is just enough to sustain the needs of the family.
H. Development History
Erick Erickson’s Psychosocial Development Theory
Trust vs. Mistrust (0-1 year old)
Mrs. G.E.M was born and grew up in Bacolod. She is the eldest among the six siblings of Mr. M and Mrs. M. During this stage, all her needs are being given by her mother as well as her whole family, she was given enough time, security, care and comfort. Mrs. G.E.M was breastfed since birth up to 4 months. Then later on, she started to eat small amount of foods such as mashed rice, potato, banana and squash on the same amount. She developed trust since she received enough attention, care and especially love from her parents and family. Those were the reasons of her being satisfied during her infancy.
With this development, Mrs. G.E.M carried her attitude of being able to learn on how to trust others until now.
Autonomy vs. Shame and Doubt (1-3 years old)
Mrs. G.E.M. already began to talk and walk at the age of 2, and being trained in toilet facility at the age of 2. According to her, at an early age she loves to do simple things independently. She always insists to dress herself. She was allowed to play outside together with her cousins and other children but still guided by her parents. She was able to choose her type of food to eat. However, her parents gave in limitations or rules or actions which they know might harm their daughter, as they promoted independently to her. At this point, the patient has established a sense of autonomy in making decisions.
In addition, she said that her mother used to tell her that whenever she feels like she needs to go to the bathroom, she tends to hold back its urge. This may cause her attitude of being thrifty.
Initiative vs. Guilt (3-6 years old)
At this stage, Mrs. G.E.M learned to do things by her own. She can do simple decisions like what clothes to wear knowing that it was the appropriate clothes. Through this, she can explore things. According to her, she was also exposed on playmates and different kinds of play such as running, playing doll and playing luto-lutuan. The sense of initiative was reinforced.
Industry vs. Inferiority (6-12 years old)
During this stage, Mrs. G.E.M was a responsible daughter of Mr. and Mrs. M. from simple and independent household chores such as washing her own clothes and sometimes the clothes of her siblings, do her school projects and assignments on her own as well as her sibling’s. She is also a type of person who really wants to try anything that can challenge her so that she can develop her confidence in doing things in her own ability. This made her foundation to work and grab opportunity in every action. And through these things, she was able to developed industry over inferiority.
Identity vs. Role Confusion ages 12-21 years old
When Mrs. G.E.M is on her high school years, she said that she is a part of a group of eight. She sees herself just like her friends. She added that at that time she never got confused on her identity, thus, showing that she developed identity rather than role confusion.
At that time, she is already thinking of ways on how to help her family by selling different goods to her classmates and even to her teachers. Since her father died when she was in the 3rd level, she viewed her role as the bread winner of the family.
Intimacy vs. Isolation ages 21-40 years old
At the age of 22, Mrs. G.E.M has established a sense of intimacy. She decided to get married and settled her life with her husband and started building her own family. Her husband works as a government employee while she plays as a plain housewife. One year after their marriage, G.E.M, become pregnant and she was very happy with the gift of God had given to them. At this point, the patient had developed intimacy from her husband took care of her and their child.
I. Review of System & Physical Examination
Date Conducted: September 25, 2008
|SYSTEM |SUBJECTIVE |NORMAL FINDINGS |ACTUAL RESULT/ |INTERPRETATION/ |
| | | |ASSESSMENT |SIGNIFICANCE |
|Integument |“Napapansin ko nga |Color, warm, smooth and|- dry skin |Abnormal: dry skin and poor |
| |nagiging dry na yung balat|elastic |- poor skin turgor |skin turgor |
| |ko ngayon” | |- pallor nail | |
| | |- nail bed pink |- no abnormal pigmentation | |
| | | |- absence of rashes and lesions | |
| | | |- nail bed is pink | |
|Head |No subjective cues |- plate colorless, |- Normocephalic |Normal |
| | |convex, curve 160 |- round in shape | |
| | |texture |-symmetric and proportion to the | |
| | |- texture smooth |body | |
| | |- hair evenly |- hair is thick equally | |
| | |distributed (scanty), |distributed | |
| | |resilient, smooth, |- without scalp lesions | |
| | |silky |-absence of dandruff | |
|Eyes |“Hindi naman nanlalabo ang|- fissure equal in size|- fissure equal in size |Normal |
| |mga mata ko” |- lid margin- clear |- eyelashes is evenly distributed| |
| | |- eye lashes- evenly |- Conjunctiva (pink) and sclera | |
| | |distributed, turn |(white) moist without jaundice | |
| | |outward |- presence of clear discharge | |
| | |- conjunctiva- pink |(tears) due to crying | |
| | |- sclera- white and |-PERRLA | |
| | |clear | | |
| | |- pupils- PERRLA | | |
| | |- normal vision 20/20 | | |
|Ears |“Pareho naman nakakarinig |- pinna- color same as |- no external tenderness or |Normal |
| |ang tenga ko at hindi |facial |lesions of pinna | |
| |naman ako nabibingi” |- skin- smooth |- pinna’s color is same as facial| |
| | |- alignment- equal eye |- auricle is mobile and firm | |
| | |level |- tip of the ear is inline of the| |
| | |- auricle- mobile, firm|outer cantus of the eye | |
| | |- (-) tenderness |- no discharge | |
| | |- hearing acuity- able | | |
| | |to hear sound | | |
|Nose and Sinus |“Wala naman akong sipon |-symmetrical- straight |- symmetric and proportional to |Normal |
| |ngayon at maayos naman ang|- (-) discharge |the face | |
| |pakiramdam ko” |- (-) flaring |- intact nasal septum | |
| | | |- proportional nares | |
| | | |- nares patent | |
| | | |- septum on midline | |
| | | |- mucous membranes pink without | |
| | | |discharge | |
| | | |- no lesions | |
|Mouth and Throat |“Madalas akong mauhaw |- lips- pink, soft, |- dry chapped lips |Abnormal: dry chapped lips |
| |ngayon kumpara noon” |moist, smooth, slightly|- soft lips | |
| | |rough, thin whitish |- Mucous membranes pink without | |
| | |color, moves freely |inflammation or lesions | |
| | |- uvula- position at |- tonsil is pinkish | |
| | |the midline |- absence of bleeding and | |
| | |- tonsil –pink, |swelling | |
| | |oral hygiene |- uvula is in midline | |
|Neck |“Wala naman akong |- Symmetrical |- No parotid gland enlargement or|Normal |
| |nararamdaman na kakaiba sa|- (-) masses. nodes, no|tenderness | |
| |leeg ko” |palpable |- No masses or tenderness | |
| | | |- able to flex, extend, rotate | |
| | | |and tilt | |
| | | |- trachea midline and mobile | |
|Gastrointestinal |“Sobrang sakit ng tiyan |- (-) bruit |- symmetrical |Normal |
| |ko” |- symmetrical |- absence of bruit an tenderness | |
| | |- (-) tenderness |- abdomen is soft | |
| | |- soft | | |
|Breast and Axilla |No subjective cues |- symmetrical |- symmetrical |Normal |
| | |- areola- equal round |- areola is round and dark red | |
| | |or oval |in color | |
| | |- nipples- equal in |- nipples is equal in size | |
| | |size |- absence of discharge | |
| | |- (-) discharge | | |
|Cardiovascular |“Hindi naman tumataas ang |- (-) bulges |- BP: 110/70 mm Hg |Normal |
| |presyon ko pero may lahi |- (-) pulsation |- PR: 96 beats per minute | |
| |kami ng hihgblood” |- (-) thrills normal |- absence of thrills | |
| | |heart sounds |- absence of murmurs | |
|Urinary |“Hindi naman masakit ang |- 1200 ml-1500 ml urine|- unable to observe the actual |none |
| |pag-ihi ko” |output per day |color, characteristics of urine | |
| | |- straw, amber, | | |
| | |transparent, faint, | | |
| | |aromatic | | |
|Reproductive |The patient refused to |- pubic hair- inverted |------- |------- |
| |examine her genitalia |triangle, kinky, | | |
| | |symmetrical | | |
| | |- (-) odor | | |
|Mental status |No subjective cues |- mentally alert ( |- mentally alert |Normal |
| | |oriented to time, place|- oriented to time, place, | |
| | |and person) |person, and situation | |
| | |- memory- able to |- able to follow command | |
| | |follow command, |- able to respond to stimulus | |
| | |response to stimulus | | |
|Extremities |No subjective cues |- able to perform ADL |- able to perform ADL such as |Normal |
| | |- no deformities |walking, sitting and standing | |
| | | |- no deformities | |
J. Laboratory Studies
|Procedure |Indication |Normal Values |Actual Findings |Significance |Nursing responsibility |
| | | | | |PRE |
|Urinalysis |A physical microscopic or chemical |Macroscopic |Macroscopic | |-Explain the procedure to the patient |
|September 24, 2008 |examination of urine. The specimen is |Color: Amber to |Color: yellow |Normal |-Tell the patient that no fasting is |
| |physically examined for color, |clear | | |required |
| |turbidity and specific gravity. Then |Transparency: Clear |Transparency: turbid |Turbid appearance usually means some sort | |
| |is spun in a centrifuge to allow of a | | |of infection. |INTRA |
| |small amount of sediment, which is |Reaction: Acid |Reaction: Acidic |Normal |-Collect a urine specimen |
| |examined microscopically for blood |Specific Gravity: |Specific Gravity: | |-If the specimen is contaminated by |
| |cells, cast, crystals, pus and |1.010-1.030 |1.010 |Normal |vaginal discharge or bleeding, collect a |
| |bacteria. Chemical may be performed to| | | |“clean catch” or “midstream” specimen. |
| |measure the pH and ketones, sugar, |Chemical |Chemical | |This requires meticulous cleansing of |
| |protein, blood components and other |Sugar: Negative |Sugar: Negative |Normal |urinary meatus with an iodine preparation |
| |substance. |Albumin: Negative |Albumin: Negative |Normal |to reduce contamination of the specimen by|
| | | | | |external organism. |
| | | | | | |
| | |Microscopic |Microscopic | |POST |
| | |WBC(Pus): 2-3/hpf |WBC(Pus): 2-3/hpf |Normal |-Send urine specimen to the laboratory |
| | |RBC: 0-2/hpf |RBC: 0-2/hpf |Normal |immediately. |
| | |Mucous Thread: Occasional |Mucous Thread: few |Urine often has mucus in it and is | |
| | | | |considered normal unless there is a large| |
| | | | |amount | |
| | |Bacteria: None | |May indicate presence of infection | |
| | | |Bacteria: few | | |
|Procedure |Indication |Examination |Normal |Actual Findings |Significance |Nursing Responsibility |
| | | |Values | | | |
| | | |
|Hematology |Hematology is the scientific studies the red and white blood cells, |RBC count |
|September 24, 2008 |their relative proportions and general cell health, and the diseases | |
| |that are caused by imbalances between them, notably leukemia and | |
| |anemia. | |
| | | |
| | | |
| | |Hemoglobin |
| | | |
| | | |
| | | |
| | | |
| | |Hematocrit |
| | | |
| | | |
| | | |
| | | |
| | | |
| | |MCH |
| | |MCHC |
| | |Platelet count |
| | | |
| | |WBC count |
| | |Lymphocyte |
| | |Monocyte |
| | |Segmenters |
| | |PRE |
|Transvaginal Ultrasound |Transvaginal ultrasound is a method to look at a woman's reproductive |-Explain the procedure to the patient |
|September 26, 2008 |organs, including the uterus, ovaries, cervix, and vagina. |-Ask the patient to empty bladder |
| |Transvaginal means across or through the vagina. |-Assist the patient to be on a lithotomy position |
| |Transvaginal ultrasound is a type of pelvic ultrasound. |-Drape the patient and secure privacy |
| | |-Tell the patient that it is painless, although mild discomfort may be felt from|
| | |the pressure of the probe |
| | |INTRA |
| | |-A probe, called the transducer, was placed into the vagina |
| | |POST |
| | | |
| | |- Document relevant data. |
K. Functional Assessment
a. Health Perception and Management
Before hospitalization, Mrs. G.E.M. considers herself as a healthy individual because she is not experiencing any serious illness. This is the second time that she is admitted to the hospital. The first was when she undergone D&C due to miscarriage on her 3rd pregnancy last December 2007.
Mrs. G.E.M. believes that health is an important part one’s life. She values her health by avoiding vices such smoking and drinking alcoholic beverages. Furthermore, she takes prescribed drug.
Today, after having two consecutive miscarriages, Mrs. G.E.M feels frustrated and sad for the loss of her baby. According to her, she also feels scared of being pregnant because of the possibility of another abortion. She also became confused about the reasons on why her two consecutive pregnancies ended this way.
b. Self-Esteem, Self-Concept and Self- Perception
Mrs. G.E.M. stated that she is an emotional person. She easily cries whenever something unhappy happened. However, she never loses hope and doesn’t easily give up even though she encounters lots of problems in life. She always looks at the brighter side of life.
When Mrs. G.E.M. was hospitalized, she felt homesick because she missed her children so much. She became frustrated for herself because she was not able to give enough attention and time for their needs because of her condition.
Furthermore, Mrs. G.E.M. also stated that she values and treasures her family so much. She‘s afraid to loose her children. She’s easily become depressed whenever her children got sick. And when she was hospitalized, she became depressed again when she learned that her present pregnancy is in threatened condition. Her previous pregnancy resulted into a miscarriage that’s why she’s scared of becoming pregnant and then losing the baby again.
c. Activity-Exercise Pattern
Just like other housewives, before her hospitalization, Mrs. G.E.M. stays at home and does things for her family. She starts her day by cooking and preparing food for them. She also takes the task of preparing the things needed by her children before going to school and for his husband before he goes to work.
During the afternoon, when all her house works are done, she spends her free time chatting with their neighbors and sometimes goes to her mother’s house. She also accepts laundry works from her neighbors. This serves as her source of income to be used for her children’s needs.
During the interview, she stated that she can feed herself alone but needs assistance when going to the toilet and in dressing.
d. Sleep-Rest Pattern
Mrs. G.M.E. sleeps at around 10-11 pm and wakes up at 4 am. During her confinement, her hours of sleep decreased because she cannot sleep well due to the pain that she is feeling on her abdomen.
Regarding her rest, she was restricted to move and walk. She prefers to lie down or sit on her bed.
After the complete abortion, she immediately gained her strength and had an early ambulation.
e. Nutrition and Elimination Patterns
Mrs. G.E.M. eats 3x a day but not always on time. For example, instead of eating her lunch at 12:00PM, she will eat at around 1:00PM because of being pre-occupied by her activities. She usually eats meat, fish and vegetables. She drinks 7-9 glasses of water everyday. Sometimes, she also drinks soft drinks but only in small amount. She voids at least 4x a day and defecates regularly, every morning.
During the interview, Mrs. G.E.M. was in soft diet. She voided twice and had defecated once during the shift.
f. Sexuality / Reproductive Pattern
She had her menarche at the age of 11. According to her, she doesn’t experience any irregularities on her menstrual cycle. At present, she has 2 children. She has an obstetric record of G4P2 (T2P0A2L2). She uses pills as her birth control method.
In addition, she said that she and her husband have a good relationship. They had fights once in a while but are then easily resolved. She added that his husband is sweet, supportive and understanding.
g. Interpersonal Relationship Pattern
Mrs. G.E.M. considers herself as a friendly person because she has many friends around the community. She said that she has no known enemies in their place. She has good interpersonal relationship with her family especially with her husband. Based on the interview, we concluded that Mrs. G.E.M. is a nice and cooperative person.
h. Coping and stress mechanism
The patient gets stressed after work, cleaning and preparing the things needed for her husband. Her present pregnancy and confinement worsen the stress she experience.
Regarding her coping mechanism, talking to her husband heals the stress she carried. Telling her problems to her mother also relives the worries she experiences resulting to a decline of stress level.
I. Personal Habits
Her good habits reflect good doings which are good for her health and such habits are going to churches, cooking and teaching their children after school.
Mrs. G.E.M. is also workaholic. Instead of having her rest, she would rather d the household chores or look for someone whom she can do service of laundry,
J. Environmental Hazard
Mrs. G.E.M is living at Trece along with their two children. They don’t have easy access to health care facilities in the city because their barangay is far from the city proper. In addition, the tricycle fare, their only means of transportation, is expensive. Instead, they get their usual health care needs from the nearby health center.
Some of the hazards that may affect the health of the entire family are seen outside in their home such as moving vehicle in the streets and pollutants. Also, the place where Mrs. G.E.M does the laundry presents a hazard for her since it is wet and slippery.
II. Problem List
A. Actual or Active
|Problem No. |Problem |Date Identified |Date Resolved/ |
| | | |Remarks |
| | | | |
|1 |Hypovolemia |September 25, 2008 |September 26, 2008 |
| | | |Goal met as the patient showed signs |
| | | |and symptoms of improved hydration. |
| | | | |
|2 |Acute Pain |September 25, 2008 |September 25, 2008 |
| | | |Goal unmet. The pain did not decrease |
| | | |by the end of the shift for the reason |
| | | |that the patient was sent to DR for |
| | | |VSD. |
| | | | |
| | | | |
|3 |Knowledge Deficit |September 26, 2008 |September 26, 2008 |
| | | |Goal met as the patient was able to |
| | | |discuss possible reasons of her |
| | | |abortion. |
III. NURSING CARE PLAN
HYPOVOLEMIA
|ASSESSMENT/ |NURSING DIAGNOSIS |BACKGROUND KNOWLEDGE |GOAL/ |NURSING INTERVENTIONS |RATIONALE |EVALUATION |
|CUES | | |OBJECTIVES | | | |
| | | | | | | |
|Subjective |Isotonic fluid volume deficit|Fluid volume deficit is the |Long term goal: |Monitored and recorded V/S. |To save as baseline data. |Goal met. |
| |related to active loss of |state in which an individual |To facilitate the maintenance| | | |
|“Pakiramdam ko uhaw ako palagi,” |blood as manifested by |experiences vascular, cellular|of fluid balance. |Assessed skin turgor and mucous |To asses any signs of |At the end of the shift, the |
|as verbalized by the patient. |continuous vaginal bleeding, |or intracellular dehydration | |membranes. |dehydration. |patient showed signs and |
| |thirst and body weakness. |[excess of needs or |Short term goal: | | |symptoms of hydration such as|
|Objective | |replacement capabilities due |At the end of the shift, the |Monitored I-O. |To monitor if there is still |hydrated skin and unchappy |
|Presence of vaginal bleeding | |to active loss]. |patient will be able to | |dehydration. |lips, less feeling of thirst,|
|Verbalization of thirst | | |demonstrate a positive signs | | |use of 2 pads for the last 13|
|Evident body weakness | | |of hydration such as | | |hours and improved skin |
|Dry and chapped lips | |Hypovolemia basically means |moisturized and improved skin| |To evaluate the degree of fluid |turgor. |
|With poor skin turgor | |low blood volume. "Hypo" means|turgor. |Estimated the procedural fluid |deficit. | |
|Decreased perspiration and | |low, "vol" is for volume, and | |loses. | | |
|salivation | |"emia" refers to blood. | | |To correct/ replace loses to | |
|Use of 6 sanitary pads within the| |Symptoms of hypovolemia may | |e. Encouraged patient to increase |reverse patho-physiologic | |
|shift | |include cold hands and feet, | |fluid intake. |mechanism. | |
| | |light headedness, infrequent | | | | |
| | |urination, increased heart | | |Dehydration can alter mental | |
| | |rate, and weakness. | | |status. | |
| | | | |f. Documented baseline mental | | |
| | | | |status and record. |g. This prevents complications | |
| | | | | |associated with therapy. | |
| | | | |g. Monitored closely for signs of | | |
| | | | |circulatory overload (headache, | | |
| | | | |flushed skin, tachycardia, | | |
| | | | |shortness of breath, increased BP, | | |
| | | | |tachypnea). | | |
| | | | | | | |
| | | | |f. Maintained and regulated IVF |f. D5LR is the IV fluid | |
| | | | |(D5LR1L x 8°). |recommended to treat dehydration.| |
ACUTE PAIN
|ASSESSMENT/ |NURSING DIAGNOSIS |BACKGROUND KNOWLEDGE |GOAL/ |NURSING INTERVENTIONS |RATIONALE |EVALUATION |
|CUES | | |OBJECTIVES | | | |
| | | | | | | |
|Subjective |Alteration in comfort: Acute |Acute pain is an unpleasant |Long Term: |Assessed pain by providing pain |To evaluate the patient’s |Goal unmet. |
| |hypogastric pain related |sensory and emotional |To facilitate the maintenance|rating scale of 0 to 10. |response to pain. | |
|“Sobrang sakit talaga ng tyan |to ineffective tissue |experience arising from actual|of regulatory mechanism and | | |Although the patient has |
|ko,” as vebalized by the patient.|perfusion as manifested by |or potential tissue damage; |functions. |Monitored and recorded V/S. | |identified the different |
| |verbal response of a pain |sudden or slow onset of any | | |To serve as baseline data. |predisposing factors and was |
|Objective |scale of 9/10, 10 being the |intensify from mild to severe |Short term: | | |encouraged to use the |
|Hypogastric pain |highest, body weakness and |with an anticipated end and a |At the end of the shift, the |Discussed with the patient the | |different relaxation |
|Guarding Behavior |facial mask. |duration of less than 6 |patient will report a |different predisposing factors that|To find ways on how to avoid them|techniques taught, the pain |
|Evident body weakness | |months. |decrease in the pain scale |may cause or increase pain such as |or avoid increasing pain being |did not decrease by the end |
|Facial mask | | |from 9 as severe pain to 5 as|stress. |felt. |of the shift for the reason |
|Pain scale of 9/10 | | |moderate pain. | | |that the patient was sent to |
| | | | | | |DR for VSD. |
|Pain scale: | |Pain resulting from uterine | |Encouraged use of relaxation skills| | |
|Severe pain: 8-10 | |cramping is an expected part | |like proper breathing technique, | | |
|Moderate pain: 4-7 | |of the abortion process. | |positioning on a side-lying | | |
|Mild& tolerable:1-3 | | | |position, and therapeutic touch. |To control the pain felt and to | |
|No pain at all: 0 | | | | |promote partner participation. | |
| | |Pain preceded by vaginal | |Encouraged a complete bed rest and | | |
| | |bleeding, in the middle | |having adequate rest. | | |
| | |&intermittent. | | | | |
| | | | | | | |
| | | | |Observed for untoward signs and | | |
| | | | |symptoms like continuous increase | | |
| | | | |of pain felt by the patient. |To promote wellness and avoid | |
| | | | | |putting tension on the pain site.| |
| | | | | | | |
| | | | | |To prevent any other | |
| | | | | |complications and to implement | |
| | | | | |immediate action. | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
KNOWLEDGE DEFICIT
|Assessment/Cue |Nursing Diagnosis |Background knowledge |Objectives of Care |Nursing Intervention |Rationale |Evaluation |
| | | | | | | |
|Subjective: |Knowledge deficit related to |Knowledge deficit is the |Long Term Goal: |a. Determined patient’s |a. To determine if the |Goal met. |
|“Di pa nga din malinaw sa’kin kung |incomplete information |lack of specific |To facilitate awareness of |ability/readiness and barriers to|individual may not be | |
|bakit ako laging nakukunan. Di ko |presented to the patient as |information necessary for |self as individual with |learning. |physically, emotionally, or |The patient was able to |
|pa din alam kung anong gagawin |manifested by concerns and |patient to make informed |varying physical, emotional, | |mentally capable of receiving|distinguish the possible|
|sakin ngayon, as verbalized by the |requests for information. |choices regarding health |and developmental needs. | |information. |reasons why she had |
|patient. | |condition. | | | |miscarriage and was |
| | | | | |b. To encourage the patient |encouraged to take some |
|Objective: | | |Short Term: | |to learn. |preventive measures such|
|unable to give coherent responses | | |At the end of the shift, the |b. Provided an atmosphere of | |as avoiding strenuous |
| | | |patient will become informed |respect, openness, trust, and | |activities, having |
|has many questions regarding her | | |regarding with the possible |collaboration. | |adequate rest, and |
|condition | | |causes of miscarriage, the |c. Assessed patient's desire to |c. To make learning fun and |maintaining proper diet.|
| | | |different processes it |learn and preferred learning |acceptable for the patient. | |
| | | |undergoes, and how to prevent |mode. | | |
| | | |it. |d. Determined the level of |d. To serve as a guide in | |
| | | | |knowledge and ability to learn by|giving appropriate | |
| | | | |asking significant questions |interventions and ways on how| |
| | | | |regarding her awareness on her |to deliver necessary | |
| | | | |condition. |information. | |
| | | | | | | |
| | | | |e. Conducted health teaching |e. To answer the need of the | |
| | | | |about abortion. |patient for information. | |
| | | | | | | |
| | | | | |f. To give the patient a | |
| | | | |f. Identified support persons and|support system, this is her | |
| | | | |significant others requiring |family with needed | |
| | | | | |information and health | |
| | | | | |teaching. | |
| | | | | | | |
IV. ANATOMY AND PHYSIOLOGY
The Reproductive System
All living things reproduce. This is something that sets the living apart from non-living. Even though the reproductive system is essential to keeping a species alive, it is not essential to keeping an individual alive.
Once a complication or interruption occurs before the time the fetus is viable, an abortion may occur. If not properly managed, it could lead to fetal death and later on, the expulsion of the fetus. Therefore, a thorough understanding on the whole structure of the system involved is needed.
The following topic describes the different parts of the female reproductive system: the organs involved in the process of reproduction, hormones that regulate a woman's body, the menstrual cycle, ovulation and pregnancy, the female's role in genetic division.
Reproduction
Reproduction can be defined as the process by which an organism continues its species. In the human reproductive process, two kinds of sex cells ( tes), are involved: the male te (sperm), and the female te (egg or ovum). These two tes meet within the female's uterine tubes located one on each side of the upper pubic cavity,and begin to create a new individual. The female needs a male to fertilize her egg; she then carries offspring through pregnancy and childbirth.
External Genitals
Vulva
The external female genitals are collectively referred to as The Vulva. This consists of the labia majora and labia minora (while these names translate as "large" and "small" lips, often the "minora" can be larger, and protrude outside the "majora"), mons pubis, clitoris, opening of the urethra (meatus), vaginal vestibule, vestibular bulbs, vestibular glands.
The term "vagina" is often improperly used as a generic term to refer to the vulva or female genitals, even though - strictly speaking - the vagina is a specific internal structure and the vulva is the exterior genitalia only. Calling the vulva the vagina is akin to calling the mouth the throat.
Mons Veneris
The mons veneris, Latin for "mound of Venus" (Roman Goddess of love) is the soft mound at the front of the vulva (fatty tissue covering the pubic bone). It is also referred to as the mons pubis. The mons veneris is sexually sensitive in some women and protects the pubic bone and vulva from the impact of sexual intercourse. After puberty it is covered with pubic hair, usually in a triangular shape. Heredity can play a role in the amount of pubic hair an individual grows.
Labia Majora
The labia majora are the outer "lips" of the vulva. They are pads of loose connective and adipose tissue, as well as some smooth muscle. The labia majora wrap around the vulva from the mons pubis to the perineum. The labia majora generally hides, partially or entirely, the other parts of the vulva. There is also a longitudinal separation called the pudendal cleft. These labia are usually covered with pubic hair. The color of the outside skin of the labia majora is usually close to the overall color of the individual, although there may be some variation. The inside skin is usually pink to light brown. They contain numerous sweat and oil glands. It has been suggested that the scent from these oils are sexually arousing.
Labia Minora
Medial to the labia majora are the labia minora. The labia minora are the inner lips of the vulva. They are thin stretches of tissue within the labia majora that fold and protect the vagina, urethra, and clitoris. The appearance of labia minora can vary widely, from tiny lips that hide between the labia majora to large lips that protrude. There is no pubic hair on the labia minora, but there are sebaceous glands. The two smaller lips of the labia minora come together longitudinally to form the prepuce, a fold that covers part of the clitoris. The labia minora protect the vaginal and urethral openings. Both the inner and outer labia are quite sensitive to touch and pressure.
Clitoris
The clitoris, visible as the small white oval between the top of the labia minora and the clitoral hood, is a small body of spongy tissue that functions solely for sexual pleasure. Only the tip or glans of the clitoris shows externally, but the organ itself is elongated and branched into two forks, the crura, which extend downward along the rim of the vaginal opening toward the perineum. Thus the clitoris is much larger than most people think it is, about 4" long on average.
The clitoral glans or external tip of the clitoris is protected by the prepuce, or clitoral hood, a covering of tissue similar to the foreskin of the male penis. However, unlike the penis, the clitoris does not contain any part of the urethra.
During sexual excitement, the clitoris erects and extends, the hood retracts, making the clitoral glans more accessible. The size of the clitoris is variable between women. On some, the clitoral glans is very small; on others, it is large and the hood does not completely cover it.
Urethra
The opening to the urethra is just below the clitoris. Although it is not related to sex or reproduction, it is included in the vulva. The urethra is actually used for the passage of urine. The urethra is connected to the bladder. In females the urethra is 1.5 inches long, compared to males whose urethra is 8 inches long. Because the urethra is so close to the anus, women should always wipe themselves from front to back to avoid infecting the vagina and urethra with bacteria. This location issue is the reason for bladder infections being more common among females.
Hymen
The hymen is a thin fold of mucous membrane that separates the lumen of the vagina from the urethral sinus. Sometimes it may partially cover the vaginal orifice. The hymen is usually perforated during later fetal development.
Because of the belief that first vaginal penetration would usually tear this membrane and cause bleeding, its "intactness" has been considered a guarantor of virginity. However, the hymen is a poor indicator of whether a woman has actually engaged in sexual intercourse because a normal hymen does not completely block the vaginal opening. The normal hymen is never actually "intact" since there is always an opening in it. Furthermore, there is not always bleeding at first vaginal penetration. The blood that is sometimes, but not always, observed after first penetration can be due to tearing of the hymen, but it can also be from injury to nearby tissues.
A tear to the hymen, medically referred to as a "transection," can be seen in a small percentage of women or girls after first penetration. A transection is caused by penetrating trauma. Masturbation and tampon insertion can, but generally are not forceful enough to cause penetrating trauma to the hymen. Therefore, the appearance of the hymen is not a reliable indicator of virginity or chastity.
Perineum
The perineum is the short stretch of skin starting at the bottom of the vulva and extending to the anus. It is a diamond shaped area between the symphysis pubis and the coccyx. This area forms the floor of the pelvis and contains the external sex organs and the anal opening. It can be further divided into the urogenital triangle in front and the anal triangle in back.
Perineum in some women may tear during the birth of an infant and this is apparently natural. Some physicians however, may cut the perineum preemptively on the grounds that the "tearing" may be more harmful than a precise cut by a scalpel. If a physician decides the cut is necessary, they will perform it. The cut is called an episiotomy.
Internal Genitals
Vagina
The vagina is a muscular, hollow tube that extends from the vaginal opening to the cervix of the uterus. It is situated between the urinary bladder and the rectum. It is about three to five inches long in a grown woman. The muscular wall allows the vagina to expand and contract. The muscular walls are lined with mucous membranes, which keep it protected and moist. A thin sheet of tissue with one or more holes in it, called the hymen, partially covers the opening of the vagina. The vagina receives sperm during sexual intercourse from the penis. The sperm that survive the acidic condition of the vagina continue on through to the fallopian tubes where fertilization may occur.
The vagina is made up of three layers, an inner mucosal layer, a middle muscularis layer, and an outer fibrous layer. The inner layer is made of vaginal rugae that stretch and allow penetration to occur. These also help with stimulation of the penis. The middle layer has glands that secrete an acidic mucus (pH of around 4.0.) that keeps bacterial growth down. The outer muscular layer is especially important with delivery of a fetus and placenta.
Purposes of the Vagina
• Receives a males erect penis and semen during sexual intercourse.
• Pathway through a womans body for the baby to take during childbirth.
• Provides the route for the menstrual blood (menses) from the uterus, to leave the body.
• May hold forms of birth control, such as a diaphragm, FemCap, Nuva Ring, or female condom.
Cervix
The cervix (from Latin "neck") is the lower, narrow portion of the uterus where it joins with the top end of the vagina. Where they join together forms an almost 90 degree curve. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall. Approximately half its length is visible with appropriate medical equipment; the remainder lies above the vagina beyond view. It is occasionally called "cervix uteri", or "neck of the uterus".
During menstruation, the cervix stretches open slightly to allow the endometrium to be shed. This stretching is believed to be part of the cramping pain that many women experience. Evidence for this is given by the fact that some women's cramps subside or disappear after their first vaginal birth because the cervical opening has widened.
The portion projecting into the vagina is referred to as the portio vaginalis or ectocervix. On average, the ectocervix is three cm long and two and a half cm wide. It has a convex, elliptical surface and is divided into anterior and posterior lips. The ectocervix's opening is called the external os. The size and shape of the external os and the ectocervix varies widely with age, hormonal state, and whether the woman has had a vaginal birth. In women who have not had a vaginal birth the external os appears as a small, circular opening. In women who have had a vaginal birth, the ectocervix appears bulkier and the external os appears wider, more slit-like and gaping.
The passageway between the external os and the uterine cavity is referred to as the endocervical canal. It varies widely in length and width, along with the cervix overall. Flattened anterior to posterior, the endocervical canal measures seven to eight mm at its widest in reproductive-aged women. The endocervical canal terminates at the internal os which is the opening of the cervix inside the uterine cavity.
During childbirth, contractions of the uterus will dilate the cervix up to 10 cm in diameter to allow the child to pass through. During orgasm, the cervix convulses and the external os dilates.
Uterus
uterus is shaped like an upside-down pear, with a thick lining and muscular walls. Located near the floor of the pelvic cavity, it is hollow to allow a blastocyte, or fertilized egg, to implant and grow. It also allows for the inner lining of the uterus to build up until a fertilized egg is implanted, or it is sloughed off during menses.
The uterus contains some of the strongest muscles in the female body. These muscles are able to expand and contract to accommodate a growing fetus and then help push the baby out during labor. These muscles also contract rhythmically during an orgasm in a wave like action. It is thought that this is to help push or guide the sperm up the uterus to the fallopian tubes where fertilization may be possible.
The uterus is only about three inches long and two inches wide, but during pregnancy it changes rapidly and dramatically. The top rim of the uterus is called the fundus and is a landmark for many doctors to track the progress of a pregnancy. The uterine cavity refers to the fundus of the uterus and the body of the uterus.
Helping support the uterus are ligaments that attach from the body of the uterus to the pelvic wall and abdominal wall. During pregnancy the ligaments prolapse due to the growing uterus, but retract after childbirth. In some cases after menopause, they may lose elasticity and uterine prolapse may occur. This can be fixed with surgery.
Some problems of the uterus include uterine fibroids, pelvic pain (including endometriosis, adenomyosis), pelvic relaxation (or prolapse), heavy or abnormal menstrual bleeding, and cancer. It is only after all alternative options have been considered that surgery is recommended in these cases. This surgery is called hysterectomy. Hysterectomy is the removal of the uterus, and may include the removal of one or both of the ovaries. Once performed it is irreversible. After a hysterectomy, many women begin a form of alternate hormone therapy due to the lack of ovaries and hormone production.
Fallopian Tubes
At the upper corners of the uterus are the fallopian tubes. There are two fallopian tubes, also called the uterine tubes or the oviducts. Each fallopian tube attaches to a side of the uterus and connects to an ovary. They are positioned between the ligaments that support the uterus. The fallopian tubes are about four inches long and about as wide as a piece of spaghetti. Within each tube is a tiny passageway no wider than a sewing needle. At the other end of each fallopian tube is a fringed area that looks like a funnel. This fringed area, called the infundibulum, lies close to the ovary, but is not attached. The ovaries alternately release an egg. When an ovary does ovulate, or release an egg, it is swept into the lumen of the fallopian tube by the frimbriae.
Once the egg is in the fallopian tube, tiny hairs in the tube's lining help push it down the narrow passageway toward the uterus. The oocyte, or developing egg cell, takes four to five days to travel down the length of the fallopian tube. If enough sperm are ejaculated during sexual intercourse and there is an oocyte in the fallopian tube, fertilization will occur. After fertilization occurs, the zygote, or fertilized egg, will continue down to the uterus and implant itself in the uterine wall where it will grow and develop.
If a zygote doesn't move down to the uterus and implants itself in the fallopian tube, it is called a ectopic or tubal pregnancy. If this occurs, the pregnancy will need to be terminated to prevent permanent damage to the fallopian tube, possible hemorrhage and possible death of the mother.
|STRUCTURE |LOCATION & DESCRIPTION |FUNCTION |
|Cervix |The lower narrower portion of the |During childbirth, contractions of the uterus will dilate |
| |uterus. |the cervix up to 10 cm in diameter to allow the child to |
| | |pass through. During orgasm, the cervix convulses and the |
| | |external os dilates |
|Clitoris |Small erectile organ directly in |Sexual excitation, engorged with blood. |
| |front of the vestibule. | |
|Fallopian tubes |Extending upper part of the uterus |Egg transportation from ovary to uterus (fertilization |
| |on either side. |usually takes place here). |
|Hymen |Thin membrane that partially covers | |
| |the vagina in young females. | |
|Labia majora |Outer skin folds that surround the |Lubrication during mating. |
| |entrance to the vagina. | |
|Labia minora |Inner skin folds that surround the |Lubrication during mating. |
| |entrance to the vagina. | |
|Mons |Mound of skin and underlying fatty | |
| |tissue, central in lower pelvic | |
| |region | |
|Ovaries (female gonads) |Pelvic region on either side of the |Provides an environment for maturation of oocyte. |
| |uterus. |Synthesizes and secretes sex hormones (estrogen and |
| | |progesterone). |
|Perineum |Short stretch of skin starting at | |
| |the bottom of the vulva and | |
| |extending to the anus. | |
|Urethra |Pelvic cavity above bladder, tilted.|Passage of urine. |
|Uterus |Center of pelvic cavity. |To house and nourish developing human. |
|Vagina |Canal about 10-8 cm long going from |Receives penis during mating. Pathway through a womans body|
| |the cervix to the outside of the |for the baby to take during childbirth. Provides the route |
| |body. |for the menstrual blood (menses) from the uterus, to leave |
| | |the body. May hold forms of birth control, such as an IUD, |
| | |diaphragm, neva ring, or female condom |
|Vulva |Surround entrance to the | |
| |reproductive tract.(encompasses all | |
| |external genitalia) | |
|Endometrium |The innermost layer of uterine wall.|Contains glands that secrete fluids that bathe the utrine |
| | |lining. |
|Myometrium |Smooth muscle in uterine wall. |Contracts to help expel the baby. |
Female Reproductive Cycle
Towards the end of puberty, girls begin to release eggs as part of a monthly period called the female reproductive cycle, or menstrual cycle (menstrual referring to "monthly"). Approximately every 28 days, during ovulation, an ovary sends a tiny egg into one of the fallopian tubes. Unless the egg is fertilized by a sperm while in the fallopian in the two to three days following ovulation, the egg dries up and leaves the body about two weeks later through the vagina. This process is called menstruation. Blood and tissues from the inner lining of the uterus (the endometrium) combine to form the menstrual flow, which generally lasts from four to seven days. The first period is called menarche. During menstruation arteries that supply the lining of the uterus constrict and capillaries weaken. Blood spilling from the damaged vessels detaches layers of the lining, not all at once but in random patches. Endometrium mucus and blood descending from the uterus, through the liquid creates the menstruation flow.
Menstrual cycle
The reproductive cycle can be divided into an ovarian cycle and a uterine cycle (compare ovarian histology and uterine histology in the diagram on the right). During the uterine cycle, the endometrial lining of the uterus builds up under the influence of increasing levels of estrogen (labeled as estradiol in the image). Follicles develop, and within a few days one matures into an ovum, or egg. The ovary then releases this egg, at the time of ovulation. After ovulation the uterine lining enters a secretory phase, or the ovarian cycle, in preparation for implantation, under the influence of progesterone. Progesterone is produced by the corpus luteum (the follicle after ovulation) and enriches the uterus with a thick lining of blood vessels and capillaries so that it can sustain the growing fetus. If fertilization and implantation occur, the embryo produces Human Chorionic Gonadotropin (HCG), which maintains the corpus luteum and causes it to continue producing progesterone until the placenta can take over production of progesterone. Hence, progesterone is "pro gestational" and maintains the uterine lining during all of pregnancy. If fertilization and implantation do not occur the corpus luteum degenerates into a corpus albicans, and progesterone levels fall. This fall in progesterone levels cause the endometrium lining to break down and sluff off through the vagina. This is called menstruation, which marks the low point for estrogen activity and is the starting point of a new cycle.
Common usage refers to menstruation and menses as a period. This bleeding serves as a sign that a woman has not become pregnant. However, this cannot be taken as certainty, as sometimes there is some bleeding in early pregnancy. During the reproductive years, failure to menstruate may provide the first indication to a woman that she may have become pregnant.
Menstruation forms a normal part of a natural cyclic process occurring in healthy women between puberty and the end of the reproductive years. The onset of menstruation, known as menarche, occurs at an average age of 12, but is normal anywhere between 8 and 16. Factors such as heredity, diet, and overall health can accelerate or delay the onset of menarche.
Signs of ovulation
The female body produces outward signs that can be easily recognized at the time of ovulation. The two main signs are thinning of the cervical mucus and a slight change in body temperature.
Thinning of the Cervical Mucus
After menstruation and right before ovulation, a woman will experience an increase of cervical mucus. At first, it will be thick and yellowish in color and will not be very plentiful. Leading up to ovulation, it will become thinner and clearer. On or around the day of ovulation, the cervical mucus will be very thin, clear and stretchy. It can be compared to the consistency of egg whites. This appearance is known as 'spinnbarkeit'.
Temperature Change
A woman can also tell the time of ovulation by taking her basal body temperature daily. This is a temperature taken with a very sensitive thermometer first thing in the morning before the woman gets out of bed. The temperature is then tracked to show changes. In the uterine cycle, a normal temperature will be around 97.0 – 98.0. The day of ovulation the temperature spikes down, usually into the 96.0 – 97.0 range and then the next morning it will spike up to normal of around 98.6 and stay in that range until menstruation begins.
Both of these methods are used for conception and contraception. They are more efficient in conception due to the fact that sperm can live for two to three days inside of the fallopian tubes. A woman could be off by a couple of days in her calculations and still become pregnant.
Menopause is the physiological cessation of menstrual cycles associated with advancing age. Menopause is sometimes referred to as "the change of life" or climacteric. Menopause occurs as the ovaries stop producing estrogen, causing the reproductive system to gradually shut down. As the body adapts to the changing levels of natural hormones, vasomotor symptoms such as hot flashes and palpitations, psychological symptoms such as increased depression, anxiety, irritability, mood swings and lack of concentration, and atrophic symptoms such as vaginal dryness and urgency of urination appear. Together with these symptoms, the woman may also have increasingly scanty and erratic menstrual periods.
Technically, menopause refers to the cessation of menses; the gradual process through which this occurs, which typically takes a year but may last as little as six months or more than five years, is known as climacteric. A natural or physiological menopause is that which occurs as a part of a woman's normal aging process. However, menopause can be surgically induced by such procedures as hysterectomy.
The average onset of menopause is 50.5 years, but some women enter menopause at a younger age, especially if they have suffered from cancer or another serious illness and undergone chemotherapy. Premature menopause is defined as menopause occurring before the age of 40, and occurs in 1% of women. Other causes of premature menopause include autoimmune disorders, thyroid disease, and diabetes mellitus.
Premature menopause is diagnosed by measuring the levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH). The levels of these hormones will be higher if menopause has occurred. Rates of premature menopause have been found to be significantly higher in both fraternal and identical twins; approximately 5% of twins reach menopause before the age of 40. The reasons for this are not completely understood. Post-menopausal women are at increased risk of osteoporosis.
Perimenopause refers to the time preceding menopause, during which the production of hormones such as estrogen and progesterone diminish and become more irregular. During this period fertility diminishes. Menopause is arbitrarily defined as a minimum of twelve months without menstruation. Perimenopause can begin as early as age 35, although it usually begins much later. It can last for a few months or for several years. The duration of perimenopause cannot be predicted in advance.
Premenstrual Syndrome (PMS) It is common for women to experience some discomfort in the days leading up to their periods. PMS usually is at its worst the seven days before a period starts and can continue through the end of the period. PMS includes both physical and emotional symptoms: acne, bloating, fatigue, backaches, sore breasts, headaches, constipation, diarrhea, food cravings, depression, irritability, difficulty concentrating or handling stress.
HORMONAL CHANGES DURING PREGNANCY
Human Chorionic Gonadotropin (hCG)
It stimulates the production of estrogen and progesterone within the ovary. It is released very early in pregnancy and isn't present at any other time. This is the hormone which pregnancy tests look for. Production of this hormone diminishes once the placenta is mature enough to take over estrogen and progesterone production.
Estrogen
This hormone causes the breast tenderness and enlargement which are typical of early pregnancy. It is produced throughout pregnancy, and helps to regulate levels of progesterone and prepare the womb for the baby and the breasts for feeding.
Progesterone
Prevents the womb from spontaneously aborting the fetus by building up the lining so that it can support the placenta, and by preventing the natural movement and contractions of the womb. This is the hormone which is responsible for the loss of interest in sex during pregnancy.
Prolactin
Prolactin is produced by the pituitary gland. It is responsible for the increase in cells which produce milk within the breasts. Progesterone and estrogen actually prevent milk from being produced. Immediately after birth, the levels of these hormones drop dramatically, allowing prolactin to stimulate the initial production of milk. Suckling also controls milk production. Prolactin also helps prevent a nursing mother from falling pregnant, but cannot be relied on as the only form of contraception.
Relaxin
This is found early in pregnancy and is responsible for helping limit the activity of the womb and soften the cervix in preparation for delivery.
Oxytocin
Oxytocin seems to be involved in reproductive behaviour in both men and women, and apparently triggers "caring" behaviour. It is also the hormone which allows contractions of the womb during pregnancy and labour . Contractions felt during breast feeding are also due to oxytocin. Also used to induce labour .
Prostaglandins
These are tissue hormones and seem to play a role in getting labour started. Synthetic prostaglandins are used to induce labour in a pregnancy which has gone past its 40th week.
Ovarian and Uterine Cycles in the Nonpregnant Woman
|Ovarian Cycle |Events |Uterine Cycle |Events |
|Follicular phase - Days |FSH secretion begins. |Menstruation - Days 2-5 |Endometrium breaks down. |
|1-13 | | | |
| |Follicle maturation occurs. |Proliferative phase - Days |Endometrium rebuilds. |
| | |6-13 | |
| |Estrogen secretion is prominent.|- |- |
|Ovulation - Day 14* |LH spike occurs. |- |- |
|Luteal phase - Days 15-28|LH secretion continues. |Secretory phase - Days 15-28 |Endometrial thickens, and glands are |
| | | |secretory. |
| |Corpus luteum forms. |- |- |
| |Progesterone secretion is |- |- |
| |prominent. | | |
There are two phases of the ovarian cycle the follicular phase and the luteal phase. In the follicular phase about 10-25 follicles are taken from preantral or early antrial follicles to develop further. Seven days later the dominant follicle is selected to develop to full maturity. This is the pre-cursor for ovulation. Follicles themselves secrete FSH and estrogen, and these two hormones stimulate follicular growth and development. Ovulation marks the beginning of the luteal phase. This is started by the wall of the Graffian follicle to rupture and cause a flow of antral fluid that will carry the oocyte to the ovary's surface. The ruptured follicle is then turned into a gland (corpus luteum). Which secretes estrogens and progesterone. This is all triggered by and abrupt change in plasma LH levels. After ovulation the released oocyte enters the uterine tube, where it will be either fertilized or discarded.
The uterine cycle operates in sync with the ovarian cycle and is divided into three phases. The first phase in the menstrual phase. It is named the menstrual phase because in corresponds with the shedding the the uterine lining or more commonly called menstruation. The corpus luteum degenerates causing plasma estrogen and progesterone levels to decrease and in turn causes menstruation. Blood vessels in the outer most layer of the endometrium constrict and decrease blood flow to the tissues killing these tissues. After the tissues die they start to separate from the underlying endometrail tissues. Eventually the dead tissue is shed. This shedding of the tissues ruptures blood vessels and causes bleeding. Now we have the proliferative phase. During this phase the uterus renews itself and prepares for pregnancy. The endomitrial tissue that is left after menstruation begins to grow. The endometrial glands grow and enlarge causing more blood vessels. The cervical canal has glands that secrete a thin mucous that helps deposited sperm. Estrogen promotes uterine changes in this phase. The last phase is the secretory phase. This is where the endometrium is transformed to make it the best environment for implantation and subsequent housing and nourishment of the developing embryo. By doing this the endometrium will do things like have an enriched blood supply, begin to secrete fluids rich in glycogen, and even form a plug at the end of the cervical canal so that microorganisms can not enter. These changes in the uterus are caused by progesterone, due to the corpus luteum. At the end of the secretory phase the corpus luteum degenerates, and progesterone levels fall. This will trigger menstruation.
Sexual Reproduction
Sexual reproduction is a type of reproduction that results in increasing genetic diversity of the offspring. In sexual reproduction, genes from two individuals are combined in random ways with each new generation. Sex hormones released into the body by the endocrine system signal the body when it is time to start puberty. The female and male reproductive systems are the only systems so vastly different that each sex has their own different organs. All other systems have "unisex" organs.
Reproduction is characterized by two processes. The first, meiosis, involves the halving of the 46 of chromosomes. The second process, fertilization, leads the fusion of two gametes and the restoration of the original number of chromosomes: 23 chromosomes from the paternal side and 23 from the maternal side. During meiosis, the chromosomes of each pair usually cross over to achieve genetic recombination.
Sexual reproduction cannot happen without the sexual organs called gonads. Both sexes have gonads: in females, the gonads are the ovaries. The female gonads produce female gametes (eggs); the male gonads produce male gametes (sperm). After an egg is fertilized by the sperm, the fertilized egg is called the zygote.
The fertilization usually occurs in the oviducts, but can happen in the uterus itself. The zygote then implants itself in the wall of the uterus, where it begins the processes of embryogenesis and morphogenesis. The womens body carries out this process of reproduction for 40 weeks, until delivery of the fetus from the uterus through the vagina or birth canal. Even after birth, the female continues with the reproduction process by supplying the milk to nourish the infant.
V. PATHOPHYSIOLOGY
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Legend:
- Precipitating/Predisposing Factors
- Physiologic Activities
- Laboratory Procedures
- Signs and Symptoms
VI. MEDICAL-SURGICAL MANAGEMENT
|Name |Indication |Nursing Responsibilities |
| | | |
| | |PRE |
|D5LRiLx80 |Treats dehydration |Verify doctors order |
| |Restore normal fluid after extra |Know the type, amount and indication |
| |cellular fluid shift from injection etc.|Inform patient and explain the purpose of|
| | |the IV therapy. |
| | |Should not be given to the patient with |
| | |renal failure because it contains |
| | |potassium and can cause hyperkalemia. |
| | | |
| | |INTRA |
| | |Calculate the infusion rate and regulate |
| | |flow of infusion |
| | |Label the intravenous container with date|
| | |and time |
| | |Regulate the IV fluid frequently |
| | | |
| | | |
| | | |
| | |POST |
| | |Document relevant data |
| | |Observe for potential complication |
| | |such as infiltration, thrombophlebitis, |
| | |air embolism, circulatory overload, |
| | |catheter embolism, infection of |
| | |venipuncture site and allergic reaction |
|Name |Indication |Nursing Responsibilities |
| | | |
| | |PRE |
|D5W |It is used to supply water and calories |Verify doctors order |
| |to the body. It is also used as a mixing|Know the type, amount and indication |
| |solution (diluent) for other IV |Check the product visually for particles |
| |medications. |or discoloration |
| | |Follow all instructions for proper mixing|
| | |with other IV medications |
| | |Inform patient and explain the purpose of|
| | |the IV therapy. |
| | | |
| | |INTRA |
| | |Calculate the infusion rate and regulate |
| | |flow of infusion. |
| | |Label the intravenous container with date|
| | |and time. |
| | | |
| | | |
| | | |
| | |POST |
| | |Document relevant data |
| | |Observe for potential complication such |
| | |as infiltration, thrombophlebitis, air |
| | |embolism, circulatory overload, infection|
| | |of venipuncture site and allergic |
| | |reaction |
Imminent Abortion
|DRUG |MECHANISM OF ACTION |INDICATION |CONTRAINDICATIONS |ADVERSE EFFECT |NURSING RESPONSIBILITIES |
| | | | | | |
|Generic: Name: |Composed of vitamins (A, B-complex, |Prevention of neural tube defects & |Known hypersensitivity to any of the |>Tooth staining |a. Review form of drug prescribed and |
|Vitamins + Minerals |C, D, E, K) and minerals (selenium, |as supplement for maternal nutrition|vitamins in this product or a pre-existing| |the frequency of administration. |
| |pantothenic acid, Ca, ferrous |during pregnancy. |hypervitaminosis. |>Increased urination | |
|Brand: |fumarate, chromium, boron, etc) | | | |b. May be administered with food for |
|Mosvit |providing maternal nutrition. | | |>Stomach bleeding |better absorption or if GI discomfort |
| | | | | |occurs. |
|Classification: | | | |>Uneven heart rate | |
|Vitamins & Minerals (Pre & Post | | | | |c. Remind the patient to never take |
|Natal) / Antianemics | | | |>Confusion |more than the recommended dose of a |
| | | | | |multivitamin. |
|Dosage/Form: | | | |>Muscle weakness or limp | |
|1 tab | | | |feeling |d. Store multivitamins in their |
| | | | | |original container. |
|Frequency: | | | | | |
|OD | | | | |e. Store this medication at room |
| | | | | |temperature away from moisture and |
| | | | | |heat. |
|Route: | | | | | |
|po | | | | |f. Keep the liquid medicine from |
| | | | | |freezing. |
| | | | | | |
| | | | | |g. Advise patient to report any unusual|
| | | | | |effect of drug. |
| | | | | | |
| | | | | |h. Do not take extra medicine to make |
| | | | | |up the missed dose. |
| | | | | | |
| | | | | |i. Inform patient on the indication of |
| | | | | |the drug she’s taking. |
| | | | | | |
| | | | | | |
| | | | | | |
|DRUG |MECHANISM OF ACTION |INDICATION |CONTRAINDICATIONS |ADVERSE EFFECT |NURSING RESPONSIBILITIES |
| | | | | | |
|Generic Name: Ampicillin |Bactericidal action against |Exerts bactericidal action on both |>hypersensitivity to drug/class/component |>GI upset |a. Note history of sensitivity/reactions |
| |sensitive organisms. It inhibits the|gm+ve and gm-ve organisms. Its | | |to the drug. |
|Brand Name: |synthesis of bacterial cell wall, |spectrum includes gm+ve organisms |>infectious mononucleosis. |>nausea & vomiting | |
|Ampicillin sodium |therefore, causing cell death. |eg, S pneumoniae and other | | |b. Check for compatibility and length of |
| | |Streptococci, L monocytogenes and |>to be used cautiously to patient with |> gastritis |time drug retains potency in particular |
|Classification: | |gm-ve bacteria eg, M catarrhalis, N |renal function | |solution. |
|Antibiotic | |gonorrhoea, N meningitidis, E coli, | |>stomatitis | |
| | |P mirabilis, Salmonella, Shigella, | | |c. Be sure that the solution is used |
|Dosage/Form: | |and H influenzae. | | |within the hour after reconstituting and |
|Powder for injection: 1g | | | | |give IV slowly. |
| | | | | | |
|Frequency: | | | | |d. Give an hour before or 2 hours after |
|q6° | | | | |meals (food may interfere with absorption)|
| | | | | | |
|Route: | | | | |e. Remind patient to report any adverse |
|IV | | | | |effects or if S/Sx do not improve or have |
| | | | | |worsen. |
| | | | | | |
|DRUG |MECHANISM OF ACTION |INDICATION |CONTRAINDICATIONS |ADVERSE EFFECT |NURSING RESPONSIBILITIES |
| | | | | | |
|Generic: |Composed of Ca ascorbate and Ca |Increased needs during |Known hypersensitivity to any of the |>Tooth staining |a. Note reasons for therapy, age of patient and |
|Calcium + |monohydrogen phosphate that |pregnancy & lactation, skeletal|vitamins in this product or a pre-existing | |physical condition. |
|Vitamins |compensate to the increased need of |disorders, leg cramps & |hypervitaminosis |>Increased urination | |
| |pregnant women for stronger muscular |allergic conditions, prolonged | | |b. Give the drug at the same time of the meal to |
|Brand: |tone as well as increased body |illness & convalescence; to | |>Stomach bleeding |increase drug effectiveness. |
|Calcebone |resistance. |increase body resistance | | | |
| | |against stress, listlessness, | |>Uneven heart rate |c. Store multivitamins in their original container.|
|Classification: | |cold & other infections. | | | |
|Calcium/with Vitamins | | | |>Confusion |d. Inform patient on the indication of the drug |
| | | | | |she’s taking. |
|Dosage/Form: | | | |>Muscle weakness or | |
|1tab | | | |limp feeling |e. Store this medication at room temperature away |
| | | | | |from moisture and heat. |
|Frequency: | | | | | |
|OD | | | | |f. Keep the liquid medicine from freezing. |
| | | | | | |
|Route: | | | | | |
|po | | | | | |
| | | | | |g. Advise patient to report any unusual effect of |
| | | | | |drug. |
| | | | | | |
| | | | | |h. Do not take extra medicine to make up the missed|
| | | | | |dose. |
| | | | | | |
| | | | | | |
|DRUG |MECHANISM OF ACTION |INDICATION |CONTRAINDICATIONS |ADVERSE EFFECT |NURSING RESPONSIBILITIES |
| | | | | | |
|Generic Name: |Used for threatened abortion. It |For treatment of progesterone |To be used with caution in patients with |>breakthrough bleeding |a. Review patient’s history including |
|Dydrogesterone |restores the luteal function, thereby |deficiency such as threatened |undiagnosed irregular vaginal bleeding and| |past illnesses and present case. |
| |decreasing the incidence of first |abortion (others include: habitual |hormone-dependent breast or genital |>altered liver | |
|Brand: |trimester abortions. It also relaxes |abortion, dysfunctional uterine |cancer. |function w/ asthenia |b. Use drug cautiously if patient has |
|Duphaston |the smooth musculature of the uterus |bleeding, dysmenorrhea, amenorrhea, | |or malaise |irregular vaginal bleeding and/or has |
| |and modulates maternal immune response.|luteal insufficiency, and irregular | | |breast or genital cancer. |
|Classification: | |cycles) | |> jaundice | |
|Progestogen Hormone (anti-abortive) | | | | |c. Inform patient on the indication of |
| | | | |>abdominal pain |the drug she’s taking. |
|Dosage/Form: | | | | | |
|10 mg tab | | | | | |
| | | | | | |
|Frequency: | | | | | |
|bid | | | | | |
| | | | | | |
|Route: | | | | | |
|DRUG |MECHANISM OF ACTION |INDICATION |CONTRAINDICATIONS |ADVERSE EFFECT |NURSING RESPONSIBILITIES |
| | | | | | |
|Generic: |Iron is absorbed from the duodenum |Prophylaxis and treatment of iron |>hypersensitivity to drug/class/component |>constipation |a. Take a drug history including |
|Ferrous sulfate |and upper jejunum by an active |deficiency and iron-deficiency | | |drugs taken that may interact with |
| |mechanism through the mucosal cells |anemias. |>hemosiderosis(iron overload) |>gastric irritation |FeSO4, and allergy to the drug or its|
|Brand: |where it combines with the protein | |>hemochromatosis(increase body iron stored | |components. |
|Iberet |transferrin. It is then stored in the| | |>nausea | |
| |body as hemosiderin or aggregated | |>peptic ulcer | |b. Review pregnancy & menstrual |
|Classification: |ferritin which is found in | | |>abdominal cramps |history. |
|Antianemic, iron |reticuloendothelial cells of the | |>regional enteritis | | |
| |liver, spleen, and bone marrow. About| | |>anorexia |c. Review form of iron prescribed and|
|Dosage/Form: |2/3 of the total body iron is in the | |>ulcerative colitis | |the frequency of administration. |
|200 mg tab |circulating RBCs in hemoglobin. | | |>diarrhea | |
| | | |>cirrhosis of the liver | | |
|Frequency: | | | |>dark-colored stools | |
|OD | | | | | |
| | | | | | |
|Route: | | | | | |
|po | | | | | |
| | | | | | |
| | | | | | |
After Complete Spontaneous Abortion
|Name of Drug |Mechanism of Action |Indication |Contraindication |Adverse Effects |Nursing Responsibilities |
| | | | | | |
|Generic name: |Interferes with final step in the cell |Treatment of susceptible |>Hypersensitivity to cephalexin, |>Abdominal pain |Take without regard to food. If GI distress, take |
|Cephalexin |wall formation (inhibition of |bacterial infections. |any component of the formulation, | |with food. Give around-the-clock to promote less |
| |mucopeptide biosynthesis), resulting in| |or other c |>diarrhea |variation in peak and through serum levels. |
|Brand name: |unstable cell membranes that undergo | |ephalosporins | | |
|Cephalex |lysis. Also, cell division and growth | | |>dyspepsia |Complete full course of medication, even if you feel |
| |are inhibited. | | | |better. |
|Classification: | | | |>gastritis | |
|Cephalosporin, first-generation| | | | | |
| | | | |>nausea |Maintain adequate hydration (2-3 L/day of fluids) |
|Dosage/Form: | | | | |unless instructed to restrict fluid intake. |
|Tablet, 500mg. | | | |>pseudomembranous | |
| | | | | |Monitor for any untoward S/Sx. |
|Frequency: | | | |>colitis | |
|q6° | | | | | |
| | | | |>vomiting | |
|Route: | | | | | |
|Oral | | | |>allergic reactions. | |
|Name of Drug |Mechanism of Action |Indication |Contraindication |Adverse Effects |Nursing Responsibilities |
| | | | | | |
|Generic name: |The normal daily iron intake for female|Dietary supplement for iron. |Hemolytic anemia, |>Constipation |Eggs, milk, coffee, or tea consumed with a meal or 1 |
|Ferrous Sulfate |is 8-15mg although only 10% of this | |pyridoxine-responsive anemia, and | |hour after may significantly inhibit absorption of |
| |iron is absorbed. Iron is absorbed in | |cirrhosis of the liver. Use with |>gastric |dietary iron. |
|Brand name: |the duodenum and upper jujenum by an | |normal iron balance. | | |
|Iberet |active mechanism through the musosal | | |>irritation |Note any GI bleeding; tarry stools or bright blood in |
| |cells where it combines with the | | | |stool or vomitus. |
|Classification: |protein transferin. Iron is stored in | | |>nausea | |
|Antianemic, iron |the body as hemosiderin or aggregated | | | | |
| |ferritin which is found in | | |>abdominal cramps |Tell client to adhere to prescribed regimen; report any|
|Dosage/Form: |reticuloendothelial cells of the liver,| | | |problems immediately. |
|Tablet, 500mg. |spleen and bone marrow. About | | |>anorexia | |
| |two-thirds of total body iron is in the| | | |Take with meals to reduce gastric irritation. |
|Frequency: |circulatory RBCs in hemoglobin. | | |> diarrhea | |
|1 tab, twice a day | | | | | |
| | | | |>dark-colored stools |Increase intake fruit, fiber and fluids to minimize |
|Route: | | | | |constipating effects. |
|Oral | | | | | |
|Name of Drug |Mechanism of Action |Indication |Contraindication |Adverse Effects |Nursing Responsibilities |
| | | | | | |
|Generic name: |Inhibits prostaglandin synthesis by |Short-term relief of mild to |Hypersensitivity to NSAIDs |>Gastric irritation |Use exactly as indicated. Report any problems |
|Mefenamic acid |decreasing the activity of the enzyme, |moderate pain including primary|including aspirin or any component| |immediately. |
| |cyclooxygenase, which results in |dysmenorrhea. |of the formulation |>nausea | |
|Brand name: |decreased formation of prostaglandin | | | |Take with food, milk, or antacids. While using this |
|Ponstan |precursors. | | |>vomiting |medication, do not use alcohol, excessive amounts of |
| | | | | |vitamin C, or salicylate-containing foods other |
|Classification: | | | |>dizziness |prescription or OTC medications containing aspirin or |
|Non-steroidal anti-inflammatory| | | | |salicylate, or other NSAIDs without consulting |
| | | | |>heartburn |prescriber. |
| | | | | | |
|Dosage/Form: | | | |>headaches |Maintain adequate hydration (2-3 L/day of fluids) |
|Tablet, 250mg. | | | | |unless instructed to restrict fluid intake. |
| | | | | | |
|Frequency: | | | | | |
|q6h | | | | | |
| | | | | | |
|Route: | | | | | |
|Oral | | | | | |
VII. Progress Notes
|DATE |NOTES |
| | |
|September 25, 2008 |Received patient awake resting on chair although there was a standing order of CBR ĉ|
| |IVF #2D5WiL x 8° @ 200cc in 14 gtts per minute + #3D5LR x 12° @ 950cc in 20-21 |
| |gtts/min. Patient was on soft diet, experiencing body weakness, was observed having |
| |facial mask and with active BM. |
| |Monitor v/s of temp= 36.9°C, RR= 18 cpm, PR= 96 bpm and BP= 110/70 @ 8:00 am. The |
| |patient was S/E by Dr. Rodis ĉ request done for VSD at 10:00 am. BP taken before she|
| |was transferred in the delivery room. A live baby boy was born via normal |
| |spontaneous delivery. The baby, however, died immediately due to immaturity. The |
| |patient was then brought to RR at 1:15 PM. |
| | |
|September 26, 2008 |Received patient awake standing ĉ IVF #2D5LRiL x 8° + oxytocin at 300cc level to |
| |consume. On DAT diet. With active BM. I/O monitored ĉ the latest v/s of temp= |
| |36.6°C, RR= 18cpm, PR= 77bpm and BP= 90/60. BM= 1x, UO= 2x. Dr. Rodis with request |
| |done for ultrasound. |
| |Encourage mobilization and deep breathing exercise. |
| |Request for discharge. |
Health Teaching Plan
| | |
|Medication |Mosvit, Ferrous, Sulfate and Calcebone as vitamin |
| |Ampicillin- anti-infective |
| |Dupaston- anti-abortive |
| |Cefallexin- anti-infective |
| |Mefenamic- analgesic |
| | |
|Environment |Provide quite, cool and well ventilated environment. |
| |Encouraged to maintain clean surroundings. |
| | |
|Health Teaching |Encourage adequate rest. |
| |Discussed the different relaxation techniques and comfort |
| |measure to pain management. |
| |Encourage patient to increase fluid intake. |
| |Emphasized proper hygiene. |
| |Encouraged mild and avoid strenuous activities. |
| | |
|Out Patient Bases |Patient was advised to take antibiotic and pain reliever as |
| |indicated and to have an adequate rest. |
| | |
|Diet |Well balanced protein diet, food rich in iron, protein and |
| |vitamin C to promote fast recovery and resistance |
VIII. Discharge Summary
The last day of examination is September 26, 2008. We received the patient standing beside the bed, conscious and coherent, with IVF#2 D5LR1L x 8 + oxytocin at 300cc level 10-15 gtts/min to consume. The patient was on a DAT diet.
I/O monitored ĉ the latest v/s of temp= 36.6°C, RR= 18cpm, PR= 77bpm and BP= 90/60. BM= 1x, UO= 2x.
The patient is seen by Dr. Rodis with orders made and carried out. There are no noted discomforts on patient such as pain and vomiting. Early ambulation was already practiced. Health teachings about post-abortive was done.
-----------------------
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S.E.
D.E.
A.M.
R.M.
A.P.
J.N.
G.M.
B.M.
C.M.
G.M.
P.L.
A.N.
J.M.
R.M.
T.M.
E.E.
I.G.
J.B.
A.B.
P.O.
69 y.o.
A & W
85 y.o.
Senility
79 y.o.
A & W
48 y.o.
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58 y.o.
A & W
55 y.o.
HPN
36 y.o.
Vehicular accident
42 y.o.
A & W
53 y.o.
Leukemia
52 y.o.
Asthma
50 y.o.
A & W
45 y.o.
A & W
40 y.o.
A & W
27 y.o. A & W
26 y.o. A & W
25 y.o.
A & W
24 y.o.
A & W
20 y.o.
A & W
18 y.o.
A & W
Mons Pubis
Prostaglandins are released
Endometrial sloughing
Decrease estrogen and progesterone due to stress and strenuous activities
Pituitary gland secretes oxytocin interfering hypothalamus
Positive Pregnancy
Amenorrhea
Implantation of zygote in endometrium
Predisposing Factors:
Previous Procedures
Precipitating Factors:
Lifestyle
Stress
Strenuous Activities
Previous Abortion
Hematology
Urinalysis
Dilatation of the cervix
Decrease of FHT
Normal Spontaneous Delivery
Fetus moves downward in the vagina and cervix opens
Expulsion of the bag of water
Early separation of the fetus and placenta with thinned uterus due to previous abortion and procedure (D & C)
Vaginal bleeding
Decrease of FHT
Uterine contraction
Dilatation of cervix
................
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