Danica Taguiam DRE, VIA, & Ultz Preparation  09-30-2020

A5

I. QUESTIONS:
1. Thirty days post Dilatation and Curretage, Is it recommended for patient Maitha to
have VIA? Why and why not? What are the indications of VIA?
I believe No, because maitha has undergone D & C just 30 days after the procedure her cervix is still
healing and recovering. And it was also observe that after the procedure maitha has experience active
vaginal bleeding which is a possible sign of infection prior to post D & C, which means that it needs
more time to heal and recover. Stated by familydoctor.org (2019), there are some risks to a D and C.
You could get an infection in your uterus/cervix. To help prevent this, avoid putting anything in your
vagina following the procedure. This includes tampons, douches, and some forms of birth control
(familydoctor.org, 2019), in which we can add to this the avoidance of doing VIA after a post D & C.
Since VIA involve the application of acetic acid in the cervix. However, Maitha can still opt to undergo
VIA but not as early as 30 days post D & C, since she is 39 yrs old and is eligible to do VIA test.
Indication includes the ff: 1.All women within the eligible age (30-49years old) attending the cervical
cancer screening clinic for the first time should have VIA, provided the screening protocol
recommends the test. 2. VIA can be done during menstruation if the woman is not bleeding heavily
(Abad et.al. 2020).

2. Before the doctor conducted D and C, What kind of ultrasound did she have? Why?
Give 3 nursing responsibilities you will perform to patient Maitha in preparing the
ultrasound.
Transvaginal Ultrasound, because it helps to determine vaginal bleeding also to see if there is any
abnormality in the uterus (womb), cervix (the neck of the womb), endometrium (lining of the womb),
fallopian tubes, ovaries, bladder or the pelvic cavity prior to D & C. This helps the physician to avoid
missing any structural findings (eg, polyps or fibroids) that may be inside the uterus, cervix, and
endometrium to take a sample of the most visibly abnormal areas prior to D & C.
 Explain the reasons for performing the procedure to the patient and inform patients that the
examination may be uncomfortable.
 Instruct patient to empty bladder prior to transvaginal ultrasound.
 Assist patient to the examining table, help her to undress and drape her for privacy.

3. Give 3 independent nursing interventions addressing the vaginal bleeding.

 Assess vital signs, especially the blood pressure and monitor for signs of shock.
 Place the patient on bed rest with legs elevated to helps venous return and slows bleeding.
 Collect and save all perineal pads used during bleeding and weigh them to determine the
amount of blood loss.

4. What is the purpose of oxygen therapy?

Since the patient is experiencing active vaginal bleeding there is decreased in blood circulation that
carries oxygen causing the patient to experience difficulty of breathing, changes in the color of the
skin, tachycardia, hypotension etc. By administering oxygen it increases the amount of oxygen carried
by available hemoglobin in the blood to compensate to the bleeding.

5. Give 6 nursing responsibilities you will perform before (2), during (2) and after (2)
patient Maitha's Blood Transfusion
Before
 Verify the BT order, double-check the order for transfusion and correlate this with the clinical
diagnosis and care plan of the patient.

 Acquire blood specimens quickly, to obtain baseline complete blood count, and to type and
crossmatch the blood in anticipation of blood transfusions.

During

 Obtain vital signs prior to the start of the BT and several times during the BT (At the first 5 minutes
after starting the transfusion;15 minutes after transfusion started; on the 30 th minute; and every hour
until the transfusion is done).
 Observe/Assess patient on an on-going basis for any untoward signs and symptoms such as flushed
skin, chills, elevated temperature, itchiness, urticaria, and dyspnea. If any of these symptoms occur,
stop the transfusion, open the IV line with Plain NSS and regulate accordingly, and report to the
doctor immediately.
After
 Once transfusion is done, the line should be flushed with normal saline solution. If there are no more
succeeding transfusions, the line is discontinued, and the BT set is disposed properly.
 Continue to monitor vital signs 1 hour after the transfusion is over and instruct to report delayed
reaction to the transfusion such as nausea, swelling, jaundice, or an itchy rash.