Concept Mapping: Hydatidiform Mole

Abolayan, Jerome
Abdullah, Juhainah
Abengoza, Ramon Jr.
Acabo, Meldred
Argonza, Lexis Jan
Barcela, Alyssa Angela
Bulandos, Rheana Xandhy
Cahambing, M a. Patricia
Camba, Kristine
Cruz, Alana Kate
Davila, Mitzi Therese
Dela Cruz, Hannah Jane
Emaas, Kyla

BSN2-Y2-1S
Distribution of Labor
I. Case Scenario
II. Diagram - Dela Cruz Hannah Jane
III. Anatomy and Physiology - Emaas Kyla
IV. Pathophysiology - Abdullah Juhainah, Abengoza Ramon Jr.
V. Laboratory and Diagnosis Procedures - Argonza Lexis Jan
VI. Medical Management/ Treatment - Dela Cruz Hannah Jane
VII. Drug Study - Cahambing, Ma. Patricia
VIII. NCP
Assessment - Barcela Alyssa Angela, Camba Kristine
Diagnosis - Barcela Alyssa Angela, Davila Mitzi, Bulandos Rheana Xandhy
Planning - Acabo Meldred, Camba Kristine
Intervention - Davila Mitzi, Cruz Alana Kate
Rationale - Bulandos Rheana Xandhy, Cruz Alana Kate
Evaluation - Abolayan Jerome, Bulandos Rheana Xandhy
XI. Discharge Planning (METHODS format) - Abdullah Juhainah, Abengoza Ramon Jr.
 I. Case Scenario
Patient R is 38 years of age, gravida 4 para 2, who had a spontaneous abortion eight months
previous. She presented at 15 weeks' gestation. Her initial obstetric appointment was completed at
11 weeks' gestation. No fetal heart tones were auscultated. Because the patient had a definite last
menstrual period and the uterine size was appropriate at the time of the examination, no
ultrasound was performed. Plans were made to schedule an ultrasound at 20 to 22 weeks'
gestation for complete evaluation secondary to a family history of cardiac anomaly. Laboratory
results from her first appointment were as follows:
•Hemoglobin (Hgb): 12.2 •Hepatitis B (HBsAg): Negative
•Hematocrit (Hct): 36% •HIV: Negative
•WBC: 8,200 •Urine culture: Negative
•Platelets: 172,000 •Urinalysis: WNL; (-)protein and glucose
•Blood type: B •Pap test: Normal
•Rh: Positive •Gonorrhea culture: Negative
•Antibody screen: Negative •Chlamydia culture: Negative
•Venereal disease research test: Negative •Rubella: Immune

Physical examination at the time of her first examination revealed a height of 65 inches, weight 212
lbs, and pulse 80 beats/minute. Her blood pressure was 114/72 mm Hg. Uterine size was
measured to be 10 to 12 weeks' gestation; cervix was noted to be long and closed.

The patient returned with complaints of brown spotting "off and on" for several days, headache,
fatigue, nausea, vomiting, and swelling in her legs. She had been unable to keep food or fluids down
for 24 hours.

Her second exam reported a weight of 222 lbs., pulse of 86 beats/minute, and blood pressure of
162/94 mm Hg. Fundal height was recorded as 20 cm, and no fetal heart tones were monitored.

Urinalysis (dipped) revealed 1+ protein and negative glucose with large ketones. Mucous
membranes are dry, and the patient appears pale. Pitting edema in the calves is noted.

The differential diagnosis for Patient R includes:

•Pre-eclampsia
•Multiple gestation
•Hyperemesis
•Molar pregnancy
•Partial molar pregnancy

An ultrasound exam was ordered and revealed no fetus but the presence of characteristic grape-like
clusters in the uterus, and the diagnosis of complete hydatidiform molar pregnancy was made.The
patient was referred to an obstetrician for evacuation and management of this pregnancy.
Because diagnosis was made before surgical evacuation of the uterus, a chest x-ray was
performed preoperatively. It was within normal limits. CBC, platelet count, PT, PTT, liver function
tests, and renal function tests were obtained. An hCG level was also obtained for baseline. Blood
type and Rh type were known from her prenatal work-up. The patient did not require RhoGAM.
II. Diagram #1
Diagram
#2
Etiology
HYDATIDIFORM PREGNANCY

Gestational trophoblastic also known as Hydatidiform mole disease is a relatively rare condition
whereby there is an abnormal proliferation and then degeneration of the trophoblastic villi.

As the cells degenerate, they become filled with fluid and appear as clear fluid-filled, grape-
sized vesicles. Resulting in a massive cyst in the uterus rather than a viable pregnancy.

Complete mole pregnancy

Pathogenesis

- Enucleate ovum+ normal sperm which replicates itself.

- Rarely: Enucleate ovum+ 2 sperms

Epidemiology

- Accounts of 90% of molar pregnancy

Karyotype

- 46XX (most common)

MODIFIABLE RISK FACTORS NON- MODIFIABLE RISK FACTORS

-Nutrition/ diet - Age ( < 20 or > 35 )

-Spontaneous abortion -Gender
-Edema
III. Anatomy and Physiology
Uterus also called the womb, it’s an inverted pear-shaped muscular
organ of the female reproductive system, located between the bladder and
the rectum. It functions to nourish and house a fertilized egg until the fetus,
or offspring is ready to be delivered.
IV. Pathophysiology
 Laboratory and Diagnostic Procedure

Test Normal Range Result Indications

Complete White Blood Cell 4.5 – 10,000 8,200 - Normal

Blood
Count Indicate that the immune
system is working.

- Low CBC usually caused

by viral infections that
temporarily disrupt the work
of bone marrow.

- A high white blood cell

count may indicate that
the immune system is
working to destroy an
infection.

Hemoglobin 13.5 - 16.5 g/dL 12.2 - Normal Hemoglobin

(male) g/dL
- High Hgb is known as
12.0 – 15.0 polycythemia.
(female) Polycythemia vera is a
cancer of the blood in
which your bone marrow
overproduces red blood
cells.

- Lower than normal

results:
● Iron deficiency.
● Vitamin B-12
deficiency.
● Folate deficiency.
● Bleeding.
Hematocrit 41 – 50 (male) 36% - Normal Hematocrit level

36 – 44 (female) - Low Hematocrit level may

cause: anemia , infection or
a white blood cell disorder
such as leukemia or
lymphoma.

- A higher than normal

hematocrit can indicate:
Dehydration and
polycythemia vera, that
causes your body to
produce too many red
blood cells. Lung or heart
disease.

Platelets 160,000 – 450,000 172,00 - Normal platelet count

- A low platelet count may

indicate Thrombocytopenia,
Easy or excessive bruising
(purpura) Superficial
bleeding into the skin that
appears as a rash of
pinpoint-sized reddish-purple
spots (petechiae), usually on
the lower legs. Prolonged
bleeding from cuts.

- A high platelet count may

be referred to as
thrombocytosis. This is
usually the result of an
existing condition (also
called secondary or
reactive thrombocytosis),
such as:

Cancer, most commonly

lung cancer,
gastrointestinal cancer,
ovarian cancer, breast
cancer, or lymphoma.
 Liver function test Normal blood test Within - Normal, there is no
results for typical normal indication of liver diseases.
liver function limits
tests include: ALT.
7 to 55 units per
liter (U/L) AST. 8 to
48 U/L.

Urinalysis Dipstick Urinalysis 4.5 to 8.0 pH 1st 1st result – Normal,

result: negative in protein and
Within glucose.
normal
limits; 2nd result – protein,
protein normally isn’t found in the
and urine. pregnancy, and
glucose some diseases, especially
(-) kidney disease, may cause
protein to be in the urine.
2nd Large ketones may also
result: indicate that the patient has
Dipped a disease.
revealed
+1
protein
and
negative
glucose
with
large
ketones.

Urine Culture 10,000 to 1,00,000 Negative - Normal, this means it

colonies/ml does not contain any
bacteria or other organisms
(such as fungi).

- Positive or abnormal
test is when bacteria or
yeast are found in the
culture. This likely means
that you have a urinary
tract infection or bladder
 infection.

Rhesus Rh test Positive

Factor

STD Venereal disease Negative Negative - Normal, it means that the

Testing/S and HIV tests did not find an STI
erological
Test - A positive result means
you have been infected
with chlamydia.

HBsAg Hepatitis B Negative Negative - Normal, A negative

Test surface antigen result means you don't
currently have hepatitis B.

- A positive result means

you have hepatitis B and
can spread the virus.

PAP Test PAP smear Negative Normal - Negative, means it didn't

find any precancerous or
cancerous cells on your
cervix.

- Positive result means

that there is unusual cells
in the cervix and there have
been cell changes caused
by the human papilloma
virus (HPV).
Nucleic Gonorrhea and Negative Negative - Normal, no presence of
acid chlamydia testing gonorrhea and no evidence
amplificati of infection at the time of
on test or the test.
NAAT
assay

PT and Prothrombin time PT: 10 to 12 Within - Normal, no coagulation

PTT and Partial seconds (this can normal disorders.
Thromboplastin vary slightly from limits
Time lab to lab)

PTT: 30 to 45
seconds (this can
value slightly from
lab to lab)

Renal function The normal serum Within - Normal, the kidneys are
creatinine range is normal working properly.
0.6–1.1 mg/dL in limits
women and 0.7–
1.3 mg/dL in men.

HCG Human Chorionic Within - Normal

Test Gonadotropin normal
limits

Diagnostic Procedure

Chest x-ray

Ultrasound

Physical examination
Dilatation and Evacuation (D&E)

V. Medical Management/ Treatment

SURGICAL MANAGEMENT

1. Dilation & Evacuation

- To evacuate the mole inside the woman’s uterus and avoid any further
complications if it stays longer inside the reproductive system.

2. Hysterectomy
- Removal of the uterus if the patient has no desire for future pregnancies.

MEDICAL MANAGEMENT

1. Furosemide
- Used to reduce extra fluid in the body (edema) caused by conditions such as
heart failure, liver disease, and kidney disease.

2. Clonidine
- treats high blood pressure by decreasing your heart rate and relaxing the blood
vessels so that blood can flow more easily through the body.

3. Methotrexate
- attacks rapidly growing cells like the abnormally growing trophoblastic
cells.

4. Dactinomycin
- Will be given if the metastasis occurs.

5. HCG Monitoring
- Repeats measurement of HCG level until it returns to normal.
VI. Drug Study

Drug Study Diagnosis: Complete Hydatidiform Mole Patient’s Initials: Patient R

MEDICATION ACTION INDICATION CONTRAINDICATI DRUG TO DRUG ADVERSE NURSING

ON INTERACTION EFFECTS CONSIDERATION

Generic Name Pharmacodynamics Treatment of Contraindicated Acyclovir: CNS: •Arrange for tests to
Antineoplastic gestational with pregnancy, Increases risk of headache, evaluate CBC,
Methotrexate action: choriocarcinoma, lactation, toxicity. dizziness, urinalysis, renal and
Methotrexate exerts chorioadenoma alcoholism, chronic blurred liver function tests,
Brand Name its cytotoxic activity destruens, liver disease, Folic acid: May vision,seizure,fa and x-ray before
by competitively hydatidiform immune decrease tigue, malaise therapy and several
Trexall inhibiting moles deficiencies, blood methotrexate weeks after
dihydrofolic acid dyscrasias, effectiveness. GI: stomatitis, therapy.
reductase, an hypersensitivity to gingivitis,
Classifications enzyme crucial to methotrexate. Immunizations: anorexia, •Ensure the patient
purine metabolism, May not be nausea, is not pregnant
Antimetabolite resulting in an effective when vomiting, before
inhibition of DNA, given during diarrhea administering the
RNA, and protein methotrexate drug.
Dosage and synthesis. therapy. GU: renal
Frequency failure •Reduce dosage or
Pharmacokinetics Oral antibiotics, discontinue if renal
15 to 30 mg such as Hematologic: failure occurs.
P.O. or I.M. Absorption: chloramphenicol, severe bone
daily for 5 Absorption across nonabsorbable marrow •Tell the patient to
days. Repeat the GI tract appears broad-spectrum depression avoid NSAIDS and
after 1 or more to be dose-related. antibiotics, alcohol;serious side
weeks, Distribution: tetracycline: May Hypersensitivity effects may occur.
according to Distributed widely decrease :
response or throughout the absorption of anaphylaxis,
toxicity. body, with the drug. sudden death
Number of highest levels found
courses is in the kidneys, Respiratory:
three to gallbladder, spleen, chronic
maximum of liver, and skin. Phenytoin: interstitial
five. Metabolism: Increases risk of obstructive
Metabolized slightly seizures. pulmonary
Stock Dose in the liver. disease
Excretion: Excreted Probenecid:
250mg per vial primarily into urine Increases
as unchanged drug. therapeutic and
Elimination has toxic effects of
been described as methotrexate.
biphasic, with a first Combined use
phase half-life requires a lower
averaging 1 1/2 to 3 methotrexate
1/2 hours and a dosage.
terminal phase half-
life of 3 to 10 hours Pyrimethamine:
for low doses and 8 Has similar
to 15 hours for high pharmacologic
doses. action.
Generic Name Pharmacodynamics For the treatment Contraindicated in Bone marrow CNS:fatigue, • Do not give IM or
of patients with suppressants: lethargy, fever. SC; IV use only.
Dactinomycin Antineoplastic nonseminomatou chickenpox or May cause
action: s testicular cancer herpes zoster. additive toxicity. GI: anorexia, •Monitor injection
Brand Name Dactinomycin as part of a nausea, site for
exerts its cytotoxic combination Vitamin K vomiting, extravasation,
Cosmegen activity by chemotherapy derivatives: abdominal pain, burning or stinging.
intercalating and/or multi- Decreases drug diarrhea, Discontinue infusion
Classification between DNA base modality effectiveness. stomatitis, immediately, apply
pairs and inhibiting treatment ulceration cold compresses to
Antibiotic messenger RNA regimen the area, and
antineoplastic synthesis and Hematologic: restart in anOther
uncoiling the DNA anemia, vein. Local
helix. The result is leukopenia infiltration with
inhibition of DNA injectable
Dosage and synthesis and DNA- Hepatic: corticosteroid and
Frequency: dependent RNA hepatotoxicity. flushing with saline
synthesis. Drug is may lessen
500 mcg (0.5 cell cycle Metabolic: reaction.
mg) I.V. daily nonspecific. increased blood
for a maximum and urine levels •Monitor response,
of 5 days. Pharmacokinetics of uric acid, including CBC,
Maximum dose hypocalcemia. often at the start of
is 15 Absorption: therapy; adverse
mcg/kg/day or Administered I.V. Musculoskeletal effects may require
400 to 600 Distribution: Widely : myalgia. a decrease in dose
mcg/m2/day distributed into body or discontinuation of
for 5 days. tissues, with highest Skin: erythema; the drug; consult a
After bone levels found in the desquamation; physician.
marrow bone marrow and hyperpigmentati
recovery, the nucleated cells. on of skin, acne
course may be Drugs don't cross like eruptions
repeated. the blood-brain
barrier to a
Stock dose significant extent.
Metabolism: Only
500mcg minimally
(0.5mg) per metabolized in the
vial liver.
Excretion: Excreted
in the urine and
bile. Plasma
elimination half-life
of drug is 36 hours.

Generic Name Pharmacodynamics Relief of pain •Contraindicated in Ace inhibitors: CNS: dizziness, • Advise the patient
including patients with May decrease headache, that the drug works
Mefenamic Aspirin-like drug muscular, hypersensitivity to antihypertensive tremors best when taken
Acid that has analgesic, rheumatic, drugs or other effects before pain
antipyretic and anti- traumatic, dental, NSAIDs. CV: congestive becomes severe.
Brand Name inflammatory post operative Aspirin: May heart failure,
activities. These and postpartum •Contraindicated in increase risk of hypertension, • Recommend the
Dolfenal, activities appear to pain, headache those who have ulcer tachycardia abstinence of
Ponstan be due to its ability migraine, fever experienced alcohol while taking
to inhibit and asthma and Diuretics: May GI: gas pain, the medicine.
Classification cyclooxygenase dysmenorrhea allergic type reduce the diarrhea,
and also antagonize reactions after natriuretic effect vomiting, • Caution the
NSAIDs certain effects of taking aspirin of furosemide ulceration patient that drugs
prostaglandins. and thiazides in can cause
Dose and •Patients with some patients Metabolic: dependence.
Frequency Pharmacokinetics acute active weight changes
ulceration or
500mg/tab/oral Absorption: Well chronic Respiratory:
for every 6 absorbed inflammation of asthma,
hours, not to either upper or dyspnea
exceed 7 days Distribution: Wide lower GI tract.
Skin: rash,
Stock dose Metabolism: Liver alopecia
500mg per tab Excretion: Excreted
in the urine

Generic Name
Pharmacodynamics Edema due to Aminoglycoside CNS: vertigo, •Test if the patient
Furosemide cardiac, hepatic antibiotics, headache, is allergic to the
Loop diuretics and renal cisplatin, dizziness, drug.
inhibit sodium and disease, burns; ethacrynic acid: paresthesia,
chloride mild to moderate May potentiate restlessness, •To prevent
reabsorption in the hypertension, ototoxicity. fever nocturia, give PO
proximal part of the hypertensive and IM preparations
ascending loop of crisis, acute heart in the morning. Give
Henle, promoting failure, chronic the second dose in
the excretion of renal failure, Amphotericin B, CV: volume the early afternoon.
sodium, water, nephretic corticosteroids, depletion and
chloride, and syndrom. corticotropin, dehydration, •Watch for signs of
potassium. metolazone: orthostatic hypokalemia such
Increases risk of hypotension, as muscle
hypokalemia. thrombophlebiti weakness and
Monitor s with I.V. cramps.
potassium levels. administration.

Antidiabetics: Musculoskeletal
Decreases : muscle spasm,
hypoglycemic weakness.
 effects.

Derm:Photosen
Antihypertensives sitivity
: Increases risk of
hypotension.
Check blood
pressure GI: abdominal
frequently. discomfort and
pain, diarrhea,
anorexia,
nausea,
Cardiac vomiting,
glycosides, constipation,
lithium,
neuromuscular
blockers:
Increases risk of
toxicity. Monitor
potassium levels.

NSAIDs: May
inhibit diuretic
response. Use
together
cautiously.

Salicylates: May
cause salicylate
toxicity. Use
together
cautiously.
 Sucralfate: May
reduce diuretic
and
antihypertensive
effect. Separate
administration by
2 hours.

Brand Name

Lasix

Classification Contraindicated in
patients
Loop Diuretic hypersensitive to
drug and patients
with anuria, hepatic
Pharmacokinetics coma, or severe
electrolyte depletion.
Absorption: About Contraindicated if
60% of a dose is increased azotemia,
absorbed from the oliguria, or
GI tract after oral progressive renal
administration. disease occur during
Food delays oral therapy. Use
absorption but cautiously in
doesn’t alter diuretic pregnant women,
response. Diuresis patients with sulfa
begins in 30 to 60 allergy, and in those
minutes and peaks with hepatic
1 to 2 hours after cirrhosis.
oral administration.
Diuresis follows I.V.
administration
within 5 minutes
and peaks in 20 to
60 minutes.

Distribution: About
95% is plasma
protein-bound. It
crosses the
placental barrier
and appears in
breast milk.

Metabolism:
Metabolized
minimally by the
liver.

Excretion: About
50% to 80% of a
dose is excreted in
urine; plasma half-
 life is about 30
minutes. Duration of
action is 6 to 8
hours after oral
administration and
about 2 hours after
I.V. administration.

Dosage &
Frequency

20 to 80 mg
P.O. daily in
morning, with
second dose
given in 6 to 8
hours, carefully
adjusted up to
600 mg daily,
p.r.n. Or, 20 to
40 mg I.M. or
I.V. Increased
by 20 mg q 2
hours until
desired
response is
achieved. I.V.
dosage should
be given slowly
over 1 to 2
minutes.
Stock Dose

Available by
prescription
only

Injection: 10
mg/ml

Solution: 10
mg/ml, 40
mg/5 ml

Tablets: 20
mg, 40 mg, 80
mg
 Clonidine is used
Generic Name Pharmacodynamics for the treatment Contraindicated in Barbiturates: May CNS: •Obtain blood
of hypertension patients increase CNS drowsiness, pressure
Clonidine Clonidine hypersensitive to depressant dizziness, immediately before
alone or in
Hydrochloride decreases drug. Transdermal effects. fatigue, each dose is
peripheral vascular combination with sedation, administered in
form is
resistance by other weakness, addition to regular
contraindicated in
stimulating central antihypertensive patients malaise, monitoring.
alpha-adrenergic agents. It is also MAO inhibitors, agitation,
hypersensitive to
receptors, thus used in the tolazoline, depression.
any component of
decreasing cerebral treatment of tricyclic
the adhesive layer.
sympathetic antidepressants: •Give without
severe pain. Use cautiously in
outflow; drug also May inhibit regard to food.
may inhibit renin patients with severe antihypertensive CV: orthostatic
release. Initially, coronary effect. hypotension,
clonidine may disease,cerebrovasc bradycardia,
Brand Name stimulate peripheral ular disease, and severe rebound •Teach patient
alpha-adrenergic impaired hepatic or hypertension. signs and
Catapres receptors, renal function. Propranolol, other symptoms of
producing transient beta blockers: adverse effects and
vasoconstriction. May have the need to report
additive effect, GI: constipation, them; patient also
producing dry mouth, should report
bradycardia. nausea, excessive weight
Pharmakokinetics vomiting, gain
anorexia.
Absorption:
Absorbed well from
Classification •Advise taking the
the GI tract when
administered orally; GU: urine last dose at bedtime
absorbed well retention, to ensure night-time
percutaneously impotence. blood pressure
Centrally
after transdermal control.
Acting Alpha-
Adrenergic topical
Agonist administration.
Metabolic:
weight gain. • Tell patient not to
 discontinue drugs
Distribution: suddenly; rebound
Distributed widely hypertension may
throughout the Skin: pruritus, develop.
body. dermatitis (with
transdermal
Metabolism: patch), rash.
Dosage and Metabolized in the
frequency liver, where nearly
50% is transformed
to inactive
metabolites.
Initially, 0.1
mg P.O. b.i.d.;
then increased
by 0.1 per day Excretion: About
at weekly 65% of a given
intervals until dose is excreted in
desired urine; 20% is
response is excreted in feces.
achieved. Half-life of clonidine
Usual dose ranges from 6 to 20
range is 0.2 to hours in patients
0.6 mg daily in with normal renal
divided doses. function. After oral
Maximum administration, the
effective dose antihypertensive
is 2.4 mg daily. effect lasts up to 8
If a hours; after
transdermal transdermal
patch is used, application, the
apply to the antihypertensive
area of effect persists for
hairless intact up to 7 days.
skin once q 7
days.
Stock dose

Tablets: 0.1
mg, 0.2 mg,
0.3 mg
VII. NCP #1

Nursing Care Plan Diagnosis: Complete Hydatidiform Mole Patient’s Initials: Patient R

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Complete Imbalanced nutrition Short term Goal: Short term:

Hydatidiform Mole r/t insufficient After 8 hours of nursing After 8 hours of
dietary intake aeb intervention the client proper nursing
SUBJECTIVE: inability to ingest will be able to: intervention the
● "Bumigat foods as well as INDEPENDENT client:
yung fluids, hypertension, 1. Verbalize
timbang ko and increased body understanding of ● Assess ● To identify 1. Verbalized
kaysa weight. the current deviations from understandi
noong mga condition( correl weight norms and ng of the
nakaraang ation between compared establish condition
buwan, weight gain and to usual baseline and the
tapos hypertension. weight and parameters. therapeutic
nakakarana Correlation norms for regimen
s ako ng between age, gender
hilo at hypertension and body
pakiramda and dizziness) size
m ko and the measure
tumataas therapeutic the muscle
yung blood regimen. mass or 2. Maintained
pressure calculate blood
ko. Hindi body fat by pressure
tuloy ako means of within
makakain o anthropome acceptable
makainom tric limits
manlang measureme
kasi nts and 3. reported
sinusuka ko growth comfort
 lang" based scales. ● Measuring vital from
on the 2. Clients will ● Measure signs helps us nausea and
complaints maintain blood vital signs with the vomiting
of the pressure within and baseline.
patient. acceptable hemodyna
limits . mic 4. retained
OBJECTIVE: parameters appropriate
when feeding
● Vomiting indicated. without
● These actions experiencin
● Grimacing 3. Client will report ● Recommen will provide g vomiting.
due to comfort from d client to comfort from
headache nausea and remain factors that
and nausea vomiting. seated after may stimulate 5. participated
meal or or worsen in
● Swelling in with their nausea. developme
her legs. head nt of, and
elevated commit to,
● Unable to above feet. a personal
keep fluids Provide weight loss
or food clean, program.
down for peaceful
24hrs. environmen
t and fresh
● Previous air with fan
Weight: or open
212lbs window.
● To enhance
● Current 4. Client will retain ● Provide food
Weight: appropriate environmen satisfaction
222lbs feeding without tal, and and stimulate
experiencing behavioral appetite.
● BP: vomiting. modification
162/94mm s as
Hg indicated.
 DEPENDENT ● Approaches to
5. Client will ● Engage the treatment
participate in client and of severely
development of, family in obese
and commit to, a structured individuals may
personal weight weight loss include lifestyle
loss program. program as modifications,
indicated. physical
activity, very
contriolled
diets, intensive
psychiatric
interventions,
including
individual,
grou, and
family therapy.

After 3 days of
nursing
Long term Goal: intervention the
After 3 days of nursing client:
intervention the client
will : ● Identifies 1. demonstrat
eating e
1. Demonstrate ● Explore practices that appropriate
appropriate lifestyle may need to changes in
changes in factors be corrected lifestyle
lifestyle and such as and provides and
behavior specific insight into behavior.
including eating eating dietary
patterns and habits, the interventions
exercise meaning of that may
program. food to the appeal to the
client, and client.
 individual
food
preferences
and
intolerance ● To set
s/aversions nutritional 2. demonstrat
goals when ed behavior
2. Client will ● Collaborate client has to attain
demonstrate the with inter specific dietary desirable
right behaviors disciplinary needs , body
to attain the team malnutrition is weight with
ideal body profound, or optimal
weight with long term maintenanc
optimal feeding e of health
maintenance of problems exist
health.
● To monitor the
effectiveness
of efforts
● Weight dietary plan
regularly
and graph
result
 VIII. NCP #2
Nursing Care Plan Diagnosis: Complete Hydatidiform Mole Patient’s Initials: Patient R

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

SUBJECTIVE: Fluid Volume Short term Goal: After 8 hours of effective
Deficit r/t active After 8 hours of nursing intervention, the
"Nakakaramdam ako ng fluid loss aeb nursing intervention, client:
pananakit ng ulo, vomiting, the client will be 1. Verbalized
pagkapagod, pagkahilo, headache, able to : INDEPENDENT understanding of
pagsusuka, pagkakaroon nausea, fatigue, 1. Verbalize ● Discuss ● To reduce risk causative factors and
ng brown spotting na on at and dry mucous understandin individual risk of injury and purpose of
off nitong mga nakaraang membrane. g of factors, dehydration therapeutic
araw, at hindi ako causative potential interventions and
makakain o makainom factors and problems, medications
nitong nakalipas na 24 purpose of and specific 2. The client is free
oras" based on the therapeutic interventions from nausea and
complaints of the patient. interventions vomiting
and ● Assess vital ● These changes 3. The client retained
medications. signs noting in vital signs her feeding without
OBJECTIVE: low blood are associated experiencing
pressure , with fluid vomiting
•Presence of swelling in 2. Report free severe volume loss
her legs from nausea hypotension, and or
and rapid hypovolemia After 3 days of effective
•Patient appears pale vomiting. heartbeat ,an Note : In an nursing intervention the
d thready acute , life client:
•Dryness of the patient's peripheral threatening
Mucous Membranes pulses hemorrhage 1.Maintained fluid volume at
state , cold a functional level, the vital
•Blood pressure of 162/94 pale,moist, skin signs of the patient are in
mmHg may be noted , normal condition, good skin
reflecting body turgor and prompt capillary
•Decreased in skin turgor compensatory refill.
mechanism to
3. Retain profound
feeding hypovolemia 2. Demonstrated behaviors
without that prevented development
experiencing ● ( dark greenish of dehydration.
vomiting. ● Observe and brown
measure because of
 urinary concentration)
output a number
(hourly/24 higher than
hrs) Note: 1,25 is
the color And associated with
specific dehydration.
gravity With usual
range being
1.010- 1.025

● Noting of
● Evaluate nutritional
nutritional status and
status, noting current type of
current diet helps to
intake type of identify factors
diet. Note that affect
problems feeding which
that can can affect fluid
negatively intake.
affect fluid
intake.

DEPENDENT ● A balanced diet

Long term Goal: ● Provide supplies the
After 3 days of nutritionally nutrients in the
nursing intervention balanced diet body in able for
the client will be and/or it to work
able to: enteral effectively.
feedings,
1.Maintain fluid when
volume at a indicated
functional level aeb (avoiding use
individual adequate of
urinary output with hyperosmola
normal specific r or
gravity, stable vital excessively
signs, moist mucous high protein
membranes, good formulas),
skin turgor and and provide
prompt capillary an adequate
refill. amount of
free water
with
2. Demonstrate feedings.
behaviors to monitor
and correct
deficiency as
indicated.
● This ensures
accurate
INDEPENDENT pictures of fluid
● Compare status.
current fluid
intake to fluid
goal. Monitor
intake and
output (I&O)
balance,if
indicated,
being aware
of changes of
intake and
output, as
well as
insensible
losses. ● Assessment of
skin and oral
● Assess skin mucous
and oral membranes
mucous can determine
membranes signs of
 dehydration
such as dry
skin and
mucous
membranes,
poor skin
turgor, delayed
capillary refill
and flat neck
veins.

● As necessary
to determine
● Encourage replacement
the client to needs.
maintain a
diary of fluid
intake,
number and
amount of
voidings and
estimate of
other fluid
losses.
 IX. Discharge Planning (METHOD)

MEDICATION ENVIRONMENT TREATMENT HEALTH OUTPATIENT DIET COITUS AND

KNOWLEDGE OF FOLLOW-UP SPIRITUAL ADVICE
DISEASE

The client must be ● Upon HOME CARE The patient has ● Make a Eat a normal diet ● Don’t do
well informed discharge ● Take an to know that she follow-up with few calories. sexual
about: make sure over-the- has been appointme intercourse or
● Drug name use tampons
you and counter diagnosed with nt.
● Drug’s until you see
effect your pain a hydatidiform your
● Dosage family reliever mole (also ● Keep your healthcare
● Symptoms check for pain, if called molar follow-up provider for a
of possible things needed. pregnancy) appointme follow-up
adverse around the where there is nt with appointment.
effect house that ● Encourag no fetus at all. your
● Ask for help if
may be in e the healthcare
As for the patient: you feel
● Pain the way patient to provider. depressed.
Reliever for you to bed rest.
Mefenamic be unsafe.
acid 500 ● Return to
mg 1 ● Provide a work or
capsule supportive daily
every 6
environme routines
hours(4x
day) nt for when
example is ready.
moral
support for ● Take
the patient showers
plus a instead of
fast- tub baths.
tracked
medical ● Don't do
service. any
strenuous
exercise
right
away.