NORTHEASTERN COLLEGE

COLLEGE OF NURSING
Santiago City, Philippines, 3311

THREATENED ABORTION

Submitted By:

Kceey Cruz

Submitted To:

ARTURO G. GARCIA JR RN, MSN, US RN

I. OBJECTIVES
A. GENERAL OBJECTIVES
B. SPECIFIC OBJECTIVES

II. OVERVIEW OF THE DISEASE

III. NURSING HISTORY

A. PATIENT’S PROFILE
B. PRESENT HISTORY OF ILLNESS
C. PAST HEALTH HISTORY
D. FAMILY MEDICAL HISTORY

IV. VITAL SIGN

V. DIAGNOSTIC PROCEDURE

VI. ANATOMY AND PHYSIOLOGY

VII. PATHOPHYSIOLOGY

VIII. NURSING CARE PLAN

IX. DRUG STUDY

X. DISCHARGE PLAN
 OBJECTIVES

General Objectives:

- At the end of this case study, we will be able to identify and analyzed the
disease itself and the date that will gather from the patient.

Specific Objectives:

Knowledge:
-To gather data appropriately, then validating it.
-To gain knowledge about the disease.
-To analyze and interpret the collected data.

Skills:
-To provide nursing skills that appropriate to patient’s condition.
-To communicate effectively in identifying the needs of the patient
-To be able to conduct discharged planning with the patient, his
family or significant others.

Attitude:
-To establish rapport with the patient and her significant others.
-To establish good relationship to the family and significant others to
provide a better intervention.
 OVERVIEW OF THE DISEASE

Threatened abortion is vaginal bleeding that occurs in the first 20 weeks of

pregnancy. The bleeding is sometimes accompanied by abdominal cramps. These
symptoms indicate that a miscarriage is possible, which is why the condition is
known as a threatened abortion or threatened miscarriage.

Vaginal bleeding is fairly common among pregnant women. About 20 to 30

percent of women will experience bleeding during the first 20 weeks of pregnancy.
Approximately 50 percent of these women will carry their baby to term.

The exact cause of a threatened abortion usually isn’t known. However, it’s more
common among women who have previously had a miscarriage.

Symptoms
Signs and symptoms of threatened abortion include:

 Bleeding may be only slight spotting, or it can be heavy.

 Pain and cramping are in the lower abdomen. They may be on one side, both
sides, or in the middle. The pain can go into the lower back, buttocks, and
genitals.

Causes

Small falls, injuries or stress during the first trimester of pregnancy can cause
threatened miscarriage. It occurs in almost one half of all pregnancies. The chance
of miscarriage is higher in older women. About one half of women who
have bleeding in the first trimester will have a miscarriage.
Risk factors
Factors that may increase your risk of threatened abortion include:

 a bacterial or viral infection during pregnancy

 trauma to the abdomen
 advanced maternal age (over age 35)
 exposure to certain medications or chemicals

Complications

 hypertension/preeclampsia (PE),
 low birth weight (LBW)
 neonatal intensive care unit (NICU) admission.

Prevention
The following can help you avoid developing threatened abortion.

 not drinking alcohol

 not smoking cigarettes
 not using illegal drugs
 minimizing consumption of caffeine
 avoiding certain foods that can make you ill and harm your baby
 avoiding exposure to toxic chemicals or harsh cleaning solutions
 promptly treating any viral or bacterial infections that occur
 taking prenatal vitamins, such as folic acid
 exercising at least two hours per week

URINARY TRACT INFECTION is an infection in any part of your urinary system —

your kidneys, ureters, bladder and urethra. Most infections involve the
lower urinary tract — the bladder and the urethra. Women are at greater risk of
developing a UTI than are men.
Symptoms
Signs and symptoms of urinary tract infection include:

 painful urination (dysuria)
 burning during urination
 passing small amounts of urine
 difficulty starting the urine stream
 frequent urination (frequency)
 constant urge to pee (urgency), even if you’ve already urinated
 pressure or pain in your abdomen, sides, pelvis, or lower back
 cloudy, foul-smelling urine
 bloody urine (red, pink, or cola-colored)

Causes

 A bladder infection is called cystitis.

 A urethra infection is called urethritis.
 A kidney infection is called pyelonephritis.

Risk factors

 sexual intercourse, especially if more frequent, intense, and with multiple or

new partners
 diabetes
 poor personal hygiene
 problems emptying the bladder completely
 having a urinary catheter
 bowel incontinence
 blocked flow of urine
 kidney stones
 some forms of contraception
 pregnancy
 menopause
  procedures involving the urinary tract
 suppressed immune system
 immobility for a long period
 use of spermicides and tampons
 heavy use of antibiotics, which can disrupt the natural flora of the bowel and
urinary tract

Complications

 septicemia
 increased risk of women delivering infants that are premature or have a low
birth weight.

Prevention

 Drink lots of water and urinate frequently.

 Avoid fluids such as alcohol and caffeine that can irritate the bladder.
 Urinate shortly after sex.
 Wipe from front to back after urinating and bowel movement.
 Keep the genital area clean.
 Showers are preferred to baths and avoid using oils.
 Sanitary pads or menstrual cups are preferred to tampons. If you want to buy
menstrual cups, then there is an excellent selection on Amazon with
thousands of customer reviews.
 Avoid using a diaphragm or spermicide for birth control.
 Avoid using any perfumed products in the genital area.
 Wear cotton underwear and loose-fitting clothing to keep the area around the
urethra dry.
 NURSING HISTORY

A. PATIENT’S PROFILE

Name: RR
Age: 19 yo
Sex: Female
Civil Status: Single
Nationality: Filipino
Address: San Mateo Isabela
Date of Birth: April 7,2002
Occupation: None
Religion: INC
Date of Admission: April 9,2020
Time of Admission: 10 am
Admitting Diagnosis: THREATENED ABORTION
Admitting Physician: Dr. Dela Cruz

Chief Complaints: vaginal bleeding, abdominal pain

B. PRESENT HISTORY OF ILLNESS

 Few days prior to admission, patient had fever on and off with vaginal
bleeding and abdominal pain. Presently, patient has signs and symptoms
of urinary tract infection.

C. PAST MEDICAL HISTORY

(Mumps)
D. FAMILY MEDICAL HISTORY

Hypertension Diabetes Cancer Heart disease

Mother (+) (+) (+) (+)
Father (+) (-) (+) (+)
 VITAL SIGNS
Date/Time Blood Temperature Respiratory Rate Pulse Rate
Pressure
04/09/20
10:00 110/70 37.1 21 81
2:00 130/90 37 20 79

DIAGNOSTIC PROCEDURE
April 9, 2020 - 12:30 pm
ULTRASOUND RESULT
Examination: Diagnostic examination
Ultrasound findings:
single
live
intrauterine pregnancy
cephalic in presentation
placenta posterior grade 3
16 weeks sonar age
adequate amniotic fluid
Impression:

HEMATOLOGY
PARAMETERS RESULT UNIT REFERENCE INTERPRETATION
RANGE
WBC 16.98/L 10^9/L 4.00-10.00 High because white
blood cell count is
elevated during
pregnancy, with the
lower limit of the
reference range being
around 6,000 cells per
μl and the upper limit
around 17,000 cells
per μl. The stress
 imposed on the body
through pregnancy
caused this rise in
white blood cells

Hemoglobin 9.8g/dl g/L 11.0-15.0 Slightly decreased

because Iron
deficiency is the most
common cause of
anemia in pregnancy.
Folate-deficiency
anemia. Folate is the
vitamin found
naturally in certain
foods like green leafy
vegetables A type of B
vitamin, the body
needs folate to
produce new cells,
including healthy red
blood cells. During
pregnancy, women
need extra folate.
 ANATOMY AND PHYSIOLOGY
Anatomy of the Reproductive System
Vulva (pudendum) refers to the external female genitalia. Its functions are
threefold:

 Acts as sensory tissue during sexual intercourse

 Assists in micturition by directing the flow of urine
 Protects the internal female reproductive tract from infection.

Vagina is an organ of the female reproductive tract. It is a distensible muscular

tube which extends posterosuperior from the external vaginal orifice to the cervix.

Cervix is the lower portion of the uterus, an organ of the female reproductive tract.
It connects the vagina with the main body of the uterus, acting as a gateway
between them.

Uterus is a secondary sex organ. Secondary sex organs are components of the
reproductive tract that mature during puberty under the influence of sex hormones
produced from primary sex organs (the ovaries in females and the testes in males).

Uterine tubes (or fallopian tubes, oviducts, salpinx) are muscular ‘J-shaped’ tubes,
found in the female reproductive tract. They lie in the upper border of the broad
ligament, extending laterally from the uterus, opening into the abdominal cavity,
near the ovaries.

Ovaries main functions are:

 To produce oocytes (female gametes) in preparation for fertilization.

 To produce the sex steroid hormones estrogen and progesterone, in
response to pituitary gonadotrophins (LH and FSH).

Ligaments of the female reproductive tract are a series of structures that support
the internal female genitalia in the pelvis.

The ligaments of the female reproductive tract can be divided into three categories:

 Broad ligament – a sheet of peritoneum, associated with both the uterus and
ovaries.
  Uterine ligaments – ligaments primarily associated with the uterus.
 Ovarian ligaments – ligaments primary associated with the ovaries.

Physiology of the Reproductive System

The female reproductive system functions to produce gametes and
reproductive hormones, just like the male reproductive system; however,
it also has the additional task of supporting the developing fetus and
delivering it to the outside world. Unlike its male counterpart, the female
reproductive system is located primarily inside the pelvic cavity. Recall
that the ovaries are the female gonads. The gamete they produce is called
an oocyte.

PATHOPHYSIOLOGY

A threatened miscarriage is indicated by vaginal bleeding, abdominal/pelvic pain

of some severity, or both during early pregnancy. In the first two trimesters, about
a quarter of all pregnant women experience any vaginal bleeding. About half of all
events result in a miscarriage. The pain and bleeding that follow a threatened
miscarriage are normally not serious. Extreme menstrual bleeding is uncommon in
threatened miscarriages. The internal cervical os is closed on vaginal inspection,
and there is no cervical motion tenderness or tissue. There may be uterine
tenderness, adnexal tenderness, or both. Threatened miscarriage is defined by the
absence of passing/passed tissue and the presence of a closed internal cervical os.
These findings differentiate threatened miscarriage from later stages of a
miscarriage. The lack of passing/passed tissue and the appearance of a closed
internal cervical os indicate a threatened miscarriage. These studies distinguish
threatened miscarriage from miscarriage in its later stages.
 DISCHARGE PLAN
Released date: April 12, 2020
Released time: 1:30 pm
Follow up checkup: after one week

Medication:
- Emphasized the importance of taking the medicine prescribed by the
physician.
- Instruct the patient to take his home medications at the right time, right dose,
and right route.

Exercise:
- Encourage patient to do mild exercises.
Treatment:
- Encourage the patient to limit heavy activity to not bleed heavily.

Hygiene
- Promote proper hygiene.
- Encourage patient and SO to maintain clean and safe environment at all
times.

Out-Patient
- Instruct the patient to attend his follow-up checkup for reevaluation of his
condition.

Diet
- Advise the patient to increase fluid intake
- Advise the patient to eat foods like fruits, vegetables, whole grain breads,
low-fat dairy product, beans, lean meats and fish.
- Avoid raw or undercooked meat and fish.
- Take prenatal vitamins

Spiritual
- Go to church every church schedule.
- Encourage patient to always pray for his fast recovery.