DE LA SALLE LIPA

J.P. Laurel Highway, Lipa City, Batangas

A CASE STUDY ABOUT A 46- YEAR OLD

FEMALE PATIENT DIAGNOSED WITH
ABNORMAL UTERINE BLEEDING AND
UNDERWENT DILATATION AND
CURETTAGE

A case study presented to the Faculty of

College of Nursing

De La Salle Lipa

In partial fulfillment of the requirements for

NCM 112 (RLE)

G3B - Group 2
Ma. Francesca Louise C. Baldemor
Roschian Lorenz C. Canicosa
Mickaela Kate L. Caringal
Sebastian Jairo S. Forteo
Mark Levi Angelo Landicho
Arteneth M. Marcellana
Gabrielle Kristine A. Silang
Jervy Emiel M. Valencia
Rafael Miguel H. Vinas

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 TABLE OF CONTENTS

I. Introduction ……………………………………………………………………….… 3

II. Demographic profile ……………………………………………………………….. 5

III. Clinical History …………………………………………………………………….. 6

IV. Physical Assessment ……………………………………………………………… 9

V. Anatomy and Physiology …………………………………………………………. 10

VI. Pathophysiology …………………………………………………………………… 12

VII. Laboratory and Diagnostic Examinations ………………………………………. 13

VIII. Medical and Surgical Management ……………………………………………... 17

IX. Drug Study …………………………………………………………………………. 20

X. Nursing Care Plan ……………………………………………………………….... 24

XI. Summary of Discharge Teaching ……………………………………………...… 30

XII. Current Trends / Innovations Clinical Management ………………………….... 31

XIII. References ……………………………………………………………………….... 33

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 I. INTRODUCTION

Uterus is a pear-shaped organ in the reproductive system of people assigned

females at birth. It is where the fertilized egg implants during pregnancy and also where
the baby develops until birth. Thus, it plays an important role in reproductive health and
has three important roles. First is during Pregnancy, the uterus stretches to grow the
baby and also contracts to push the baby out of the vagina. Second is during Fertility, it
is where the fertilized egg was implanted during conception. And last is during the
Menstrual Cycle, the uterine lining is where blood and tissue come from during
menstruation. The menstrual cycle is the monthly series of changes a woman's body
goes through in preparation for the possibility of pregnancy. If ovulation takes place and
the egg isn't fertilized, the lining of the uterus sheds. Most women have menstrual
periods that last four to seven days. A woman's period usually occurs every 28 days,
but normal menstrual cycles can range from 21 days to 35 days. Hence, Abnormal
uterine bleeding may apply to a variety of menstrual irregularities, including a heavier
menstrual flow; a period that lasts longer than seven days; or bleeding or spotting
between periods, after sex, or after menopause.

Abnormal uterine bleeding (AUB) is a broad phrase referring to abnormalities in

the menstrual cycle outside of pregnancy. Up to one out of three women will develop
abnormal uterine bleeding at menarche or perimenopause. A normal menstrual cycle
lasts 2 to 7 days and bleeds 5 to 80 milliliters. Abnormal uterine bleeding occurs when
any of these four parameters change (Frequency, Regularity, Duration and Volume).
Frequency is described as frequent (less than 24 days), normal (24 to 38 days), or
infrequent (greater than 38 days). Meanwhile, Regularity can be described as absent,
regular or irregular. While duration can be described as prolonged (greater than 8 days),
normal (approximately 4 to 8 days), or shortened (less than 4 days) And lastly, volume
of flow can be described as heavy (greater than 80 mL), normal (5 to 80 mL), or light
(less than 5 mL of blood loss)

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 Approximately 25% of pregnant women experience bleeding before 12 weeks
gestation (Hendricks et al., 2019). Several bleeding disorders can complicate early
pregnancy, including spontaneous abortion, ectopic pregnancy, and hydatidiform mole.
Maternal blood loss decreases the oxygen-carrying capacity of the blood, resulting in
fetal hypoxia, and placing the fetus at risk.

Abnormal uterine bleeding (AUB), the most common cause of abnormal uterine
bleeding, occurs most often in women > 45 (> 50% of cases) and in adolescents (20%
of cases). Women aged 40 to 44 years had a rate of 36.9%, while those aged 45 to 49
years had a rate of 39.2%. Women between the ages of 50 and 55 were considerably
underrepresented at 5.4%. The cause is usually estrogen production unopposed by
progesterone, which can lead to endometrial hyperplasia. The endometrium sloughs
and bleeds incompletely, irregularly, and sometimes profusely or for a long time.
Endometrial hyperplasia, particularly atypical adenomatous hyperplasia, predisposes to
endometrial cancer. Thus, it affects 3%-30% of reproductive-aged women globally, with
a higher incidence around menarche and perimenopause. When irregular and
intermenstrual bleeding is included, the prevalence climbs to 35% or more.

This case study is about a 46-year-old woman who was admitted last December
11, 2022, with a chief complaint of vaginal bleeding. The primary objective of this study
is to advance the understanding of abnormal uterine bleeding and its treatment.
Especially, this study aims:
● To discuss the given case scenario about abnormal uterine bleeding, its
pathophysiology, medications used, and all other treatment regimens offered to
the patient, as well as related nursing care plans in relation to the patient's health
concerns under review
● To discuss the most recent technology developments or clinical improvements in
relation to the case
● To contribute proper nursing interventions

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 II. DEMOGRAPHIC PROFILE

Name (Initial): L.G.C

Address: Bagong Pook, Lipa City Batangas

Sex: Female

Age: 46 years old

Status: Married

Chief Complaint: Prolonged Vaginal Bleeding

Admitting Diagnosis: Abnormal Uterine Bleeding

Final Diagnosis: Abnormal Uterine Bleeding secondary to Endometrial Pathology

Date and Time of Admission: Dec 11, 2022 | 09:22

Attending Physician: Dra. A.V.L

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 III. CLINICAL HISTORY

History of Present Illness

The patient was admitted to the hospital last December 11, 2022, due to the
patient’s chief complaint of prolonged vaginal bleeding. She has a 3 weeks history of
vaginal bleeding concerning diapers being fully soaked up with blood. The persistence
of the condition made the patient sought for consultation hence she was admitted to
MMMC. And after conducting the Pre-Operative history it was recorded that the patient
has Anemia which is due to prolonged uterine bleeding.

Past Medical History

The patient has not undergone any past surgeries or previous operations. She
does not have any chronic illnesses. The patient had her first menstrual cycle at the age
of 13 and her last menstrual period was last November 16, 2022, until December 11,
2022. And she has no known allergies to drugs and food.

Family History

She is married to her husband and has 4 children. The patient’s father is
deceased and she is currently living with her relatives alongside her family and mother.
Not all of her children are living with her as they can already live on their own.

Developmental History

Mercer’s Maternal Role Attainment Theory

Ramona Mercer created the Maternal Role Attainment Theory to help nurses
deliver appropriate healthcare treatments for mothers in order to help them develop a
strong maternal identity. This mid-range theory is useful for adoptive or foster mothers,
as well as others who find themselves in the maternal role unexpectedly. This nursing
model's procedure aids the mother in forming an attachment to the newborn, which in

6
turn aids the infant in forming a bond with the mother. As the infant grows, this aids in
the development of the mother-child attachment. The developmental and interactional
process, which unfolds across time, is the central premise of this theory. The woman
develops a link with her child, gains skill in general caregiving activities, and eventually
expresses satisfaction and pleasure in her job as a mother.
According to the Maternal Role Attainment Theory, there are four stages to the
nursing process. Anticipatory, formal, informal, and personal are the four types. The
Anticipatory stage is wherein commitment and preparation for the child is done and
happens during pregnancy. The formal stage involves acquaintance, practice, &
physical restoration of the mother which happens for the first 2 weeks after birth. The
informal stage is when mothers are approaching normalization with their new role as a
mother. Mercer (2004) describes this stage as “settling in” and becoming a new family.
And lastly, in the personal stage where integration of maternal identity is done, the
mother internalizes this role and views herself as a competent mother. This stage is
expected to be attained by the mother after 4 months and beyond.

In this case, the patient had four children and is now in the personal stage, which
is the joy of motherhood. At this point, the mother feels at peace, competent, and
confident in her role as a mother. Sometimes she could feel ready for or anticipate
having another kid.

Havighurst’s Developmental Task Theory

Developmental task theory is derived from physical maturation, personal values,

and the pressure of society. There are six age-specific life stages and tasks pertaining
to each stage. The tasks identified for the middle age 31 to 60 years old include
achieving adult civic and social responsibility, assisting teenage children to become
responsible and happy adults, developing adult leisure-time activities, and adjusting to
the physiologic changes. In this theory, achievement leads to happiness and success
with the latter task, and failure in the achievement of the task leads to societal
disapproval, unhappiness, and difficulty to perform tasks associated with the next period
or stage in life. The patient in this case study is a 46 years old woman, who is already

7
in the early adulthood stage. She was able to establish herself as an independent
person and became more emotionally stable which is considered as a sign of maturity.

Jean Piaget’s Theory of Cognitive Development

Cognition refers to thinking and memory processes, while cognitive development

refers to long-term changes in these processes (Thompson, 2019). One of the widely
known perspectives on cognitive development is the staircase model of the theory of
Jean Piaget. His theory suggests that as children grow, intelligence changes. It states
that cognitive development is not just about acquiring knowledge, but also developing a
mental model of the world. Cognitive development had four stages: Sensorimotor stage:
Birth to 2 years, Preoperational stage: Ages 2 to 7, Concrete operational stage: Ages 7
to 11, and Formal operational stage: Ages 12 and up. Children actively participate in
education, expand their current knowledge, and modify new information as they interact
with their environment.
In this case, the patient is already at the formal operational stage, wherein the
patient can identify possible answers to issues. Since the patient was operated on, she
can find a solution to her problem, such as pain by participating in the interventions
throughout her stay in the hospital. Also, in this stage, they have improved their logic,
capacity for deductive reasoning, and comprehension of abstract concepts. With this,
the patient is able to understand health teachings that will help in rapid recovery.

Obstetric and Gynecologic History

The patient has been pregnant four times and has four living full-term children.
With this, the GTPAL score of the patient is G4P4 (4-0-0-4).

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 IV. PHYSICAL ASSESSMENT

Body Part Method Use Findings Interpretation

General Inspection Conscious,coherent, Normal

Appearance and awake

Abnormal (Due to
Grimace menstrual cramps)

Skin Inspection Pale Abnormal (Due to

blood loss)

H/EENT Inspection Pale Palpebral Abnormal (Due to

Conjunctiva blood loss)

Heart Auscultation AP (Adynamic Normal

Precordium)

Chest/lungs Auscultation Clear breath sounds Normal

(-) murmurs

Abdomen Palpation Soft and nontender Normal

Spine/Extremities Inspection Full ROM Normal

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 V. NORMAL ANATOMY AND PHYSIOLOGY

Female Reproductive System

Internal Anatomy of Female Reproductive System
The internal female genitalia includes the fallopian tubes, ovaries, uterus, cervix,
and vagina.

There are two fallopian tubes on each side of the uterus that allows oocyte
transport and fertilization. The ovaries are the ones that produce the ova (eggs) lying in
the pelvic cavity on the sides of the uterus, below the opening of the fallopian tube.

The uterus is a hollow, muscular organ where the fertilized ovum implants and
develops into a fetus. It stretches and becomes thicker when the fetal size increases
throughout pregnancy. Also, its role is to protect the fetus until its birth. The uterus has
three layers of tissue, respectively perimetrium, myometrium, and endometrium.

The narrow neck of the uterus is the cervix, which forms a tubular canal leading
to the top of the vagina. It measures around 3-4 centimeters long.

The vagina is a muscular passage located between the cervix and the external
genitalia. Its length is about 8-10 centimeters.

The ovaries are small, oval-shaped glands that are located on either side of the
uterus. The ovaries produce eggs and hormones.

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 Internal Anatomy of Female Reproductive System

Endometrial Hyperplasia
Endometrial hyperplasia is an excessive or abnormal thickening of the lining of
the uterus. It is most often caused by excess estrogen without progesterone. If ovulation
does not occur, progesterone is not made, and the lining is not shed. The endometrium
may continue to grow in response to estrogen. The cells that make up the lining may
crowd together and may become abnormal.

Comparison between normal endometrium and endometrial hyperplasia

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 VI. PATHOPHYSIOLOGY

Prognosis: Patient has a good potential in meeting the expected outcomes of

intervention due to awareness of the current condition and no prior severe
complications. Although the persistence of the condition resulted in anemia, the patient
has a good response to treatments. After the surgery, no other complications were
noted, medications were taken as ordered, and it is expected that the patient will
recover and perform light daily tasks within a week.

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 VII. LABORATORY AND DIAGNOSTIC EXAMINATIONS

Hematology

Hematology tests include tests on the blood, blood proteins, and blood-producing
organs. These tests are done to evaluate a variety of blood conditions including
infection, anemia, inflammation, hemophilia, and blood-clotting disorders. The results of
a blood test can give an accurate assessment of body conditions and how internal or
external influences may affect a patient’s health.

Parameters Reference Actual Units Interpretation

Range Results

WBC 5.0 - 10.0 11.22 10^3/ Slightly Increased

µL

RBC 3.50 - 6.50 2.73 10^6/ Decreased due to bleeding

µL

HGB 12.0 - 18.0 7.2 g/dL Decreased due to bleeding

HCT 36.0 - 54.0 21.8 % Decreased due to bleeding

MCH 27.0 - 32.0 26.4 Pg Normal

MCHC 32.0 - 36.0 33.0 g/dL Normal

PLT 150 - 400 373.0 10^3/ Normal

µL

LY 20.0 - 40.0 0.34 10^3/ Normal

µL

MO 0.0 - 9.0 0.06 10^3/ Normal

µL

Sonographic Report

Sonography is a diagnostic medical test that uses high-frequency sound waves,

or ultrasound waves, to create images of tissues, glands, organs, and blood or fluid flow
within the body.

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 Findings Interpretation

Cervix 3.30 x 2.64 x 2.96 cm Normal

Endometrium 1.47 cm, heterogenous Thickened

probably with blood endometrium,T/C
endometrial pathology

Uterus 6.02 x 5.50 x 4.34 cm, Normal

normal in size and
retroverted with no
myometrial lesion

Right ovary 3.22 x 2.29 x 1.36 cm, Consider cystic follicles

contains 2 cystic,
unilocular, anechoic
lesions with regular cyst
wall measuring as follows:
1. 2.41 x 1.80 x 0.90
cm
2. 1.22 x 1.11 x 1.07
cm, could be cystic
follicles

Left ovary 2.51 cm x 1.71 cm x 0.90 Normal

cm, normal in size and
echotexture

cul-de-sac No free fluid Normal

Other findings Inferior to the left ovary is could be a paraovarian

cystic,unilocular,anechoic cyst
and thin-walled structure
measuring 1.62 x 1.22 x
1.34 cm,

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Serology Report

A blood test to detect the presence of antibodies against a microorganism. A

serologic test can determine whether a person has been exposed to a particular
microorganism.

Test Result Interpretation

HBsAg Screening Non-Reactive HBV is not detected

Chest X-ray Report

A chest X-ray is an imaging test that uses X-rays to look at the structures and
organs in your chest. It can help your healthcare provider see how well your lungs and
heart are working.

Results Interpretation

● The lungs are clear.

● The Pulmonary vasculature
Chest is within normal limits.
● The heart is not enlarged. NORMAL
● The trachea is midline with CHEST
due allowance for obliquity. FINDINGS
● The hemidiaphragm and
costophrenic angles are
intact.
● No other remarkable
findings were noted.

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RT-PCR Swab Report

RT–PCR is done to detect the presence of specific genetic material in any

pathogen, including a virus. RT-PCR Test is a real-time reverse transcription
polymerase chain reaction test for the qualitative detection of nucleic acid from
SARS-CoV-2 in upper and lower respiratory specimens (nasopharyngeal or
oropharyngeal swabs).

Test Reference Actual Result Interpretation

Positive for
SARS-CoV 2
(causative agent of
COVID-19)
SARS-CoV 2
(causative agent of SARS-CoV-2
COVID-19) virus Negative for (causative agent of Negative for
detection by SARS-CoV 2 COVID 19) viral SARS-CoV 2
Real-Time (causative agent of RNA not detected
Polymerase Chain COVID-19)
Reaction

Negative for test

internal control
(most likely due to
poor specimen
quality)

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 VIII. MEDICAL AND SURGICAL MANAGEMENT

Date/Time Medical Regimen Rationale

12/11/2022 Vital Signs:

8:58 AM BP= 110/80
T= 36.7 C
PR= 84 bpm
RR= 20 bpm

- For BT 1U PRBC properly - to transfuse anemia

typed and crossmatched patients who require
an infusion of red
blood cell to restore
tissue oxygenation

- Watch out for blood - To check for any

transfusion reaction allergic reactions

- Refer - For collaborative

management between
healthcare
professionals

12/11/2022 - Please admit the patient - To obtain legality upon

8:58 AM under by service to OB admission
ward

- Diet as tolerated then - to decrease nausea,

NPO diarrhea, and gas in
the bowel that may
cause abdominal pain
and discomfort

- VS q shift + record - To provide a baseline

for further interventions

- For Dilatation and - To diagnose and treat

Curettage on December many conditions that
12, 2022, 8:30 am affect the uterus, such
as abnormal bleeding

- Secure Consent - For patient’s protection

and create trust with
the doctors

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 - Transfuse 2 units of - to transfuse anemia
PRBC x 4 hours each patients who require
after typing and infusion of red blood
crossmatched cell to restore tissue
oxygenation

- Perform VS upon - To provide baseline for

admission further interventions

IV Fluids:
- IVF on admission - NSS - For fluid and
1L x KVO electrolyte
replenishment

- Cefuroxime (Zoltax) - To prevent infection

750mg IV ANST 30 from the surgery and
minutes prior to surgery spread of bacterial
infection

- Benadryl 50mg IV prior to - To relieve symptoms of

BT fever

Medication:
- Paracetamol 500mg tab - To relieve mild to
prior to BT moderate pain

12/11/2022 Recommendation:
10:54 AM - For blood typing and Rh - For blood transfusion
typing

- Refer - For collaborative

management between
healthcare
professionals

12/12/2022 - Dilatation and Curettage -

9:00 AM done

- VS q 15 minutes until - To provide baseline for

further interventions

- Flat on bed - To provide comfort

- IVF to consume since the patient was
under anesthesia

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 Medication:
- Zoltax (Cefuroxime)
500mg BID x 2 days
- Hemostan (Tranexamic
Acid) 500mg cap TID for
bleeding
12/12/2022 - May transfer to own room
9:10AM
- To prevent infection
from the surgery and
spread of bacterial
infection
- For treatment and
control of excessive
bleeding
- For a patient to be
relaxed and help for
recovery
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 IX. DRUG STUDY

NAME OF DRUG MECHANISM OF INDICATION AND ADVERSE EFFECTS/ NURSING RESPONSIBILITIES

ACTION CONTRAINDICATION SIDE EFFECTS

Generic name: By adhering to the Indication: Side effects: Before:

Cefuroxime cell wall, it ● For bacterial infection ● Nausea ● Check for history of hypersensitivity to
interferes with ● Uncomplicated skin ● Vomiting cefuroxime and penicillin
Brand name: Zoltax bacterial cell-wall and soft tissue ● Vaginal itching or ● Monitor fluid imbalances
synthesis and infections discharge ● Check for allergy/hypersensitivity
Dosage/Frequency: division, causing ● Diarrhea ● Assess Vital Signs
750 mg the cell to die Contraindication: ● Check doctor’s order
● Hypersensitivity to Adverse Effects: ● Observe 10 rights of administration
Route of cefuroxime or other ● Severe stomach pain, ● Make sure the pt. had a meal before
administration: cephalosporins diarrhea that is watery or administration
Intravenous bloody
● Fever, chills, headache, During:
Classification: muscle pain ● Inform the patient about the drug
Cephalosporins ● Check the dosage and frequency
● Check the route of administration

After:
● Monitor Input and Output
● Check for side effects
● Notify physician if any of the side effects
worsen
● Report for severe diarrhea with blood,
pus, or mucus; rash; difficulty breathing;
unusual tiredness, fatigue; unusual
bleeding or bruising

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Generic name: By competing with Indication: Side effects: Before:
Diphenhydramine free histamine for ● Skin rash ● Dizziness ● Check doctor’s order
binding at ● Itching ● Dry mouth, nose, or ● Observe 10 rights of administration
Brand name: H1-receptor sites. ● Motion sickness throat ● Make sure the pt. Had a meal before
Benadryl Antihistamines ● To induce sleepiness ● Constipation administration
don’t prevent the
Dosage/Frequency: release of Contraindication: During:
50 mg/ml histamine. ● Hypertension Adverse Effects: ● Inform the patient about the drug
● Blockage of urinary ● Painful or difficult ● Check the dosage and frequency
Route of bladder urination ● Check the route of administration
administration: IV ● Enlarged prostate ● Little or no urination
After:
Classification: ● Check for side effects
Antihistamine ● Notify physician if any of the side effects
worsen or last
● Notify physician if any of the adverse
effects are present

Generic name: Hemostan is a Indication: Side effects: Before:

Tranexamic Acid synthetic lysine ● Hemorrhage caused ● Anemia ● Check for history of Hypersensitivity to
amino acid by general or local ● Fatigue tranexamic acid
Brand name: derivative, which fibrinolysis such as ● Assess Vital Signs
Hemostan diminishes the menorrhagia and ● Check doctor’s order
dissolution of metrorrhagia, Adverse Effects: ● Observe 10 rights of administration
Dosage/Frequency: hemostatic fibrin gastrointestinal ● Blood clots ● Make sure the pt. had a meal before
500 mg cap TID by plasmin. bleeding, hemorrhagic ● Allergic reaction administration
urinary disorders
Route of ● Management of During:
administration: Oral hemorrhage due to ● Inform the patient about the drug
the administration of a ● Check the dosage and frequency
Classification: fibrinolytic agent ● Check the route of administration
Antifibrinolytic
After:
Contraindication: ● Check for side effects
● Acute venous or

21
 arterial thrombosis ● Notify physician if any of the side effects
● Severe renal worsen or lasts
impairment ● Notify physician if any of the adverse
● History of convulsions effects are present
● Report for continued menstrual bleeding

Generic name: Generally Indication: Side effects: Before:

Paracetamol considered to be a ● Headache ● Redness or soreness in ● Assess Vital Signs
weak inhibitor of ● Migraine or around rectum ● Check doctor’s order
Brand name: synthesis of ● Backache ● Observe 10 rights of administration
Panadol, Calpol, prostaglandins ● Fever Adverse effects: ● Make sure the pt. had a meal before
Tylenol, Alvedon (PGs) ● Period pain ● Swelling of throat, administration
(dysmenorrhea) tongue, or face
Dosage/Frequency: ● Shortness of breath or During:
500 mg Contraindication: wheezing ● Inform the patient about the drug
● Acute liver failure ● Check the dosage and frequency
Route of ● Liver problems ● Check the route of administration
administration: ● Acetaminophen
Oral overdose After:
● Caloric undernutrition ● Check for side effects
Classification: ● Notify physician if any of the side effects
Analgesic and worsen or lasts
antipyretic acid ● Notify physician if any of the adverse
effects are present

Generic name: Functions to Indication: Side effects: Before:

0.9% Normal Saline expand ● Extracellular fluid ● Fever ● Assess Vital Signs
intravascular replacement ● Injection site swelling ● Check doctor’s order
Brand name: volume without ● Metabolic alkalosis ● Redness ● Observe 10 rights of administration
NS, 0.9NaCl, or NSS disturbing ion ● Mild sodium depletion
concentration or Adverse effects: During:
Dosage/Frequency: causing large fluid Contraindication: ● Fast heartbeat ● Inform the patient about the drug
1L shifts between ● Heart failure ● Rash ● Check the dosage and frequency
intracellular, ● Pulmonary edema ● Shortness of breath ● Check the route of administration
Route of admin: intravascular, and ● Renal impairment
IV interstitial spaces ● Conditions that cause After:

22
 sodium retention as it ● Check for side effects
Classification: may risk fluid volume ● Notify physician if any of the side effects
Isotonic crystalloid overload worsen or lasts
fluid ● Notify physician if any of the adverse
effects are present

23
 X. NURSING CARE PLANS

NURSING CARE PLAN NO.1

ASSESSMENT NURSING CASE PLAN INTERVENTIONS RATIONALE EVALUATION

CUES Dx BACKGROUND

Objective Short Term: Independent Short Term:

Cues: Fluid Low
volume progesterone Within 4 hours Monitor VS, compare with the To create a baseline for further After 4 hours of
● Pallor (+) deficit during the luteal of proper patient's observations proper nursing
● Vaginal related to phase nursing normal or previous readings intervention, the
bleeding(10 excessive intervention the patient has fully
to 12 pads blood loss patient will Note individuals' physiological Symptomatology may be useless recovered the
per day) as partially obtain response to bleeding such as in gauging the severity or length fluid volume she
● RBC: 2.73 evidenced the fluid weakness, restlessness, and of bleeding episodes. lost
High production
● HGB: 7.2 by volume she pallor.
of Estrogen
prolonged has lost. . Goal is met
vaginal Monitor intake and output and To maintain fluid balance
bleeding monitor serum electrolytes
and Hyperexcitability Long Term:
Maintain bed rest. Schedule Activity increases
decreased of uterine Long Term:
activities to provide intra-abdominal pressure and
some CBC muscles Within 8 hours
undisturbed rest periods. can predispose to further
results of nursing After 8 hours of
bleeding.
intervention, nursing
the patient will intervention,the
Assess signs of severe Excessive bleeding may cause
Severation and be able to: patient was able
dehydration dehydration
damage to blood to:
vessels 1.Demonstrate: Dependent
Improve fluid 1. Demonstrate
balance as Administer IV fluids(e.g. To prevent dehydration and Improve fluid
evidenced by D5LR 1x 8 hrs) restore electrolytes. balance as

24
Vaginal Bleeding stable vital Administer Hemostan 500 mg To manage hemorrhage evidenced by
signs, good cap TID stable vital
skin turgor. signs, and good
For blood transfusion(PRBC) To obtain the amount of blood skin turgor.
that has been lost
Goal partially
Collaborative met

Collaborate and educate the To provide comfort to the patient

family/relatives on assisting and to avoid possible
the patient in doing tasks. complications and increase

Refer to the physician if This is to prevent or recognize

severe bleeding is noted after hypovolemic shock.
D & C.

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 NURSING CARE PLAN NO.2

ASSESSMENT NURSING CASE PLAN INTERVENTIONS RATIONALE EVALUATION

CUES Dx BACKGROUND

Subjective Short Term: Independent Short Term:

Cues: Acute pain Hyperplasia of Within 30
“Ang sakit po ng related to Endometrium Minutes to 1 Assess the patient’s vital signs To create a baseline for After 30
parteng puson AUB hour of nursing q4 further observations Minutes to 1
ko” as verbalized secondary intervention, the hour of
by the patient” to client will be Assess the client's pain scale To identify intensity, onset, nursing
endometrial As follicles able to display duration, and quality of pain intervention,
Objective Cues: Hyperplasia regenerate, and verbalize the goal was
as estrogen levels minimized or met as the
evidenced increase controlled Provide nonpharmacological pain To relieve pain client was
by a pain feelings of pain management (patterned able to display
1. Pain scale of as evidenced by breathing, serene environment, and verbalize
scale: 7/10 the pain scale comfortable position) minimized or
7/10 Irregular of 4/10. controlled
(cramps) sloughing of Dependent feelings of
2. Facial endometrial pain as
Grimace Basalis Layer Administer IV fluids(e.g. D5LR 1L To prevent dehydration and evidenced by
3. Pallor(+) Long Term: x 8 hrs) restore electrolytes. the pain scale
Within 1 week 9of 4/10 by
Administer oral medication (e.g. To ease mild to severe pain
of nursing verbalization
Paracetamol; 500 mg tab and inflammation caused by
intervention, the of:
Abnormal birth, muscle, or trauma
client will be
Uterine Bleeding surgery. “Nurse
able to manifest
a decrease in nabawasan
Collaborative
the pain scale na ang
of manageable Refer to a physician when pain is To make a rapid alternative pagsakit ng
Acute Pain level of pain intolerable solution to induce pain parteng may
2/10 to 0/10 or puson ko
no pain at all. nasa 4/10
nalang ang

26
Concur with the physician in To be educated about the pain.” as
regards to analgesic proper intake of analgesic verbalized by
administration medication to aid pain the patient.”

Goal is met
Collaborate and educate the To avoid possible
family/relatives on assisting the complications and
patient in doing tasks. increasing pain
Long Term:
Educate the patient and To avoid possible
significant others on the complications After 1 week
of nursing
identifying signs and symptoms
intervention,
the client was
able to
Encourage the patient and family To be able to get information manifest a
to collaborate with other patient’s to manage the case decrease in
with the same diagnosis. the pain scale
of 2/10
manageable
level of pain
as evidenced
by the
patient’s
verbalization
of:

“Nurse
nabawasan
na yung sakit
at hilab
ngayon nasa
2/10 nalang.”

Goal not met

27
 NURSING CARE PLAN NO.3

ASSESSMENT NURSING CASE PLAN INTERVENTIONS RATIONALE EVALUATION

CUES Dx BACKGROUND

Objective Short Term: Independent Short Term:

Cues: Risk for Abnormal
infection uterine bleeding Within 3 hours Monitor vital signs, especially This is to assess irregularities and After 3 hours of
● Px related to of nursing temperature. increased temperature may be an nursing
scheduled invasive intervention, indicator of infection. intervention,
or procedure the patient will the px was
underwent D&C ordered be Monitor px’s WBC count. Increased WBC may indicate the knowledgeable
D&C knowledgeable presence of infection. about the
about the procedure and
procedure and Verify sterility of the This is to ensure all instruments was well-aware
Probable uterine is well-aware of instruments used in D & C. are sterile and do not carry any of its benefits
perforation its benefits as pathogens. as well as its
well as its risks risks and
Encourage px to take Vit. This is to strengthen the immune
and possible possible
C-rich foods (if tolerated) and system and prevent dehydration.
complications. complications.
Occurrence of diet PO is advised by a
hemorrhage that physician; encourage fluid
might reach intake.
Long Term: Goal is met.
other organs
Educate px on the importance This is to monitor changes,
such as the Within 5 hours
of follow-up visits. improvements, and abnormalities.
bowel of nursing
intervention, Dependent
the patient is Long Term:
informed about Administer medications This is to eliminate bacterial
May lead to numerous (Cefuroxime) ordered. infections (if present) and prevent
sepsis or measures on post-surgical infections. After 5 hours of
infection how to prevent nursing
or reduce the Collaborative intervention,
presence of the patient was
infection. Refer to the physician if px This is for early detection of informed about

28
has a severe increased infection and for the physician to numerous
temperature. reassess the px. measures on
how to prevent
or reduce the
Educate px about ways on presence of
how to perform proper This is to prevent the growth of infection.
hygiene. bacteria.

Goal is met.

29
 XI. SUMMARY OF DISCHARGE TEACHING

Discharge Care

● Apply heat on your lower abdomen to decrease pain and muscle spasms. Apply
heat for 20 to 30 minutes every 2 hours for as many days as directed.
● Include foods high in iron if needed. Examples of foods high in iron are leafy
green vegetables, beef, pork, liver, eggs, and whole-grain breads and cereals.
● Keep a diary of your menstrual cycles. Keep track of the number of tampons or
pads you use each day.
● Talk to your healthcare provider before you start a weight loss program. You may
need to wait until the abnormal bleeding has stopped before you try to lose
weight. The amount of iron in your blood should be normal before you lose
weight. Ask your provider if weight loss will help your AUB. He or she can tell you
what weight is healthy for you. He or she can help you create a safe weight loss
plan, if needed.

Follow up with your doctor or gynecologist as directed: You may need to return in 4
to 6 months so your provider knows if the AUB has stopped. Bring the diary of your
menstrual cycles to your follow-up visits. Write down your questions so you remember
to ask them during your visits.

Always consult your healthcare provider to ensure the information displayed on this
page applies to your personal circumstances.

30
 XII. CURRENT TRENDS / INNOVATIONS / CLINICAL MANAGEMENT

Adaptive Vapor Ablation

The AEGEA Vapor System is an in-office treatment option for endometrial

ablation that is safe, simple and effective, as demonstrated in the company’s pivotal trial
data that was the basis for FDA approval. Seventy-three percent of the U.S. procedures
from the pivotal trial were performed in the office setting. No serious device or
procedure-related adverse events were reported through the study’s 12-month clinical
follow-up. The majority of patients had a reduction of their menstrual bleeding to normal
levels or had no period at all. Treatment time is two minutes, and the system is fully
automated.

In addition, a new research study is underway to evaluate uterine cavity access

following endometrial ablation. AEGEA believes this is a very important success metric
for the therapy, as it speaks to the possibility of future uterine-related interventions. Pilot
data on 11 patients treated with Adaptive Vapor Ablation technology has demonstrated
that Vapor Ablation has the potential address this unmet need, potentially preserving
physician and patient options in the future.

31
 Acuson Juniper (2019)

ACUSON Juniper is a new ultrasound system created by Siemens Healthineers.

It has advanced applications and imaging capabilities featuring an ergonomic design,
lightweight, and complete mobility for use across various clinical segments. Siemens
Healthineers incorporated feedback from the 365 participants in its largest-ever
ultrasound co-creation project to ensure that ACUSON Juniper meets the needs of
today’s changing healthcare landscape. The system’s versatility and adaptability make it
ideal for diverse patient anatomies and physiologies. Users can customize the
ACUSON Juniper based on patient interactions for improved clinical workflow.

The most miniature, a lightweight system in its class, the ACUSON Juniper, is
powered by a completely new imaging platform designed from the ground up with user
needs in mind. Its new front-end engine offers exceptional system sensitivity, specificity,
and a high dynamic range for improved tissue differentiation. It also has a new signal
processor that allows advanced elastography imaging. The ultrasound system has 16
transducers; it is customizable with advanced imaging applications in radiology and
interventional radiology, urology, cardiovascular, orthopedic, and
obstetrics/gynecological imaging.

32
 XIII. REFERENCES

Biggers A. (2021, October 7). Female reproductive organ anatomy. Retrieved from
https://www.medicalnewstoday.com/articles/female-reproductive-organ-anatomy

Cassling. (2018, March). Siemens Healthineers launches ACUSON juniper

next-generation ultrasound system. Cassling Medical Imaging Equipment Sales, Leasing &
Service | Cassling. https://www.siemens-healthineers.com/en-ph/ultrasound

MIMS (n.d.). Cefalexin. MIMS Philippines [Website].

https://www.mims.com/philippines/drug/info/cefalexin?mtype=generic

MIMS (n.d.). Cefuroxime. MIMS Philippines [Website].

https://www.mims.com/philippines/drug/info/cefuroxime?mtype=generic
MIMS (n.d.). Mefenamic Acid. MIMS Philippines [Website].
https://www.mims.com/philippines/drug/info/mefenamic%20acid?mtype=generic
Practical Psychology (2022, December 8). Havighurst’s Developmental Task Theory.
Practical Psychology [Website]. Retrieved from
https://practicalpie.com/havighursts-developmental-task-theory/
Cherry K. (2022, December 16). Piaget’s 4 Stages of Cognitive Development Explained.
Very Well Mind [Website]. Retrieved from
https://www.verywellmind.com/piagets-stages-of-cognitive-development-2795457
Martinez, L., & Johns, E. (2020, December 3). Abnormal uterine bkeeding. MedlinePlus.
Retrieved January 11, 2023, from https://medlineplus.gov/ency/article/000903.htm
Meighan M. (2017, January 10). Mercer’s Becoming a Mother Theory in Nursing
Practice. Nurse Key [Website]. Retrieved from
https://nursekey.com/mercers-becoming-a-mother-theory-in-nursing-practice/
Nursing Theory (n.d.). Mercer’s Maternal Role Attainment Theory. Nursing Theory
[Website]. Retrieved from
https://nursing-theory.org/theories-and-models/mercer-maternal-role-attainment-theory.php
Tidy C. (2022, November 22). Endometrial Hyperplasia. Patient [Website]. Retrieved
from https://patient.info/womens-health/endometrial-hyperplasia-leaflet

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