Hydatidiform Mole

Submitted to:

August Malabanan RN, MAN

Table of Contents

CHAPTER I: INTRODUCTION………………………………………………………………………03

CHAPTER II: DEMOGRAPHIC PROFILE AND CLINICAL HISTORY………………………….05

CHAPTER III: PHYSICAL ASSESSMENT…………………………………………………………10

CHAPTER IV: NORMAL ANATOMY AND PHYSIOLOGY……………………………………….16

CHAPTER V: PATHOPHYSIOLOGY………………………………………………………………..24

CHAPTER VI: LABORATORY/DIAGNOSTIC EXAMINATIONS………………………………...26

CHAPTER VII: MEDICAL AND SURGICAL MANAGEMENT……………………………………34

CHAPTER VIII: DRUG STUDY……………………………………………………………………….39

CHAPTER IX: NURSING CARE PLAN/PROCESS………………………………………………..46

CHAPTER X: CURRENT TRENDS/INNOVATIONS/CLINICAL MANAGEMENT…………...…54

CHAPTER XI: SUMMARY OF DISCHARGE TEACHINGS……………………….…………...…57

CHAPTER XII: REFERENCES…………………………………………………………………….....59

 Introduction

Expectant parents are frequently concerned about pregnancy risks. This is not uncommon

considering pregnancy-related issues can cause serious complications and even death in both the

mother and the child. A molar pregnancy — also known as hydatidiform mole — is a rare

complication of pregnancy (Mayo Clinic, 2021). A hydatidiform mole is growth of an abnormal

fertilized egg or an overgrowth of tissue from the placenta. Women appear to be pregnant, but the

uterus enlarges much more rapidly than in a normal pregnancy (Ramirez, 2020). There are two

types of molar pregnancy, complete molar pregnancy and partial molar pregnancy. In a complete

molar pregnancy, the placental tissue is abnormal and swollen and appears to form fluid-filled

cysts. In a partial molar pregnancy, there may be normal placental tissue along with abnormally

forming placental tissue (Mayo Clinic, 2021).

This case study is about a 20 year old female patient who was admitted last April 30,

2022 with unusual vaginal bleeding as her chief complaint. 3 days prior to admission, the patient

experienced severe nausea and vomiting with low back pain. The patient took a pregnancy test

that came out positive but did not consult an OB. Few hours prior to admission, the patient

 experienced unusual vaginal bleeding. The patient was later diagnosed with Hydatidiform Mole,

Complete.

The purpose of this case study is to provide in-depth information about Hydatidiform

Mole. It also aims to enlighten clients and healthcare providers on how to deal with the stated

maternal problem in a healthy manner. The primary objectives of this case study are as follows:

➔ Determine the predictors of Hydatidiform Mole

➔ Provide an overview of the pathophysiology of Hydatidiform Mole

➔ Input a detailed clinical management plan

➔ Provide current trends on the management of the clinical finding

 Demographic Profile

Name: S.G.

Address: No Data Provided

Age: 20 years old

Status: Single

Occupation: College Student

Educational Attainment: College Undergraduate

Chief Complaint: Unusual Vaginal Bleeding

Admitting Dx: Hydatidiform Mole, Complete

Date and Time of Admission: April 30, 2022; 8:14 AM

Attending Dr: Dr. Luna

 Clinical History

History of Present Illness

The patient, who is a 20 year old female, was admitted for unusual vaginal bleeding.

Three days prior to admission the patient was also experiencing severe nausea, vomiting and low

back pain. The patient’s last menstrual period was recorded last January 3, 2022 and the patient

took a pregnancy test that came out positive however, the patient did not consult an obstetrician.

Past Medical History

The patient has no history of other illnesses prior to this admission, and no known

allergies to any food or drug.

Genogram with Family History

 The father was diagnosed with Type II Diabetes Mellitus, controlled. The mother is

known to have hypertension under maintenance medication. The older sibling is athmatic since 4

years old.

Social Data

The patient denied drinking alcohol and she is a smoker of 1 pack of cigarettes a day.

Lifestyle

The patient denied drinking alcohol and she is a smoker of 1 pack of cigarettes a day.

Patterns of Healthcare

The patient has no known illnesses prior to admission and no known allergies.

 Developmental History

Erikson’s Stages of Development

The 6th stage of Erik Erikson's psychosocial development is intimacy vs. isolation. This

stage emphasizes the significance of developing a strong and loving relationship with others. At

this stage, success could lead to meaningful relationships. Failure at this stage, on the other hand,

may result in a person's feelings of loneliness and isolation. The majority of those that take the

stage are between the ages of 19 and 40. In relation to the case study, the patient is a 20 year old

female. These are the times where she will develop strong and loving relationships with others

which could soon lead to meaningful relationships.

Freud’s Stages of Psychosexual Development

 The genital stage, which begins at puberty, is the final phase of Freud's psychosexual

theory of personality development. It's a period of adolescent sexual exploration, with the

successful resolution involving settling down in a loving one-on-one relationship with another

person in our twenties. In relation to the case study, the patient is 20 years old, single and is

probably in the period of her adoloscent sexual exploration as evidenced by her history of

present illness.

Berne’s Transactional Analysis

The method of transactional analysis is often used to examine how people communicate

with one another. It necessitates us from being conscious of how we feel, think, and act in social

situations. TA believes that we have three different states or ways of being during interactions,

which are; the child ego state, the parent ego state, and the state of adult (Berne, 1957).

In relation to the case study, the patient, a 20 year old female, is on her adult stage where

she forms her interactions, she interacts with people and its environment in the here and now, not

from past conditioning or how other people have told them to be. When communication takes

place from the adult state, we are more likely to be respectful, make compromises, listen fully to

others, and have more healthy social interactions.

 Physical Assessment

A structured physical examination allows the nurse to obtain a complete assessment of

the patient. This can be very helpful because it can help determine the status of the patient’s
health and this can give way to early intervention and prevention of any health issues that they
are currently at risk for.

Body Part Method Use Findings Interpretation

 NEURO Inspection ● Alert ABNORMAL

● Oriented
Distress can indicate
● In obvious
feelings of extreme
distress
worry, anxiety, and/or

pain. As for the client’s

condition, 3 days prior to

admission, she

experienced severe

nausea and vomiting

with lower back pain,

and a few hours prior to

admission, she

experienced unusual

vaginal bleeding. These

instances can lead to

distress.

 SKIN Inspection and ● Cold ABNORMAL

Palpation ● Clammy
The normal skin should

be not too dry, oily, or

wet, as well as not too

cold or warm.

The client’s skin

assessment indicates that

she is having an anxiety

or stress reaction due to

her situation.

 RESPIRATORY Inspection, ● (+) Labored ABNORMAL

Palpation, Breathing
The normal breathing
Percussion, and
should have an
Auscultation
automatic pause (or

period of no breathing)

for about 1 to 2 seconds

after the out breath

(exhale).

The client may be

feeling panicked or

scared that can cause her

to hyperventilate or

breathe very quickly.

This then can result in

her breathing to be

labored.

 CARDIOVASCULAR Inspection, ● (+) Thready ABNORMAL

Palpation, Peripheral
The normal rhythm of
Percussion, and Pulses
the pulses should be
Auscultation
regular and consistent

(Nursing Times, 2015).

The patient may be

showing thready pulses

as she is having some

anxiety and stress in

relation to her present

condition.
FUNDAL HEIGHT Inspection ● 5 cm above NORMAL

the umbilicus

 ABDOMEN Inspection, ● Soft ABNORMAL

Palpation, ● Mild
The normal abdomen
Percussion, and tenderness on
should be tender.
Auscultation bilateral lower

standards The client’s assessment

of mild tenderness

indicates that there is a

sign of inflammation or

other acute processes in

or more organs. In her

case, she has seen with

Hydatidiform Mole, a

non-cancerous tumor in

the uterus.

 PELVIC Inspection ● Loose ABNORMAL

discharge of
The normal pelvic
blood clots
assessment should not be
● Large amounts
found with blood clots or
of brown
any materials that can
colored-
indicate diseases.
grapelike

material The client’s assessment

indicates presence of

molar pregnancy, which

the client has. It usually

begins between 6 and 12

weeks of pregnancy.

 CERVICAL OS Inspection, ● 2 cm dilated ABNORMAL

Palpation, and ● Slightly tender

The normal cervical os
Auscultation ● No fetal heart
should not be tender, and
sounds
if a woman is pregnant,

fetal heart sounds should

be present, otherwise

indicating certain

problems.

The client’s assessment

of tender cervical os

indicates that there is an

inflammation (Mayo

Clinic, 2020).

No fetal heart sounds

also indicate a definite

miscarriage, which is

possible in relation to the

client’s condition of

molar pregnancy

(Danielsson, 2021).

 Normal Anatomy and Physiology

Anatomy refers to the internal and external structures of the body and their physical

relationships, whereas physiology refers to the study of the functions of those structures. This

chapter discusses the anatomy and physiology of the concerned body part and its importance.

FEMALE REPRODUCTIVE SYSTEM

 Figure 1. Female Reproductive System

The Female Reproductive System is designed to carry out several functions. It produces

the female egg cells necessary for reproduction, called the ova or oocytes. The system is

designed to transport the ova to the site of fertilization.

The main feature of the living thing is that they reproduce and give birth to the young

ones of their species. This is the important process of nature, to increase and maintain the ratio of

the population of that particular species. This essential process is named reproduction, which

itself means to reproduce. This is the process of fusion of male and female gamete, to produce

their species. While the organs of an individual body are involved in this process, together

known as the reproductive system. (Rachna C., 2018). Below are some of the functions of the

reproductive system.

1. Produce gametes. Sperm cells are produced in men's testicles and egg cells are

produced in women's ovaries.

2. Transport and sustain egg and sperm cells. Sperm transport within the female

reproductive tract is a cooperative effort between the functional properties of the sperm and

seminal fluid on the one hand and cyclic adaptations of the female reproductive tract that

facilitate the transport of sperm toward the ovulated egg.

3. Nurture developing offspring. The human reproductive system functions to

produce human offspring, with the male providing sperm and the female providing the ovum.

With this, The fetus is nourished in the uterus and is given milk after its birth.

 4. Produce hormones. Reproductive hormones are usually made in the ovaries (in

females) and testes (in males). Female reproductive hormones include estrogen and progesterone

while the male reproductive hormone is testosterone.

Structure and Functions of the Female Reproductive System

The most important part is played by the female reproductive system as here only the

fertilization and further development of the fetus takes place and ultimately supports in

increasing the population of the particular species. Although there is a critical role played by the

male gamete also, as until and unless the male sperms are not delivered to the female genital

part, and met with the ovum, it will not get developed further (Rachna C., 2018).

The Female Reproductive System consists of internal and external structures. The

function of the external female reproductive structures (the genital) is twofold: To enable sperm

to enter the body and to protect the internal genital organs from infectious organisms.

The main external structures of the female reproductive system include:

● Mons pubis: The mons pubis is a rounded mound of fatty tissue that covers the

pubic bone. During puberty, it becomes covered with hair. The mons pubis contains oil-secreting

(sebaceous) glands that release substances that are involved in sexual attraction (pheromones)

(Knudston, 2019).

● Labia majora: The labia majora (“large lips”) enclose and protect the other

external reproductive organs. During puberty, hair growth occurs on the skin of the labia majora,

which also contains sweat and oil-secreting glands.

 ● Labia minora: The labia minora (“small lips”) can have a variety of sizes and

shapes. They lie just inside the labia majora, and surround the openings to the vagina (the canal

that joins the lower part of the uterus to the outside of the body) and urethra (the tube that carries

urine from the bladder to the outside of the body). This skin is very delicate and can become

easily irritated and swollen.

● Bartholin’s glands: These glands are located next to the vaginal opening on each

side and produce a fluid (mucus) secretion.

● Clitoris: The two labia minora meet at the clitoris, a small, sensitive protrusion

that is comparable to the penis in males. The clitoris is covered by a fold of skin, called the

prepuce, which is similar to the foreskin at the end of the penis. Like the penis, the clitoris is very

sensitive to stimulation and can become erect.

● Pudendal Cleft: The mons pubis separates into two folds of skin called the labia

majora, literally “major (or large) lips.” The cleft between the labia majora is called the pudendal

cleft, or cleft of Venus, and it contains and protects the other, more delicate structures of the

vulva.

● The vaginal opening (meatus): the entrance to the vagina.

● The urethral opening (meatus): the end of the tube which carries urine from the

bladder to the outside (urethra).

 Photo from Cleveland Clinic

Figure 2. Female External Genitalia

The internal female reproductive system contains two main parts: the uterus, which hosts

the developing fetus, produces vaginal and uterine secretions, and passes the anatomically male

sperm through to the fallopian tubes; and the ovaries, which produce the anatomically female

egg cells.

The internal female reproductive organs include:

● Vagina: The vagina is a canal that joins the cervix (the lower part of the uterus) to

the outside of the body. It also is known as the birth canal.

● Uterus (womb): The uterus is a hollow, pear-shaped organ that is the home to a

developing fetus. The uterus is divided into two parts: the cervix, which is the lower part that

 opens into the vagina, and the main body of the uterus, called the corpus. The corpus can easily

expand to hold a developing baby. A canal through the cervix allows sperm to enter and

menstrual blood to exit.

● Ovaries: The ovaries are small, oval-shaped glands that are located on either side

of the uterus. The ovaries produce eggs and hormones.

● Fallopian tubes: These are narrow tubes that are attached to the upper part of the

uterus and serve as pathways for the ova (egg cells) to travel from the ovaries to the uterus.

Fertilization of an egg by a sperm normally occurs in the fallopian tubes. The fertilized egg then

moves to the uterus, where it implants to the uterine lining.

 Photo from Cleveland Clinic

Figure 3. Female Internal Genitalia

The Uterus is a hollow muscular organ located in the female pelvis between the bladder

and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg

has left the ovary it can be fertilized and implant itself in the lining of the uterus. The uterus, also

known as the womb, is a female reproductive organ that is responsible for many functions in the

processes of implantation, gestation, menstruation, and labor. The uterus is divided into 3 main

parts: the fundus, body, and cervix.

Figure 4. Uterus

The placenta is an organ that develops in the uterus during pregnancy. The placenta looks

like a disc of bumpy tissue rich in blood vessels, making it appear dark red at term. Most of the

 mature placental tissue is made up of blood vessels. They connect with the baby through the

umbilical cord and branch throughout the placenta disc like the limbs of a tree. This structure

provides oxygen and nutrients to a growing baby. It also removes waste products from the baby's

blood. The placenta attaches to the wall of the uterus, and the baby's umbilical cord arises from

it.

Figure 5. Placenta

 Pathophysiology

The pathophysiology depicts the unique process through which the client developed the

obstetric complication in question. As a result, pathophysiology comprises predisposing

variables, which are the determinants that put the client at risk for a particular problem. Along

with the predisposing factors are the precipitating factors, which are the principal stimulators of

the onset of a certain complication. The pathophysiology of the obstetric complication

experienced by the client in this case study is depicted below.

 Laboratory / Diagnostic Examinations

HEMATOLOGY

Hematology includes the study of blood wherein different laboratory blood tests are done

to determine a client’s blood condition. Complete blood count is a major factor being analyzed in

laboratory examinations since it is an effective tool utilized in detecting any blood-related

complications such as anemia (Mayo Foundation for Medical Education and Research, 2020).

Legend:
Red - Elevated from Reference Value Green - Within Reference Value or Normal
Orange - Low from Reference Value

Date of Laboratory or Actual Results Reference Values Interpretation

Diagnostic Results

Laboratory of Diagnostic
Procedure

 04/30/2022
0930H
COMPLETE BLOOD COUNT

RBC 4.45M/cumm 4.00-9.50 Within Reference Value

WBC 5400.00/ cumm 4000-11000 Within Reference Value

NEUTROPHILS 60.80% 40.0-75.0 Within Reference Value

LYMPHOCYTE 35.80% 20-45 Within Reference Value

MONOCYTE 0.90% 2.0-10.0 Within Reference Value

EOSINOPHILS 2.50% 1.0-6.0 Within Reference Value
BASOPHILS 0.01 0.0-1.0 Within Reference Value
PLATELET COUNT 194.00K/cumm 150-400 Within Reference Value

HEMOGLOBIN 11.54mg/dl 11.0-16.0 Within Reference Value

HEMATOCRIT 34.30% 35.0-55.0 Within Reference Value

Nursing Responsibility: The nurses ensure that the patient has had the appropriate

preparation. The nurse will remind the patient to do fasting if needed. The nurse should be aware

of the normal and abnormal ranges of blood tests in order to understand or interpret the test

results.

 B-HCG

Beta Human Chorionic Gonadotropin (HCG) is a hormone produced by the placenta

during pregnancy, and is typically detected in the blood. A beta HCG test is a blood test used to

diagnose pregnancy, and usually becomes positive around the time of the first missed period

(Health Engine, 2018).

Date of Laboratory or Actual Results Reference Values Interpretation

Diagnostic Results

Laboratory of Diagnostic
Procedure

04/30/2022
0930H
B-HCG 25490 Gestational Age: The patient is in her 2nd to 3rd
1st week:
10-50mIU/ml month of gestation.

2nd week:
30-300mIU/ml

3rd week:
100-2000mIU/ml

4th week:
500-10000mIu/ml

2nd to 3rd month:

10000-100000mI
U/ml

2nd Trimester:
5000-50000mIU/
ml

3rd Trimester:
3000-30000mIU/
ml

 PELVIC ULTRASOUND

A pelvic ultrasound is a noninvasive diagnostic exam that produces images that are used

to assess organs and structures within the female pelvis (Johns Hopkins Medicine).

Date of Laboratory or Actual Results Interpretation

Diagnostic Results

Laboratory of Diagnostic
Procedure

04/30/2022
0930H

 PELVIC ULTRASOUND ● Urinary bladder is empty

● Uterus is anteverted, bulky

in size. A/P diameter is

93mm

● Myometrium appears

homogeneous

● Multiple cystic lesions

having snow storm

appearance are noted in the

endometrial cavity

● Right ovary is normal in

size having multiple

follicles. Volume is 5 ml

● Left ovary is enlarged in

size having multiple

follicles. Volume is 15 ml

● Pouch of Douglas is free of

collection

IMPRESSION:

Suggestive of Molar Pregnancy

 ABO TYPING

Blood typing is a process to let us know what type of blood we have. It is done by

collecting a blood sample, centrifuging it, and separating the red blood cells (RBCs) from the

serum or plasma. Our blood will be classified as Type A, Type B, Type AB, or Type O (Raman,

2018). In this case study, the patient’s blood type is O Positive. Rhesus (Rh) typing is applied to

discover if we have some protein known as the Rh factor on the outside layer of our red blood

cells (University of Rochester Medical Center, 2016). In this case study, the Rh typing of the

patient is positive which means that the client has protein in her blood and has an Rh factor.

Date of Laboratory or Actual Results

Diagnostic Results

Laboratory of Diagnostic
Procedure

04/30/2022
0930H
BLOOD TYPING O Positive

RH TYPING Positive

Nursing Responsibility: Many components of the transfusion process are handled by

nurses, these responsibilities are taking and labeling blood samples, collecting blood from the

blood bank, storing it in ward areas for brief periods of time, checking while administering,

documenting the transfusions, and the patient monitoring.

 HEPATITIS B SURFACE ANTIGEN

Hepatitis B surface antigen (HBsAg) is screened on the client to detect if she has the

actual presence of HBV called surface antigen (Hepatitis B Foundation, n.d.). The client in this

case study tested negative or non-reactive to HBsAg that can indicate a low-risk pregnancy for it

ensures that the infant to be born is not infected with said virus.

Date of Laboratory or Actual Results

Diagnostic Results

Laboratory of Diagnostic
Procedure

04/30/2022
0930H
HBSAG Non-Reactive

Nursing Responsibility: The nurses ensure that the patient has had the appropriate

preparation. There is no fasting required but the nurse shall instruct the patient to stop biotin

consumption several hours prior to the collection of the sample. The nurse should be aware of a

positive or a reactive result in order to understand or interpret the test results.

RAPID PLASMA REAGIN

RPR (rapid plasma reagin) is a screening test for syphilis. It measures substances

(proteins) called antibodies that are present in the blood of people who may have the disease

(Mount Sinai). The client in this case study tested negative or non-reactive to RPR that can

indicate that the patient does not have the disease.

 Date of Laboratory or Actual Results

Diagnostic Results

Laboratory of Diagnostic
Procedure

04/30/2022
0930H
RPR Non-Reactive

CHEST X-RAY POSTEROANTERIOR

The posteroanterior (PA) chest view examines the lungs, bony thoracic cavity,

mediastinum and great vessels. The PA view is frequently used to aid in diagnosing a range of

acute and chronic conditions involving all organs of the thoracic cavity (Radiopaedia, 2021).

Date of Laboratory or Actual Results Interpretation

Diagnostic Results

Laboratory of Diagnostic
Procedure

04/30/2022
0930H
CHEST X-RAY IMPRESSION:
POSTEROANTERIOR
Normal Chest Radiograph

 Medical and Surgical Management

This section lists detail and course of the treatment as ordered by the physician with its

relative rationale. It is crucial to document every medical and surgical management performed

by the healthcare workers in order to assess the different approaches conducted to the patient.

 This also modifies consumer and provider behavior to improve the quality and outcome of

healthcare delivery (Gartner, n.d.).

Day 1
04/30/22
0814H

Medical Regimen Rationale

Please admit to ROC under the service of Dr. Luna
To promptly provide the patient with essential healthcare
actions.
Secure consent for admission and management To obtain informed consent
VS q4 and record To assess, monitor and record the patient’s condition.
I and O qshift and record To prevent dehydration, fluid retention and other
problems related to fluid imbalances.
Diet: DAT To provide a well balanced diet and ensure that
individuals who do not require dietary modifications
receive adequate nutrition.
Hook to PNSS 1L x 125cc/hr To perform extracellular fluid replacement
Diagnostics:
● For CBC with platelet - To determine a patient’s blood condition.
● Serum B- Hcg - To diagnose pregnancy.
● Pelvic UTZ - To provide visualization of the female
reproductive system to diagnose hydatidiform
mole.
● ABO Typing - To determine a patient's blood type to prepare for
possible blood transfusion.
● HbsAg - To check if a patient is infected with hepatitis B
virus.
● RPR - To determine if a patient acquired syphilis.
● CXR P/A - To provide visualization of the structures and
organs in the chest and help spot abnormalities.

 Therapeutics:
● Cephradine 1g IV () ANST now then - To treat bacterial infections.
q6 - To be used as antibiotic treatment.
● Metronidazole 500mg / 100ml ()ANST - To stop the rapid growth of hydatidiform mole.
q8 - To be used as an antidote to the harmful effects of
● Methotrexate 20 mg IM daily for 5 methotrexate and to prevent certain kinds of
days anemia.
● Leucovorin 15 mg i tab q 6 hours for
Keep on bedrest To provide comfort and let the patient rest.
WOF heavy bleeding To monitor and provide proper interventions to avoid risks
for infection.
Check pads regularly To weigh, calculate and record cumulative blood loss.
Refer accordingly To notify and advise attending health practitioners
regarding the patient’s condition.
0930H
Laboratories are seen
Patient seen and examined To monitor the condition of the patient and promptly
provide the patient with essential healthcare actions.
For D&C today at 4pm To treat life threatening complications by removing
abnormal tissue from the uterus.
Secure consent To obtain informed consent

Refer to anesthesiologist on deck For collaborative management between healthcare

Inform OR
Keep on CBR s BRP
Secure 2 units of PRBC properly typed and
crossed-matched
Patient informed of current situation
Discussed possibility of hysterectomy
providers.
To notify healthcare workers in that area and to prepare
for the surgery intervention and ensure safety and care of
the patient.
To provide comfort and let the patient rest
To be used for blood transfusion, replacing blood loss.
To notify the patient regarding current condition and be
prepared for surgery intervention.
To treat molar pregnancy if it causes too much blood and
to prevent the potentially life threatening complications.

 1730H

Transfer to PACU To let the patient recover and for continuous monitoring.

Shift present IVF to D5LR 1L x 125cc/hr To replace water and electrolyte loss in patient after
significant blood loss
VS q1 until stable To assess, monitor and record the patient’s condition.

NPO for the next 6 hrs, then DAT
WOF heavy bleeding and refer
Start Paracetamol 300 mg IV q6
To prevent nausea or vomiting to keep any food or liquids
from getting into the lungs as anesthesia increases the
chances of regurgitating
To monitor and provide proper interventions to avoid risks
for infection.
To relieve pain

Refer accordingly To notify and advise attending health practitioners

regarding the patient’s condition.
2130H
Stable Vital Signs, (-) Profuse Bleeding, Conscious and Coherent
May trans-out to room For continuous monitoring

VS q4 and record To assess and record vital signs deviated from normal

IVF TF: D5LR 1L x 125cc/hr x 2 cycles To replace water and electrolyte loss in patient after
significant blood loss
Maintain on CBR s BRP TFO To provide comfort and let the patient rest

Day 2
05/01/22
0900H
(-) Profuse Bleeding
IVF to consume To replace water and electrolyte loss in patient after
significant blood loss
May sit up on bed To provide comfort and let the patient rest

 Shift Cephradine IV to oral 1gm tab q6 To treat bacterial infections.

Metronidazole 500mg/100ml x 1 more dose To be used as antibiotic treatment.

then D/C
Methotrexate 20 mg IM daily for 5 days To stop the rapid growth of hydatidiform mole.

Leucovorin 15 mg 1 tab q 6 hours for 10 doses To be used as an antidote to the harmful effects of
to start 24 hours after the administration of methotrexate and to prevent certain kinds of anemia.
methotrexate
Shift Paracetamol IV to oral 500mg tab q6 To relieve pain
PRN for pain
Refer accordingly To notify and advise attending health practitioners
regarding the patient’s condition.
Day 3
05/02/22
1100H

MGH today To rest at home, observe any complications and notify the
attending physician
Home Medications:
● Cephradine 1gm tab BID x 5 days - To treat bacterial infections.
● FeSO4 1 cap OD - To treat and prevent iron deficiency anemia
● Leucovorin 15 mg 1 tab q 6 hours for - To be used as an antidote to the harmful effects of
10 doses methotrexate and to prevent certain kinds of
anemia.
- To relieve pain
● Paracetamol 500mg tab for pain
Minimal ambulation , Avoid strenuous activity To get rapid and maximum muscle function and
restoration of health.
Advised not to get pregnant at least 6 months To inform the patient of possible complications of
pregnancy after surgical intervention that is done.
FFup after 1 week with repeat serum B-Hcg To ensure that the patient is recovering well from surgery
result and histopathology report at Luna’s and check for changes in lab results to verify if there are
Clinic 10am to 2pm no serious life threatening complications.

 Day 1
04/30/22
1700H
Time of Operation: 1600H
Indication for Operation: Hydatidiform Mole, Complete
Height of Uterus: 5 weeks
Amount of Product: Moderate
Amount of Bleeding: Moderate
Surgical Regimen Rationale
Dilation and Curettage To treat life threatening complications by removing
abnormal tissue from the uterus.
No complications occurred during the Indicates that the procedure is successful.
procedure
Specimen was sent to lab for histopathology To examine tissue and help healthcare providers to
provide the patient with essential healthcare actions.

 Drug Study

Name of Drug Classification Indications Adverse Side Effects Nursing

Mechanism of Effects Responsibility

Action

 PNSS 1L Classification: Indication: Adverse Effects:The following - Do not administer unless

PNSS belongs to aIndicated for sterileCommon adverseare the side the solution is clear and
Generic Name: n/a class of drugs called
irrigation of body effects of the effects undamaged.
Crystalloid Fluid. cavities, tissues or solution are associated: - In patients receiving
Brand Name: n/a wounds, indwellingallergic reactions,hives, itching, corticosteroids or
Mechanism of urethral catheters, such as localizedswelling of the corticotropin, caution
Dosage & Frequency:
Action: surgical drainage or generalized eyes, face or should be exercised when
Crystalloid fluids tubes, and for hives and itching,throat, administering parenteral
125cc per hour
function to expandwashing, rinsing orswelling of the coughing, fluids, particularly those
intravascular
Route of Administration: soaking surgical eyes, face, or sneezing, containing sodium ions.
volume without dressings, throat, coughing,difficulty - Acetate-containing
Intravenous Administration
disturbing ion instruments and sneezing, or breathing, feversolutions should be used
concentration or laboratory specimen.
difficulty and infection atwith caution, as excess
causing significant breathing. injection site. administration of it can
fluid shifts between
Contraindications: cause metabolic alkalosis.
intracellular, The infusion of - Discard unused portions.
intravascular, and hypertonic dextrose - Dextrose-containing
interstitial spaces injection is solutions should be used
contraindicated in with caution in patients
patients having who have diabetes
intracranial or mellitus, whether
intraspinal subclinical or overt.
hemorrhage, in - Properly label the IV
patients who are fluid.
severely dehydrated,
in patients who are
anuric, and in
patients in hepatic
coma.

 D5LR Classification: Indication:

It Lactated
Adverse Effects:The following - Do not administer unless
is used to replace Ringer's solution isCommon adverse
are the side the solution is clear and
Generic Name: Lactated
water and an intravenous fluid
effects of Lactated
effects undamaged.
Ringer’s Solution electrolyte loss in that doctors use to Ringer’s solutionassociated: - In patients receiving
patients with low treat dehydration and
are allergic hives, itching, corticosteroids or
Brand Name: Lactatedblood volume or restore fluid balance
reactions, such asswelling of the corticotropin, caution
Ringer’s Solution low blood pressure.
in the body. localized or eyes, face or should be exercised when
It is also used as an generalized hivesthroat, administering parenteral
Frequency: alkalinizing agent,Contraindications:
and itching, coughing, fluids, particularly those
125cc per hour which increases the
This solution is swelling of the sneezing, containing sodium ions.
pH level of the contraindicated eyes, face, or difficulty - Acetate-containing
Route of Administration:
body. where the throat, coughing,breathing, feversolutions should be used
Intravenous Therapy (IV) administration of sneezing, or and infection atwith caution, as excess
Mechanism of sodium, potassium,difficulty injection site. administration of it can
Action: calcium, chloride or
breathing. cause metabolic alkalosis.
Ringer's solution islactate could be - Discard unused portions.
a solution of several
clinically - Dextrose-containing
salts dissolved in detrimental. Lactate solutions should be used
water for the administration is with caution in patients
purpose of creating
contraindicated in who have diabetes
an isotonic solution
severe metabolic mellitus, whether
relative to the body
acidosis or alkalosis, subclinical or overt.
fluids. Ringer's and in severe liver - Properly label the IV
solution typically disease or anoxic fluid.
contains sodium states which affect
chloride, potassium
lactate metabolism. - Observe aseptic

chloride, calcium technique when changing

chloride and sodium IV fluid.

bicarbonate, with
the last used to
balance the pH.

 Paracetamol Classification: Indication: Adverse Effects:The following - Check the doctor’s

Paracetamol, also Paracetamol solution
The most are the side orders.
Generic Name: n/a known as for Infusion is commonly effects - Check the patient’s
acetaminophen, isindicated
a for the reported adverseassociated: allergy status -
medication used toshort-term treatment
reactions have An allergic Advise the patient that the
Brand Name: n/a treat fever and mild
of moderate pain, included nausea,reaction, whichmedication can be taken
to moderate pain. especially following
vomiting, can cause a rashwith or without food.
surgery, and for theconstipation. and swelling, - Stop medications if any
Dosage & Frequency: Mechanism of short-term treatment
Injection site pain
flushing, low adverse effects occur.
Action: of fever. and injection siteblood pressure
300mg once every 6 hours
Paracetamol has a reaction have been
and a fast
central analgesic Contraindications:
reported with theheartbeat – this
Route of Administration:
effect that is Contraindications to
IV product. can sometimes
mediated through the use of
Intravenous Therapy (IV) happen when
activation of acetaminophen paracetamol is
descending include given in hospital
serotonergic hypersensitivity to into a vein in
pathways. Debate acetaminophen, your arm.
exists about its severe hepatic
primary site of impairment, or
action, which maysevere active hepatic
be inhibition of disease.
prostaglandin (PG)
synthesis or through
an active metabolite
influencing
cannabinoid
receptors.






 Cephradine Classification: Indication: Adverse Effects:Some side - Determine history of

Cephradine is in aThis medication is Some
a adverse previous hypersensitivity to
effects included
Generic Name: n/a group of drugs first generation effects include nausea, cephalosporins, penicillins,
and other drug allergies
called cephalosporin
cephalosporin diarrhea that is vomiting, and
before therapy is initiated.
(SEF a low spor in)
antibiotic, prescribed
watery or bloody;
diarrhea, and are
- Inspect IV insertion site
Brand Name: n/a antibiotics. for certain types offever, chills, body
among the most
frequently for
bacterial infectionsaches, flu common side
thrombophlebitis (see Signs
Mechanism of such as pneumonia,symptoms; effects. & Symptoms, Appendix F).
Dosage & Frequency: Action: ear, urinary tract and
tightness in your Lab tests: Perform culture
Cephradine, like the
skin infections. It chest; unusual and sensitivity tests and renal
1 gram orally every 6
penicillins, is a works by fighting bleeding; seizure function studies before and
hours periodically during drug
beta-lactam against the bacteria(convulsions);
antibiotic. By in the body. pale or yellowed therapy.
Route of Administration: - Consult physician if
binding to specific skin, dark colored
patient's creatinine clearance
penicillin-bindingContraindications:
Intravenous Therapy (IV) urine, fever,
is below normal.
proteins (PBPs) Cephradine is confusion or
- Recommended dosage
located inside the contraindicated with
weakness;
schedule in patients with
bacterial cell wall,patients
it diagnosedjaundice reduced renal function is
inhibits the third with diarrhea from(yellowing of the lowered based on creatinine
and last stage of an infection with skin or eyes). clearance determinations and
bacterial cell wall Clostridium difficile severity of infection.
synthesis. bacteria and severe
renal impairment.






 Metronidazole Classification: Indication: Adverse Effects:The following - Report balance problems

Metronidazole is in
Metronidazole is It can give you are the side and functional limitations
Generic Name: n/a a class of indicated for the severe side effects
effects to the physician and
medications calledtreatment of such as feeling orassociated: nursing staff, and caution
nitroimidazole confirmed being sick, Dizziness, the patient and family/
Brand Name: n/a antimicrobials. trichomoniasis stomach pain, hotheadache, caregivers to guard against
caused by flushes, difficultystomach upset, falls and trauma.
Mechanism of Trichomonas breathing, a nausea, - Be alert for confusion,
Dosage & Frequency: Action: vaginalis (except for
pounding vomiting, loss agitation, headache, or
Metronidazole in the first trimesterheartbeat of appetite, other alterations in mental
500mg/100ml x 1 more
diffuses into the of pregnancy) and (palpitations) anddiarrhea, status. Notify the
dose then D/C
organism, inhibitsthe patient's sexualheadaches. Afterconstipation, orphysician promptly if
protein synthesis by
partners, bacterial finishing your metallic taste inthese symptoms develop.
Route of Administration:
interacting with vaginosis, certain treatment, wait for
your mouth may

Orally DNA, and causes types

a of amebiasis,2 days before occur. If any of
loss of helical DNA
and various drinking alcoholthese effects last
structure and strand
anaerobic infections.
again. This allows
or get worse, tell
breakage. the metronidazole
your doctor or
Therefore, it causes
Contraindications:
to leave your pharmacist
cell death in contraindicated in body. promptly. This
susceptible patients with a prior medication may
organisms. history of cause your urine
hypersensitivity to to turn darker in
metronidazole or color. This
other nitroimidazole effect is
derivatives. In harmless and
patients with will disappear
trichomoniasis, when the
FLAGYL Tablets is medication is
contraindicated stopped.
during the first
trimester of
pregnancy.

 Methotrexate Classification: Indication: Adverse Effects:The following - Inform patients that

Methotrexate is a It is used to treat Even a low doseare the side adverse reactions such as
Generic Name: n/a type of medicine inflammatory of methotrexate is
effects dizziness and fatigue
called an conditions, not free from side
associated: might affect their ability to
immunosuppressant.
including: effects. The mostNausea, drive or operate
Brand Name: n/a It slows down your
rheumatoid arthritis.
common adversevomiting, machinery.
body's immune psoriasis (includingeffects are stomach pain, - Inform patients of the
system and helps psoriatic arthritis) gastrointestinal drowsiness, or risks of adverse effects of
Dosage & Frequency: reduce Crohn's disease. manifestations dizziness may many-body systems,
inflammation. such as nausea, occur. including gastrointestinal,
20mg daily for 5 days
Contraindications:
vomiting, mucosal hematologic, hepatic,
Mechanism of Methotrexate is ulcers, loss of infections, neurologic,
Route of Administration:
Action: contraindicated forappetite. These pulmonary, renal, and
Intramuscularly (IM)
The inhibition of use in patients withare noted in most skin.
DHFR by folate hypersensitivity of the patients and - Advise patients for close
antagonists reactions to this are easily follow-up. Advise patients
(methotrexate) medication. managed. The to avoid alcohol, including
results in a major adverse beer, wine, and hard
deficiency in the effect of liquor, because of the
cellular pools of methotrexate is increased risk of liver
thymidylate and hepatotoxicity. disease.
purines and thus in - Advise patients that
a decrease in methotrexate can cause
nucleic acid teratogenicity.
synthesis. - Inform both female and
Therefore, male patients of
methotrexate reproductive age that they
interferes with DNA should practice any two
synthesis, repair, forms of birth control-
and cellular abstinence, oral
replication. contraceptives, or condom
plus foam.
- Discuss potential drug
interactions, particularly
salicylates and over-the-
counter NSAIDs.






 Leucovorin Classification: Indication: Adverse Effects:The following - Monitor neurologic

Leucovorin is in aLeucovorin calcium
Seek immediate are the side status. Use of leucovorin
Generic Name: n/a class of medications
is indicated in the medical attentioneffects alone in treatment of
called folic acid treatment of if you notice associated: pernicious anemia or other
analogs. megaloblastic symptoms of a Infrequent sidemegaloblastic anemias
Brand Name: n/a Mechanism of anemias due to folic
serious allergic effects of associated with vitamin
Action: acid deficiency when
reaction, including
Leucovorin B12 deficiency can result
Leucovorin is folicoral therapy is not rash, itching or Calcium in an apparent
Dosage & Frequency: acid in its active feasible. Leucovorin
swelling include: facial hematological remission
(reduced) form, soisitalso indicated for(especially of theflushing, nausea,
while allowing already
15mg; 1 tab every 6
allows nucleic aciduse in combinationface/tongue/ and vomiting present neurologic damage
hours
synthesis to proceed
with 5-fluorouracilthroat), severe to progress.
even in the presence
to prolong survivaldizziness, hives, - Lab tests: Do Clcr
Route of Administration:
of methotrexate. in the palliative or trouble determinations prior to

Orally Leucovorin can also

treatment of patients
breathing. initiation of leucovorin,
compete with with advanced urine pH prior to and
methotrexate for the
colorectal cancer. about every 6 h throughout
same transport therapy; daily serum
processes into the Contraindications: creatinine levels are
cell. Leucovorin is recommended to detect
contraindicated in onset of kidney function
cases of pernicious impairment.
anemia and other - Notify physician of S&S
vitamin B12 of a hypersensitivity
deficiency reaction immediately
megaloblastic - Do not breastfeed while
anemia because taking this drug without
leucovorin can consulting a physician.
alleviate the
hematologic effects
of B12 deficiency
while allowing the
neurologic
complications to
continue. Severe
nervous system
damage can occur
before a proper
diagnosis is made.

 Nursing Care Plan / Process

Assessment / Cues
Nursing Dx Case Plan Interventions Rationale Evaluation

Background

Subjective Cues Anxiety Experiencing Goal INDEPENDENT GOAL MET

related to signs and

➔ 3 days prior Short Term Maintain a To After 51 hours of
Lack of symptoms of a calm, non develop
to threatening feeling of nursing
Knowledge disease After 4 hours of manner security in
admission, while presence intervention, the
regarding without prior nursing working of calm
the patient with the staff patient was able to
symptoms knowledge intervention, the Move the client
To enhance a
stated that to a quiet and sense of overcome her
and small
leads to patient will be able area with security as
she minimal stimuli compared to a anxiety attacks
progressionhaving anxiety to respond to large area
experienced which can
of condition attacks and relaxation make the PARTIALLY
severe client feel lost
as evidencedcreates panic techniques with a and panicked MET
nausea

 that attacks
on of leads to relaxation
she
Observe for To detect
condition having techniques with PARTIALLY
increasing early and
experie
as anxiety anxiety minimize the
a decreased MET
nced spread of
evidenced attacks and anxiety level anxiety
severe Assess, To obtain [no data
by creates record, and
baseline
nausea Long Term monitor data and provided]
Restlessn panic as vital signs
assess
results
Objective ess the client After 51 hours deviated NOT MET
from
Cues is not able of nursing DEPENDENT
[no data
to intervention,
➔ Severe Administer To aid the provided]
determine the patient will medications as patient’s
nausea ordered health
what be free from condition
➔ Physic
causes her anxiety attacks COLLABORATIVE
al However,
current
Encourage To reduce
Assess more
situation the client’s anxiety
participatio
ment information is
n in
Objectives
results relaxation
needed in
exercises
Teach signs To give
➔ The and the client order to fully
symptoms confidenc
patient of e in determine
escalating having
will be anxiety, and control whether the
ways to over her
able to interrupt its anxiety goal and the
Perform To
reduce Physical identify remaining
Assessment and assess
own any signs objectives are
and
anxiety symptoms fully attained.

Assessment / CuesNursing Dx Case Plan Interventions Rationale Evaluation

Background

 Subjective Cues Acute Pain The patient Goal INDEPENDENT GOAL MET

related to has been

➔ 3 days prior Short Term Establish To gain After 51 hours of
hydatidiformexperiencin rapport patient’s
to admission, trust nursing
mole as g acute pain After 4 hours of To ensure
the patient Secure trust intervention, the
evidenced byin her lower nursing consent between
stated that for the nurse patient will be able
low back pain back that interventions, theadmission and the
she patient to verbalize relief
may be due patient will be able with good
experienced understan from the pain and
to the to learn ways on ding of the
low back risks and discomfort that she
growth of how to relieve fromAssess, To obtain
pain record, baseline has been
the the pain and and data and
monitor assess experiencing.
Objective Cues hydatidifor discomfort that she
vital signs results
deviated
m mole in may be from PARTIALLY
➔ Positive Assess To help
the uterus. experiencing. location, indicate MET
Pregnancy nature, the
and suitable
Test Long Term duration of choice of [no data provided]
pain treatment
➔ Unusual DEPENDENT
After 51 hours of NOT MET
Vaginal
nursing
May give To relieve
Bleeding [no data provided]
Acetamino mild to
interventions, the
Low Back phen/ moderate
➔
Paracetam
patient will be able pain
Pain ol as
to relieve from theprescribed
However, more
pain and discomfort
information is
that she has been
Administe To restore
needed in order to
experiencing. r IV fluids balance in
fluid
as
fully determine
prescribed the body.
COLLABORATIVE
whether the goal

 ➔ Low
she has been
Back Encourage Relaxation However,
experiencing. the patient techniques
Pain to do help the more
relaxation client
techniques explore information is
methods
for the needed in
Objectives control of
To help order to fully
Educate decrease
➔ To treat proper anxiety determine
relaxation and
and techniques tension, whether the
; position promote
help for comfort goal and the
comfort as and
manage possible enhance a remaining
sense of
the pain Refer the To enable objectives are
patient to the patient
that the a pain to receive fully attained.
specialist more
patient if needed informatio With this, the
n and
has specialize evaluation
d care in
been pain will be
manageme
experie Ask the To assess updated once
patient to the
ncing. re-rate the effectiven data is
pain after ess of the
➔ To help 30 minutes treatment. complete.
of taking
the analgesics.

patient

verbaliz

e the

relief

from

the pain

that she

 Assessment / Cues
Nursing Dx Case Plan Interventions Rationale Evaluation

Background

Subjective Cues Deficient Molar Goal INDEPENDENT GOAL MET

Fluid pregnancy can

[no data Short Term Establish To gain After 51 hours of
Volume cause loss of rapport patient’s
trust
provided] nursing
related to water and After hours of To ensure
Secure trust interventions and
Objective Cues hydatidifor electrolytes nursing consent for between
admission the nurse monitoring, the
m mole as from the bodyinterventions, the and the
➔ Unusual patient patient was able
evidenced due to patient will have with good
vaginal understand
by unusual significant sufficient fluid ing of the to re-establish
bleeding risks and
vaginal blood loss volume. Assess, To obtain sufficient fluid
➔ Cold and record, and baseline
bleeding from vaginal monitor data and volume and a
Clammy skin Long Term vital signs assess
bleeding. results balanced input and
deviated
Therefore, theAfter the nursing from output status as the
Monitor I To prevent
body may loseinterventions, the and O dehydratio patient exhibited
n, fluid
more fluid patient will be retention, stable vital signs
and other
than it can able to be free of problems and (-) profuse
related to
take in. active bleeding fluid bleeding. (04/30/22,
imbalance
and exhibit 9pm)
Check pads To weigh,
balanced input andregularly calculate and
record PARTIALLY MET
output status. cumulative
blood loss.
[no data provided]
DEPENDENT

Continue To NOT MET

Objectives administeri regulate
ng the health
medications status of [no data provided]
➔ The clientas ordered the patient
Administer To provide
will be IV fluids as sufficient
prescribed electrolyte
able to

 [no data

COLLABORATIVE provided]

Objectives
Speak to To treat NOT MET
the patient the
➔ The and family hydatidifo
about the rm mole in [no data
client need for the
hospitalizati appropriat provided]
will on and the e setting.
need for
Secure 2 To be used
be
units of for blood
able PRBC transfusio
properly n, However, more
to typed and replacing
crossed- blood loss. information is
achie matched.
Encourage To needed in order
ve a patient to improve
take fluid the to fully
balan and patient's
importance condition determine
ced
of and
whether the
consuming maintain
fluid
healthy diet hydration
goal and the
volum status.
remaining
e
objectives are

fully attained.

Assessment / Cues
Nursing Dx Case Plan Interventions Rationale Evaluation

Background

Subjective Cues Risk for Risk for Goal INDEPENDENT GOAL MET

Infection infection can

[no data Short Term Assess for To assess After 51 hours of
related to be heightened the the factors
provided] presence, that may nursing
invasive by anything After 4 hours of existence, indicate
and history infection intervention, the
Objective Cues procedure that interferes nursing of the
common patient was free

 provide intervention,
invasive by of nursing
d] the patient
procedu anything intervention, Monitor and To detect and
report any signs manage was free from
Objective Cues re that the client will and symptomsimmediately
of infection infections
interferes be able to early Assess, To obtain
➔ Dilation record, and baseline
with the recognize the monitor data and PARTIALLY
and vital signs assess
body’s infection to MET
results
Curetta deviated
ability to allow for
from
ge Monitor WBC To assess [no data
fight off prompt Count WBC count
as elevated provided]
pathogenic treatment WBC
indicates
invasions. infection NOT MET
Long Term
One key Assess To assess
immunizati as people [no data
risk factor After 51 hours on status with
and history incomplet provided]
is the of nursing e
immunizat
breakdown intervention, ions may
not have
of the the client will sufficient
acquired However,
body’s be free from active
DEPENDENT more
physical infections
information is
defense Administer To treat a
Metronidazolewide variety needed in
mechanis of infections

ms. This Administer To aid the order to fully

Objectives medications as patient’s
ordered health determine
type of
condition
➔ The whether the
breakdown COLLABORATIVE
client goal and the
can be
will Maintain To remaining
broken strict decrease
maintai asepsis for the objectives are
skin due to dressing chances of
n changes, transmittin fully attained.
injury, wound care, g or
restore intravenous spreading With this, the
surgery, or therapy, and pathogens
defense catheter to or evaluation
other handling between

 defense evaluation
other
s Conduct To will be
invasive Complete determine
➔ The Blood the levels updated once
procedures Count of the
client Educate To gain data is
. clients and/ knowledg
will be or e in order complete.
significant to reduce
able to other about or
appropriate eliminate
alleviat cleaning, germs
disinfecting reduces
e or , and the
sterilizing likelihood
reduce Limit To reduce
visitors the
the transmissi
on of
Encourage To obtain
proble sleep and Adequate
rest sleep as it
ms is an
essential
related modulator
of immune
with
responses

Current Trends / Innovations / Clinical

Management

It is critical to understand current trends, latest breakthroughs, and modern clinical

management, as well as to apply these components into practice, in order to deliver the best

healthcare management to clients.

Dilation and Curettage

To begin with, Molar Pregnancy is more likely in women younger than 20 and older than

35. The incidence of molar pregnancy is approximately 1 in every 1,000 pregnancies. This kind

of pregnancy always ends in pregnancy loss. With that, the healthcare provider performs dilation

 and curettage, a

surgical

intervention

to treat molar

pregnancy.

Dilation and

Curettage

procedure,

also called D&C,

is surgical intervention that uses a tool to dilate the cervix in order for the uterine lining to be

scraped with curette, which is a spoon- shaped instrument to remove the molar tissue from the

uterus. On average, 1 to 2 out of every 100(1 to 2 percent) women experience a repeat molar

pregnancy. However, if the molar pregnancy causes a lot of bleeding from the uterus, the

healthcare providers will advise the mother to undergo hysterectomy, a total removal of the

womb and this helps prevent potentially life-threatening blood loss. Once the procedure is done,

the woman won't be able to have any more children.

Figure 6. Dilation and Curettage

PulseNmore

Additionally, there are also medical innovations that aid both the mother and healthcare

workers in ensuring their safety and preventing the spread of the virus. One of which is the

PulseNmore innovative miniature ultrasound devices that enables pregnant women to perform

ultrasound scans themselves and send to the attending physicians or sonographers real-time

results to remotely review and monitor the health of the fetuses. Physicians or sonographers can

observe the real-time visualization of the offline scan, amniotic fluid volumes, cardiac activity,

and more of the fetuses. The device is a smartphone dock with an ultrasonic transducer on the

bottom. An app on the patient's smartphone gives training and direction so that a scan can be

completed with high-quality results. The photos are subsequently shared with the patient's

medical staff, who can utilize them to make future decisions (Medgadget 2020). This can help

reduce face-to-face interactions, waiting and travel costs, and having immediate results to view

abnormalities in pregnancy and less complicated sharing of images.

Photo from Medical Trends Expo

Figure 7. PulseNmore

 Summary of Discharge Teachings

Medication/s

Cephradine 1mg tab twice a day for 5 days

 FeSO4 1 cap once a day

Leucovorin 15mg tab 1 tab every 6 hours for 10 doses

Paracetamol 500mg tab for pain

Environment

Strict hand washing and aseptic technique at home

Treatment

Medication Treatment at home

Health Teachings

Minimal ambulation

Avoid strenuous activity

Do not get pregnant for 6 months

OPD Follow-Up

 Follow-up after 1 week

For repeat serum B-Hcg result and Histopathology report at Luna’s Clinic, 10 am to 2 pm

Diet

Diet as tolerated

References

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https://www.almirall.com/your-health/your-skin/types-of-skin

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dictionary/english/distress

Caruso, S. (2021, October 26). Risk for Infection Nursing Diagnosis & Care Plan.

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www.nursetogether.com/risk-for-infection-nursing-diagnosis-care-plan/

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t%20missed%20period.

Johns Hopkins Medicine. (2021, August 8). Pelvic Ultrasound. Retrieved June 18, 2022,

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ultrasound

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tenderness-abdomen

Mayo Clinic. (2020c, December 18). Cervicitis - Symptoms and causes. Retrieved June

18, 2022, from https://www.mayoclinic.org/diseases-conditions/cervicitis/symptoms-

causes/syc-20370814

Mayo Clinic. (2021a, May 13). Molar pregnancy - Symptoms and causes. Retrieved June

18, 2022, from https://www.mayoclinic.org/diseases-conditions/molar-pregnancy/

symptoms-causes/syc-20375175

Medgadget Editors. (2020, August 10). PulseNmore At-Home Tele-Ultrasound for

Pregnant Women. Medgadget. https://www.medgadget.com/2020/08/pulsenmore-at-

home-tele-ultrasound-for-pregnant-women.html

Medical News Today. (n.d.). What causes a bounding pulse? Retrieved June 18, 2022,

from https://www.medicalnewstoday.com/articles/322460#symptoms

Molar pregnancy - Symptoms and causes. (2021, May 13). Mayo Clinic. https://

www.mayoclinic.org/diseases-conditions/molar-pregnancy/symptoms-causes/

syc-20375175

Mount Sinai. (n.d.). RPR test. Retrieved June 18, 2022, from https://www.mountsinai.org/

health-library/tests/rpr-test#:~:text=RPR%20(rapid%20plasma%20reagin)

%20is,the%20back%20of%20the%20hand.

 Murphy, A. (2021, September 19). Chest (PA view). Radiology Reference Article |

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