Universidad de Sta.

Isabel
College of Health Sciences
Nursing Program

Case Analysis
Area: USI-HSD (Guadalupe Unit)

1st Rotation (Second Semester A/Y 2022-2023)

Submitted by:
BSN 4C – RLE Group 14

Tapar, Rholan Gwen R.

Tan, Bryan Jeremy W.
Tapel, Ray Mark R.
Tinoko, Zaira Mae L.
Tipones, Gene Francois Marie G.
Toledano, Cherry Amor U.
Tolentino. Jasmine L.
Tuy, Marie Stella Kirstie G.
Uy, Eden Camille M.

Submitted to:

MS. CYNTHIA ABERGOS, MAN, RN

Clinical Instructor

02 March 2023
 TABLE OF CONTENTS

Overview ................................................................................................................1

Anatomy and Physiology ......................................................................................2

Pathophysiology ....................................................................................................3

Clinical Manifestations ..........................................................................................4

Laboratory and Diagnostic Tests..........................................................................5

Management ..........................................................................................................7

A. Medical Management ....................................................................................7

B. Pharmacological Management .......................................................................8

C. Surgical Management .................................................................................. 12

D. Nursing Management .................................................................................. 12

Nursing Care Plan A (Risk for Infection) ........................................................... 14

Nursing Care Plan B (Readiness for Enhanced Health Management) ............. 17

METHODS ............................................................................................................. 20

References ........................................................................................................... 22
 Overview

Mrs. CSO, a 52-year-old female (G3P3) patient, was admitted last February 26,
2023 (8:03 am) at Universidad de Sta. Isabel - Healthcare Services Department (USI-
HSD) with a chief complaint of vaginal bleeding. The admitting physician was Dr. AB, MD.

10 days prior to admission, she started to have vaginal spotting, but no

consultation was done. 9 days prior to admission, she had moderate bleeding but no
dizziness and headache were noted, and no consultation was once again done. After 3
days of moderate vaginal bleeding, she now decided to have a consultation with her
preferred M.D. Her past menstrual period was 2 years ago and her last menstrual period
was on February 17, 2023. Lately, she has experienced chronic stress due to family
problems and has turned to drink alcohol. Upon admission, she had a diagnosis of
Abnormal Uterine Bleeding - Postmenopausal Bleeding and underwent Dilation
and Curettage (D&C) last February 26, 2023.

Women over 45 who have gone more than a year without having their period are
typically diagnosed with menopause. After this point, a healthcare professional needs to
examine any vaginal bleeding in order to rule out serious causes, like cancer. There are
numerous conditions that may lead to postmenopausal bleeding; the most common
causes are ovarian cysts, endometrial hyperplasia, cervical or uterine polyps, and atrophic
vaginitis. Benign ovarian cysts can release estrogen which can cause postmenopausal
bleeding. After menopause, there may be too much estrogen and too little progesterone
and as a result, the endometrium gets thicker and can bleed which we now call
Endometrial Hyperplasia. Cervical or uterine polyps, on the other hand, are growths that
are usually non-cancerous, but they can cause vaginal spotting, heavy bleeding, or
bleeding after sex. Atrophic Vaginitis is when the skin of the vagina becomes thin because
of a drop in estrogen levels which happens after menopause. Due to this, it is more
susceptible to damage and sometimes, it develops inflammation.

Oftentimes, the bleeding's source cannot be located and healthcare professionals

establish this diagnosis by ruling out every other possibility. Common methods to
diagnose postmenopausal bleeding are an examination of the vagina and pelvis, a pap
smear, an ultrasound, and a biopsy of the endometrium or uterus. Treatment depends

1
on its cause, and these may involve medications (antibiotics, estrogen, progestin) or
surgery (Hysteroscopy, Dilation and Curettage, Hysterectomy).

Risk factors for developing Postmenopausal Bleeding:

1. Stress - An increased level of cortisol during stress affects the reproductive cycle
by creating an imbalance in the levels of reproductive hormones. This imbalance
causes a disturbance in the usual menstrual cycle and can lead to abnormal uterine
bleeding.
2. Alcohol - Excessive alcohol intake can induce a rise in circulating estrogen levels
which can lead to endometrial hyperplasia (one of the causes of PMB).
3. Hormone replacement therapy - This may cause endometrial hyperplasia (one
of the causes of PMB). The addition of progestogen may cause unacceptable
symptoms such as bleeding and spotting.
4. Endometriosis - a condition where tissue similar to the lining of your uterus
builds up on organs outside the uterus. As a result, it may cause a lot of pain,
heavy bleeding, and fertility problems, among other symptoms.

In the case of Mrs. CSO, she has experienced chronic stress and has been excessively
drinking alcohol, contributing to the development of her Postmenopausal Bleeding.

Anatomy and Physiology

In this case, the focus would be the organs and structures of the female
reproductive system, which includes:
1. Endometrium – the inner lining
of the uterus. This prepares the
optimal environment for the
implantation of the embryo and
maintains the patency of the
uterine activity.
2. Uterus – a hollow organ shaped
like a pear in between the
bladder and rectum. Its known
physiological action is the
shedding of the lining during

2
 menstruation unless a fertilized egg (ovum) becomes implanted and pregnancy
follows. It also nourishes the developing fetus prior to birth.
3. Ovaries – an organ important for the production of estrogen and progesterone
and also the development and storage of egg cells (ova).
4. Cervix – a canal opening into the
vagina located between the bladder
and rectum. It allows fluids to flow
inside and out of the uterus.
5. Vagina – a hollow passageway of
fluids connecting the cervix and
vulva.
6. Vulva – the external female
reproductive organ. It includes the
opening of the vagina (sometimes
called the vestibule), the labia
majora (outer lips), the labia minora (inner lips), and the clitoris.

Pathophysiology
Upon interviewing Mrs. CSO, she verbalized being extremely stressed due to family
problems, and as a way to cope, she drinks considerable amounts of alcohol. An increased
level of stress leads to an increase in cortisol levels in order to counteract the stress effect
that the body experiences. Progesterone is a precursor to cortisol, meaning that in order
to form cortisol in the body, progesterone is used. This leads to a decreased amount of
progesterone in the body, and an increased level of estrogen (estrogen dominant state).
Also, being stressed for a long period of time can reduce the number of white blood cells
in the body, which in turn, explains why her Neutrophils, Lymphocytes, and Monocytes
were low.

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 Continuous exposure to increased levels of estrogen without sufficient levels of
progesterone allows shedding of the endometrial lining. Moreover, due to the imbalance
between the two hormones, Endometrial hyperplasia, or the thickening of the
endometrium, will occur, causing heavy or abnormal bleeding. These are the predominant
causes of why Mrs. CSO experienced Abnormal Uterine bleeding - Postmenopausal
Bleeding.
In addition to that, excessive alcohol intake also contributes to increased levels of
estrogen. Estrogen dominant state leads to the development of ovarian cysts, and benign
ovarian cysts can release estrogen that can cause postmenopausal bleeding.

Clinical Manifestations
As presented earlier, it is most typical for women to encounter being diagnosed
with menopause ages ranging from 45 – 51 years old and above. According to a study
by Abramovits, A. and Sung, D (2022), menopause happens due to the elevation of
follicle-stimulating hormone (FSH) due to stimulation of ovulation of ovaries by the
hypothalamic-pituitary-ovarian axis. Moreover, postmenopausal bleeding is considered
indefinite to occur.

Clinical Manifestations for postmenopausal bleeding:

1. Vaginal bleeding for more than a year

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 2. Light to heavy spotting
3. Infection

In correlation with Mrs. CSO’s case, spotting and bleeding were noted. As
mentioned, the patient is a 52-year-old female which is in the menopausal stage. Her last
menstrual period was 2 years ago, however, she complained and experienced vaginal
spotting 9 days prior to admission, and continuous moderate bleeding 9 days prior to
admission.

Laboratory and Diagnostic Tests

1. Complete Blood Count

CBC (2/26/23)

Test Name Result Unit Reference Range

WBC 5.05 10^3/uL 4.8-10.8

RBC 4.59 10^6/uL 4.2-5.4

Hgb 13.8 g/dL 12-16

Hct 41.9 % 37-47

MCV 91.3 fl 81-99

MCH 30.0 pg 27-31

MCHC 32.9 (L) g/dL 33-37

Platelet 268 10^3/uL 130-400

Neutrophils (%) 54.1 % 40-74

Lymphocytes 37.3 % 19-48

Monocytes 4.6 % 3.4-9.0

Eosinophils 2.7 % 0-7

Basophils 1.3 % 0-1.6

Neutrophils (#) 2.73 (L) 10^3/uL 4.0-7.4

Lymphocytes 1.89 (L) 10^3/uL 1.9-4.8

Monocytes 0.23 (L) 10^3/uL 0.34-0.90

Eosinophils 0.13 10^3/uL 0-0.70

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 Basophils 0.07 10^3/uL 0-0.15

Mean corpuscular hemoglobin concentration (MCHC) is a measurement of

the average amount of hemoglobin in a single red blood cell. In Mrs. CSO’s CBC result,
the MCHC is low which usually indicates anemia or a condition in which the body does
not have enough healthy red blood cells. Relating to her case, this occurred due to the
abnormal uterine bleeding.

White blood cells are a major component of the body’s immune system that
destroy microorganisms that cause infections. It is divided into two main classes,
granulocytes (neutrophils, eosinophils, and basophils) and non-granulocytes
(lymphocytes and monocytes). In Mrs. CSO’s CBC result, Neutrophils, Lymphocytes, and
Monocytes are low, indicating an increased risk of getting infections. Psychological or life
stress events, as verbalized by the patient, are one of the factors that decrease WBC,
which makes her prone to infections.

2. Ultrasound

ULTRASOUND

LMP: 02-17-2023

UTERUS 1 2 3 Average

Uterus Length 4.77 4.77 cm

Uterus Height 4.10 4.10 cm

Endo. 1.29 1.29 cm

Thickness

Cervix Length 1.91 1.91 cm

Cervix Height 1.50 1.50 cm

RIGHT 1 2 3 Average
OVARY

Length 3.70 3.70 cm

Height 2.39 2.39 cm

LEFT OVARY 1 2 3 Average

Length 2.45 2.45 cm

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 Height 1.48 1.48

Comment:
● Normal sized anteverted uterus with thickened echogenic endometrium for age
and menopause with regular endomyometrial junction
● Normal left ovary
● The right ovary is cystic, anechoic as measured
● Consider endometrial pathology
● Ovarian cyst probably benign

● Correlate clinically

Uterine endometrium is a layer of tissue that lines the uterus in preparation for
implantation, maintenance of pregnancy if implantation occurs, and menstruation in the
absence of pregnancy. According to Mrs. CSO's ultrasound findings, the endometrium is
thickened which causes heavy or abnormal bleeding. Moreover, the finding shows that
Mrs. CSO’s right ovary is cystic. Though it is only probably benign since there was no
biopsy performed to confirm it.

Management
A. Medical Management
● Blood Works
- Blood works help doctors to evaluate how well a patient’s body
functions. Also, to monitor the effectiveness of the treatment.
- As for the case of Mrs. CSO, blood works were ordered to assess her
overall condition, and monitor her recovery. It will also give
information regarding her physiological state.
● Ultrasound
- Sonography or diagnostic medical sonography, is an imaging method
that uses sound waves to produce images of structures within the
body. The images can provide valuable information for diagnosing
and directing treatment for a variety of diseases and conditions.
- In the case of Mrs. CSO, this is used to properly visualize the state
of the uterus and the endometrium, and to determine the cause of
postmenopausal bleeding.

7
 B. Pharmacological Management

Clindamycin 300 mg capsule

Drug Antibiotic
Classification

Indications Used to prevent infections

Actions A semisynthetic antibiotic that inhibits protein synthesis in

susceptible bacteria by binding to ribosomes (50S subunit) and
preventing peptide bond formation

Contraindications ● Hypersensitivity to clindamycin

● Regional enteritis or ulcerative colitis
● Severe liver impairment
● Diarrhea
● Lactation

In the case of Mrs. CSO, she is not contraindicated with this drug.

Adverse GI: Nausea and Vomiting, Diarrhea, Abdominal Pain

Reactions CNS: Dizziness, Headache, Vertigo
CV: Arrhythmias, Hypotension
Derm: Rashes, Urticaria

(No noticeable adverse reactions happened to Mrs. CSO)

Nursing 1. Before giving the drug, ensure that Mrs. CSO isn’t allergic to
Responsibilities Clindamycin.
2. Instruct Mrs. CSO to take the drug with a full glass of water
to prevent esophageal ulceration.
3. Instruct Mrs. CSO to take the drug with meals to prevent GI
upset.
4. Instruct Mrs. CSO to take the drug as ordered and finish
completely as directed, even if feeling better. Take missed
doses as soon as possible unless it's almost time for the next
dose. Do not do double doses.
5. Instruct Mrs. CSO to sit upright for 30 minutes after taking
the drug.
6. Instruct Mrs. CSO to report any side effects such as
persistent vomiting, diarrhea, fever, or abdominal pain and
cramping.

Reference/s Spratto, G. R., & Woods, A. L. (2004). PDR Nurse's Drug Handbook
(2005 ed.). Thomson - Delmar Learning.

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 Vallerand, A. H., & Sanoski, C. A. (2018). Davis’s Drug Guide for
Nurses (Sixteenth ed.). F.A. Davis Company.

Mefenamic Acid 500mg Capsule

Drug Nonsteroidal anti-inflammatory drug (NSAID)

Classification

Indications Used to treat mild to moderate pain

Actions Mefenamic acid binds the prostaglandin synthetase receptors COX-

1 and COX-2, inhibiting the action of prostaglandin synthetase. As
these receptors have a role as a major mediator of inflammation
and/or a role for prostanoid signaling in activity-dependent
plasticity, the symptoms of pain are temporarily reduced.

Contraindications ● Hypersensitivity to Mefenamic Acid or other NSAID

● Active or history of recurrent peptic ulcers
● Inflammatory bowel disease
● Severe heart failure
● Rhinitis
● Angioedema

In the case of Mrs. CSO, she is not contraindicated with this drug.

Adverse Cardiac: Dyspnea, Chest Pain

Reactions Ear and labyrinth: Tinnitus.
GI: Diarrhea, Nausea, Vomiting, Abdominal pain, Flatulence,
Constipation, Dyspepsia, Heartburn, Gastritis.
Hepatobiliary: Hepatitis, Jaundice
Nervous system: Aseptic meningitis, Headache.

(No noticeable adverse reactions happened to Mrs. CSO)

Nursing 1. Before giving the drug, ensure that Mrs. CSO isn’t allergic to
Responsibilities Mefenamic Acid.
2. Assess Mrs. CSO’s skin routinely for rash or other evidence
of hypersensitivity reactions because an NSAID may cause
serious skin reactions without warning, even in patients with
no history of NSAID hypersensitivity. Stop the drug at the
first sign of a reaction, and notify the prescriber.
3. Monitor Mrs. CSO’s stools for changes in color and
consistency and instruct her to notify the prescriber if they
become black, tarry, or red.

9
 4. Instruct Mrs. CSO to take the drug with a full glass of water
to prevent esophageal ulceration.
5. Instruct Mrs. CSO to take the drug with meals to prevent GI
upset.
6. Instruct Mrs. CSO to sit upright for 30 minutes after taking
the drug.
7. Instruct Mrs. CSO to discontinue the drug promptly if
diarrhea, dark stools, hematemesis, ecchymosis, epistaxis, or
rash occur and to consult with a physician.
8. Instruct Mrs. CSO to notify her physicians if persistent GI
discomfort, sore throat, fever, or malaise occurs.
9. Instruct Mrs. CSO to not drive or engage in potentially
hazardous activities until a response to the drug is known. It
may cause dizziness and drowsiness.

Reference/s Mefenamic acid: Uses, Interactions, Mechanism of Action |

DrugBank Online. (n.d.). DrugBank.
https://go.drugbank.com/drugs/DB00784

Esomeprazole 40 mg Tablet

Drug Proton Pump Inhibitors

Classification

Indications Helps decrease gastric acid secretion

Actions Suppresses the final step in gastric acid production by inhibiting the
H+/K+-ATPase in the gastric parietal cells.

Contraindications ● Known hypersensitivity to any component of the drug

In the case of Mrs. CSO, she is not contraindicated with this drug.

Adverse CNS: Headache

Reactions GI: Abdominal pain, Constipation, Diarrhea, Dry mouth, Flatulence,
Nausea
F and E: Hypomagnesemia
CV: Hypertension, Tachycardia
MS: Bone fracture
Otic: Tinnitus, Otitis media

(No noticeable adverse reactions happened to Mrs. CSO)

Nursing 1. Assess Mrs. CSO routinely for epigastric or abdominal pain

Responsibilities and occult blood in the stool.

10
 2. Instruct Mrs. CSO to take drug as directed for the full course
of therapy, even if feeling better.
3. Instruct Mrs. CSO to take the drug before meals.
4. Instruct Mrs. CSO to report the onset of black, tarry stools;
diarrhea; abdominal pain; or persistent headache to health
care professionals promptly.
5. Instruct Mrs. CSO to avoid alcohol when taking this drug.
6. Instruct Mrs. CSO to notify health care professional if signs
of hypomagnesemia (seizures, dizziness, abnormal or fast
heartbeat, jitteriness, jerking movements or shaking, muscle
weakness, spasms of the hands and feet, cramps or muscle
aches, spasms of the voice box) occur.

Reference/s Spratto, G. R., & Woods, A. L. (2004). PDR Nurse's Drug Handbook
(2005 ed.). Thomson - Delmar Learning.

Vallerand, A. H., & Sanoski, C. A. (2018). Davis’s Drug Guide for

Nurses (Sixteenth ed.). F.A. Davis Company.

D5NM 1L Normosol M with Dextrose 5%

Drug Hypertonic Solution Non-Pyrogenic Nutrient Replenisher

Classification

Indications Used for parenteral maintenance of routine daily fluid and electrolyte
requirements with minimal carbohydrate calories from dextrose.

Actions When administered intravenously, Normosol-M and 5% Dextrose

Injection provide water and electrolytes (with dextrose as a readily
available source of carbohydrate) for maintenance of daily fluid and
electrolyte requirements, plus minimal carbohydrate calories.

Contraindications ● Hypersensitivity to any of the components

In the case of Mrs. CSO, she is not contraindicated with this drug.

Adverse Common Intravenous Fluids Complications

Reactions ● Infection at the site of injection
● Venous thrombosis or phlebitis extending from the site of
injection
● Extravasation
● Hypervolemia
● Air Embolism

(No noticeable adverse reactions happened to Mrs. CSO)

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Nursing 1. Do not administer the IV fluid to Mrs. CSO unless the solution
Responsibilities is clear and the container is undamaged.
2. Assess the IV site of Mrs. CSO for deviations from normal.
3. Caution must be exercised in the administration of parenteral
fluids to Mrs. CSO, especially those containing sodium ions to
patients receiving corticosteroids or corticotrophin.
4. Solution containing acetate should be used with caution as
excess administration may result in metabolic alkalosis.
5. Properly label the IV Fluid of Mrs. CSO, ensuring the time and
date of administration are written and the flow rate of the IVF.
6. Regulate IVF, at the desired rate, as ordered.
7. Observe aseptic technique when changing the IV fluid of Mrs.
CSO.

Reference/s Spratto, G. R., & Woods, A. L. (2004). PDR Nurse's Drug Handbook
(2005 ed.). Thomson - Delmar Learning.

Vallerand, A. H., & Sanoski, C. A. (2018). Davis’s Drug Guide for

Nurses (Sixteenth ed.). F.A. Davis Company.

C. Surgical Management
● Dilation and Curettage (D&C) – is a surgical procedure used to locate
and treat the cause of sudden, heavy bleeding. It is done by passing a small
instrument called a curette through the vagina into the uterus and scraping
the endometrium.
○ It is done to Mrs. CSO in order to remove excessive uterine tissue or
the thickened endometrial lining that causes the bleeding. Another
reason is to determine the cause of abnormal bleeding, detect cancer
and investigate the uterus and the endometrium.

D. Nursing Management
● Monitor Mrs. CSO’s vital signs, and intake and output, q4 + PRN.
● Monitor and regulate the IVF of Mrs. CSO at the desired rate, as ordered.
● Administer due medication, as prescribed, and provide Mrs. CSO with
necessary information about the medications.
● Monitor Mrs. CSO's response to the medication regimen.
● Monitor Mrs. CSO for signs and symptoms of infection.
● Encourage Mrs. CSO to sleep and rest.
● Encourage Mrs. CSO to intake protein-rich foods and Vitamin C-rich foods.

12
● Instruct Mrs. CSO on the ways to prevent infection such as proper
handwashing.
● Make appropriate referrals as necessary.

13
 Nursing Care Plan A (Risk for Infection)

Assessment Nursing Rationale Planning Intervention Rationale Evaluation

Diagnosis

Objective Risk for Mrs. CSO was Short Term Goals: Independent Interventions Short Term Goals:
Data: infection r/t diagnosed with After 8 hours of After 8 hours of nursing
● Post Dilation invasive Abnormal nursing 1. Monitor Mrs. CSO Prompt recognition and interventions, Mrs. CSO:
and procedure of Uterine interventions, Mrs. for signs and intervention of manifestations
Curettage Dilation and Bleeding - CSO will be able to: symptoms of of infection prevents the ● Maintained a normal
(D&C) Curettage and Postmenopausal infection (e.g., progression of possible body temperature of
surgery tissue trauma Bleeding ● Maintain a fever, purulent complications. 36.5°C
during the ↓ normal body vaginal discharge, ● Was free of purulent
procedure Underwent temperature or foul-smelling or foul-smelling
Dilation and (36.5-37°C) odor) every 4 vaginal discharge
Curettage ● Be free of hours, and PRN. ● Demonstrated
(D&C) surgery purulent or foul- knowledge on how
↓ smelling vaginal 2. Monitor Mrs. CSO’s Baseline data helps in to prevent or reduce
Normal bacteria discharge vital signs every 4 observing the patient’s infection
may travel from ● Demonstrate hours, and PRN. condition (The increase in
the vagina into knowledge of body temperature to 38° C Goal met. Terminate
the uterus how to prevent within the first 24 hours after the nursing care plan.
during or after or reduce operation indicates infection).
the procedure infection
↓ 3. Emphasize to Mrs. Premature discontinuation of Long Term Goals:
Possible Long Term Goals: CSO the necessity treatment when patient After 24 hours of nursing
occurrence of After 24 hours of of taking begins to feel well may result interventions, Mrs. CSO:
signs and nursing antibiotics as in return of infection and
prescribed potentiation of drug-resistant
14
 symptoms like interventions, Mrs. (dosage and strains. ● Remained free of
vaginal CSO will be able to: length of therapy). signs and
discharge, symptoms of
uterine ● Remain free of 4. Ensure that any This reduces or eliminates infection (e.g.,
cramping and signs and articles used on germs. fever, purulent or
pain, and fever symptoms of Mrs. CSO are foul-smelling
↓ infection (e.g., properly vaginal discharge)
Infection can fever, purulent disinfected before
occur at the site or foul-smelling use. Goal met. Terminate
of the surgery vaginal the nursing care plan.
↓ 5. Encourage Mrs. Adequate sleep is an essential
discharge)
Risk for CSO to sleep and modulator of immune
Infection rest. responses. A lack of sleep can
weaken immunity and
increase susceptibility to
infection.

6. Encourage Mrs. Adequate fluid intake

CSO to increase enhances the immune system
fluid intake. and aids in natural defense
mechanisms.

7. Encourage Mrs. Foods that are high in protein

CSO to increase and Vitamin C are important
her intake of for healing and to boost the
protein-rich foods immune system.
(e.g., meats,
cheese, milk) and
vitamin C-rich
foods (e.g., citrus

15
 fruits and juices,
strawberries).

8. Provide health Hand hygiene is the first-line

teaching to Mrs. defense to limit the spread of
CSO about the infection.
different ways on
how to prevent
infection (proper
hand hygiene).

Dependent Interventions

1. Administer To prevent a wide variety of

prophylactic bacterial infections after
antibiotics, as having surgery.
ordered.

2. Monitor and This will prevent bolus or

regulate IV as overdose.
ordered.

Collaborative Interventions

1. Collaborate with a Proper nutrition and a

dietitian regarding balanced diet support the
Mrs. CSO’s diet. immune systems’
responsiveness and enhance
the health of all the body’s
tissues.
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 Nursing Care Plan B (Readiness for Enhanced Health Management)

Assessment Nursing Rationale Planning Intervention Rationale Evaluation

Diagnosis

Subjective Readiness for Mrs. CSO was Short Term Goals: Independent Interventions Short Term Goals:
Data: Enhanced diagnosed with After 8 hours of After 8 hours of nursing
● Mrs. CSO Health Abnormal nursing 1. Assess and Elevations in vital signs may interventions, Mrs. CSO:
verbalized: Management Uterine interventions, Mrs. monitor Mrs. indicate complication and
“matry na r/t present Bleeding - CSO will be able to: CSO’s vital signs suggest an alteration in ● Verbalized
akong health Postmenopausal every 4 hours, client status. understanding of
bawasan condition as Bleeding ● Verbalize and PRN. different therapeutic
pagkai-stress” evidenced by ↓ understanding of regimen prescribed
● Mrs. CSO the patient’s Underwent different 2. Monitor the Helps ensure the adequate and importance of
verbalized: verbalization of Dilation and therapeutic amount of intake intake of fluid and other medication adherence
“Dae na ako wanting to Curettage regimen and output of nutrients, and determines ● Demonstrated
maparainom” reduce (D&C) surgery prescribed and Mrs. CSO every 4 bladder function. proactive
stressful events ↓ importance of hours, and PRN. management by
Objective Data: and limiting Mrs. CSO was medication minimizing potential
● (+) MGH alcohol intake continuously adherence 3. Monitor the Helps prevent the complications
monitored and ● Demonstrate medication development of an ● Increased the
vitals became proactive regimen and Mrs. infectious process and adherence to
stable management by CSO’s response to determine the effectiveness management with the
↓ minimizing the regimen. of therapy. help of SO’s
(+) MGH potential involvement
↓ 4. Identify Mrs. To establish baseline data
complications
Mrs. CSO ● Increase the CSO’s level of about Mrs. CSO’s level of Goal met. Terminate the
verbalized adherence to knowledge/under understanding and allow nursing care plan.
correction of any

17
 wanting to management standing of the misconceptions about post Long Term Goals:
reduce stressful with the help of therapeutic D&C management. After 24 hours of nursing
events and SO’s regimen. interventions, Mrs. CSO:
limiting alcohol involvement
intake 5. Identify steps Understanding the process ● Remained free of
↓ Long Term Goals: necessary to enhances commitment and preventable
Readiness for After 24 hours of reach desired the likelihood of achieving complications and
enhanced nursing health goals. goals. progression of illness
health interventions, Mrs.
management CSO will be able to: 6. Discuss the For a better understanding Goal met. Terminate the
actions, of prescribed medications nursing care plan.
● Remain free of contraindications, and helps her determine
preventable and adverse whether a drug is working
complications effects of each appropriately.
and progression prescribed
of illness medication to
Mrs. CSO.

7. Provide Minimizes risk for

information about complications and is an
the importance of important contributor to
adhering to improving Mrs. CSO’s
prescribed health.
medications to
Mrs. CSO.

8. Promote SO Increases adherence to

choices and management and SO may
involvement in intervene if Mrs. CSO needs
planning and assistance in carrying out
18
 implementing the task.
added tasks/
responsibilities.

Dependent Interventions

1. Administer NSAIDS such as Mefenamic

medications, as Acid are given to treat mild
prescribed by the to moderate pain that may
physician. occur for a few hours or
days after Dilation and
Curettage (D&C) surgery.
Clindamycin is used to
prevent infection, and
Esomeprazole is used to
reduce gastric acid
secretion.

2. Monitor and This will prevent bolus or

regulate IV, as overdose.
ordered.

Collaborative Interventions

1. Make appropriate Provides optimum

referrals, as continuity of care.
necessary.

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 METHODS

Medications 1. Clindamycin 300 mg 1 tab 2x a day (8am - 8pm) for 7 days,

taken after meals
- This drug is used to prevent infection. Monitor
strictly for any adverse reactions such as nausea
and vomiting, diarrhea, and abdominal pain.
2. Mefenamic Acid 500 mg 1 tab 3x a day (8am - 1pm - 8pm)
take after meals
- This drug is used to treat mild to moderate pain.
Monitor for any adverse reaction such as dyspnea,
chest pain, tinnitus, diarrhea, nausea, vomiting,
abdominal pain, etc.
3. Esomeprazole 40 mg 1 tab once a day (6am) for 7 days
before a meal
- This drug is used to reduce acid in the stomach,
preventing acid reflux and ulcers.

Environment and The doctor encourages Mrs. CSO to abstain from heavy activities
Exercise and instead perform light exercises such as walking slowly and
deep breathing exercises. Also, meditation can be done during
stressful events or situations.
● Ambulatory - means an individual able to walk without
any assistance and not bedridden
● Breathing exercises - can help decrease stress, relieves
pain, promote lung expansion, and improve digestion
● Meditation - helps to improve brain concentration and
induces physical and mental relaxation. It can also help the
body to lower blood pressure and improve breathing.
● Promote a stress-free environment through
distractions such as playing board games, reading books,
chatting with friends, or any light activities

Treatment ● Advise Mrs. CSO to continue home medications, as

prescribed by the physician. Clindamycin will help to
prevent infections. Mefenamic Acid is used to manage mild
to moderate pain.
● Encourage Mrs. CSO to do ambulation and deep breathing
exercises.
● Instruct Mrs. CSO to do a follow-up check-up after a week,
as ordered.

Health Teaching ● Instruct Mrs. CSO to continue medications as prescribed by

the physician.
● Encouraged Mrs. CSO to have an adequate fluid intake and
to eat nutritious meals.
● Instruct Mrs. CSO to abstain from heavy activities and
report any signs and symptoms of discomfort or unusual
changes and complications encountered to her body such
as rashes, fever, changes in skin color (bluish/yellowish),
dizziness, nausea, vomiting
● Instruct Mrs. CSO to avoid alcohol.
● Instruct Mrs. CSO to take the full course of antibiotics even

20
 if symptoms improve or disappear.
● Instruct Mrs. CSO to perform proper hand hygiene.
● Ensure that any articles used on Mrs. CSO are properly
disinfected before use.
● Encourage Mrs. CSO to sleep and rest.
● Encourage Mrs. CSO to increase fluid intake.
● Encourage Mrs. CSO to increase her intake of protein-rich
foods and vitamin C-rich foods.

Out-Patient ● Instruct Mrs. CSO to tell the physician immediately when

Referral these symptoms are experienced:
○ Vaginal bleeding
○ Heavy menstrual bleeding
○ Fever
○ Troubled breathing or shortness of breath
● Have a follow-up check-up, as instructed by the physician
to monitor recovery.

Diet ● Diet as tolerated, this includes lean protein, high in fibers,

low-fat dairy products, fruits, vegetables, and calories
● Food and drug interactions:
- Food: As for Clindamycin and Mefenamic Acid, avoid
spicy foods that may irritate the stomach. Then for
Esomeprazole, avoid greasy or fatty foods.
- Drug: Clindamycin - contraindicated to heart
medications, Clarithromycin, and some antifungal
medications; Mefenamic Acid - contraindicated to
ACE inhibitor drugs, Angiotensin II receptors
blockers and corticosteroids; Esomeprazole -
contraindicated in Anticoagulants, Diuretics,
Antifungals, and Natural Remedies like ginkgo
biloba
● Hydration, drink at least 8 glasses of water per day

Social, Spiritual ● Advise Mrs. CSO to avoid douching and abstain intercourse
and Sexual for the next following days as per advised by the physician

21
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