ARELLANO UNIVERSITY

COLLEGE OF NURSING
2600 LEGARDA ST, SAMP. MANILA

NCM 109
CARE OF MOTHER, CHILD, AT RISK OR WITH PROBLEMS
(ACUTE AND CHRONIC)
SKILLS LAB

CASE STUDY PRESENTATION

GROUP 2

TAMBALQUE, ZACHERIE SHANE M.

ADRIANO, DOMINIQUE LOVE S.
CABRAL, JOAN ROSE E.
CURATA, SARAH ANN
GABRINAO, LYKA
LAZO, MARY GRACE C.
QUINTO, VON ANDREI
SAMOLDE, CAREN
 MARCH 11, 2024
CASE SCENARIO:

INCOMPLETE ABORTION

Mrs. GGG, 35 years old, 8 weeks AOG, female, Filipino, Roman Catholic,single lives in Pampanga, admitted
at Pampanga emergency department for cramping in abdominal area along with vaginal bleeding and clots
passing on the vagina.

Over the past 2 days, she has experienced light spotting, which has increased in severity that morning. Mrs.
GGG, reported fever, chills, burning on urination, nausea or vomiting, with extreme fatigue due to her work
as saleslady in one of the mall in Pampanga. Patient took Co -trimoxazole 500 mg once a day but the
symptoms does not relieve. 1 day prior to admission,vaginal bleeding with intermittent fever and headache.
Paracetamol 500 mg was taken to relieve the symptoms, but still she had on and off fever. Few hours prior
to admission, heavy vaginal bleeding, hypogastric pain, fever with nausea and vomiting along with headache
that prompted her for hospitalization.Mrs. GGG, likes to drink coffee, and eat high fiber foods. Patient is a
smoker, consuming 5 sticks per day. Her father has hypertension. Mother has asthma. No pertinent medical
history of the siblings.

The patient has a previous hospitalization because of miscarriage. Her past obstetric history is G-4, P-2, A-
1, she was sexually active and receiving prenatal care from her obstetrician. Her Physical Examination: BP-
110/80 mm Hg, Heart Rate- 90 beats/min, RR- 20 breaths/min, Temperature - 101.4F, O2 saturation - 100%
on room air, Lungs - were clear on auscultation in all fields; S1 and S2 were normal with no murmurs, gallops,
or rubs. The patient’s abdomen was slightly distended, and severe tenderness was present over her lower
pelvic area. During Pelvic Examination, heavy bleeding accompanied with clots was noted in the vagina, with
the opening of the cervical os. Blood clots were noted on a peripad. The remainder of the patient’s physical
examination was unremarkable.

Laboratory findings showed: WBCs 12,000/uL (4,500 - 10,000), hemoglobin 10.7 g/dL (12.1-15.1), and
hematocrit 39.7% ( 36%-44%). Chemistries are normal limits and urinalysis results: Color - yellow, Specific
gravity: 1.005, Ph - 7, Blood (+), Protein(-), Bacteria 3+, WBC - 2 - 5/hpf, RBC 2/hpf, Epithelial 0-5/lpf. Mrs.
GGG blood type was B-positive. Beta-human chorionic gonadotropin (b-hCG) level was 9400.0 mIU/mL.

Transvaginal ultrasonography showed non viable fetus and blood inside the uterus.
She was given one liter of normal saline to keep her hemodynamically stable, as large amounts of blood
were lost in the ED. The patient was also given 2 g hydromorphone (Dilaudid) IV and 4 mg ondansetron
(Zofran) IV to relieve cramping pain and prevent nausea.

Prior to discharge, Mrs. GGG’s obstetrician was called, and the patient was sent home with prescriptions for
methylergonovine (Methergine) (one 0.2-mg tablet every four hours for six doses) and ibuprofen (one 800-
mg tablet three times a day for pain).

I.INTRODUCTION
Incomplete abortion is defined by clinical presence of an open cervical os and bleeding, whereby all
products of conception have not been expelled from the uterus or the expelled products are not consistent
with the estimated duration of pregnancy. Common symptoms include vaginal bleeding and abdominal pain
which are also present in the case of patient GGG. In this case study, we explore the complexity of managing
incomplete abortion of complications in pregnancy by diving through a detailed analysis of a given clinical
scenario. We are given a task to conduct a case study regarding patient GGG, a 35 year old pregnant woman
who is currently in her 8th week of gestation. Through this case study, we seek to enhance the understanding
of every nursing student in fostering greater awareness of the complexities involved in managing incomplete
abortion in pregnancy.

II.OBJECTIVES

General objective:
We aim to analyze the incomplete abortion of complications being described or stated and factors
contributing to the occurrence of pregnancy complications in the case study of patient GGG. To conduct a
thorough case analysis of Mrs. GGG's clinical presentation, integrating nursing frameworks and principles to
understand her health status, identify nursing diagnoses, and develop appropriate nursing interventions.

Specific objectives:
• To assess Mrs. GGG's health status comprehensively using Gordon's Functional Health Patterns
framework, focusing on pertinent aspects such as health perception, nutritional status, and activity
level.
• To identify deviations from normal findings in Mrs. GGG's assessment data, including symptoms
such as abdominal pain, vaginal bleeding, fever and fatigue.
• To develop a tailored nursing care plan for Mrs. GGG, addressing her immediate needs such as pain
management, fluid resuscitation, and monitoring for complications, while also promoting her overall
well-being and recovery.

III.THEORETICAL FOUNDATION

Self Care Deficit Theory

The self-care deficit theory, developed by Dorothea Orem, emphasizes the patient's ability to perform
self-care activities to maintain health and well-being. In the case of patient GGG being discharged after
experiencing cramping, vaginal bleeding, and passing of blood clots, the self care activities that can be
applied to ensure her ongoing well-being is drinking of medicines prescribed by her physician after the
discharge. Also the theory encourages the development of independent techniques that patient GGG can
utilize to manage symptoms at home such as rest, heat application, and hydration. The Self-Care Deficit
Theory asserts that individuals have a fundamental need for self-care to maintain their health and well-being.
When individuals are unable to meet their self-care needs, they experience a self-care deficit, which requires
assistance from others to achieve optimal health outcomes. In the context of incomplete abortion, the self-
care deficit theory can be applied to understand the patient's ability to care for herself during this challenging
time.

IV.NURSING HISTORY
1. Demographics:
• Name: Mrs. GGG
• Age: 35 yrs. old
• Gender: Female
• Nationality: Filipino
• Religion: Roman Catholic
 • Marital Status: Single
• Residence: Pampanga
• Occupation: Saleslady in a mall in Pampanga

2. Chief Complaint
• Presents with cramping in the abdominal area accompanied by vaginal bleeding and passing
of clots.

3. Presenting History
- Past 2 days:
• Light spotting which progressed to heavy vaginal bleeding and passing of clots.
• Fever
• Chills
• Burning on urination
• Nausea
• Vomiting
• Extreme fatigue.
- 1 day prior:
• Symptoms worsened
• Intermittent fever
• Intermittent headache
- Few hours prior:
• Heavy vaginal bleeding
• Hypogastric pain
• Fever
• Nausea
• Vomiting
• Headache

4. Past Health History

• Previous hospitalization for miscarriage.

5. Family History
• Father: Hypertension
• Mother: Asthma

6. Obstetric History
• G-4, P-2, A-1 ( Gravida 4, Preterm 2, Abortion 1 )
• Patient receiving prenatal care.
• Patient sexually active.

7. Personal History
Lifestyle
• She enjoys drinking coffee and eating high-fiber foods.
• Mrs. GGG has a smoking habit ( 5 sticks per day ).

8. Gordon's Functional Health Patterns

Health Perception- Health Management Pattern

• Mrs. GGG sought medical care promptly when her symptoms worsened, indicating
awareness of her health status. However, her self-management practices, such as taking
Co-trimoxazole without relief may need further evaluation.
Nutritional - Metabolic Pattern
• Mrs. GGG's dietary habits, particularly her preference for high-fiber foods, can impact her
nutritional status. Assessment of her food and fluid consumption relative to metabolic needs
is necessary to ensure adequate nutrient intake.
Elimination Pattern
• Mrs. GGG reports burning on urination which could indicate a urinary tract infection or other
urinary issues
Activity - Exercise Pattern:
• Mrs. GGG's occupation as a saleslady in a mall indicates that she engages in regular
physical activity. However, her extreme fatigue may impact her ability to maintain her usual
activity level.
Cognitive - Perceptual Pattern
• Mrs. GGG's cognitive function appears intact. Assessment of her sensory and perceptual
patterns, including pain perception and understanding of her health condition, is necessary
for comprehensive care.
Sleep - Rest Pattern
• Mrs. GGG reported extreme fatigue, fever, pain, and discomfort could indicate difficulty of
sleeping, disruptions in her sleep- rest pattern.
Self-perception - Self-concept Pattern
• Mrs. GGG's self-perception may be influenced by her current health condition. Assessment
of her self-concept is important for addressing any psychosocial needs.
Role - Relationship Pattern
• Mrs. GGG role as a saleslady in a mall indicates engagement in work-related roles.
However, her current health issues may affect her ability to fulfill these roles.
Sexuality - Reproductive Pattern
• Mrs. GGG is sexually active, therefore it is essential to assess various components of her
sexual and reproductive health comprehensively.
Coping - Stress Tolerance Pattern
• Mrs. GGG is coping with the physical symptoms and emotional distress associated with
pregnancy therefore social support from coworkers or friends outside of work to manage
work-related stressors can be described as a coping mechanism or strategy that Mrs. GGG
may have utilized.
Value - Belief Pattern
• Mrs. GGG is a Roman Catholic, therefore she believes in God.
V. PATHOPHYSIOLOGY
VI.MEDICAL / SURGICAL MANAGEMENT

Complete Blood Count (CBC)

• The CBC revealed an elevated white blood cell count (WBC) of 12,000/uL, indicating the presence
of infection or inflammation. Additionally, the hemoglobin level of 10.7 g/dL and hematocrit of 39.7%
suggest anemia secondary to acute blood loss. These findings help assess the severity of the
patient's condition and guide the need for blood transfusion.

Urinalysis
• The urinalysis results revealed the presence of blood in the urine (hematuria), which is likely
attributed to the suspected incomplete abortion experienced by Mrs. GGG. During this, heavy vaginal
bleeding with clots can lead to blood entering the bladder, resulting in hematuria. This finding
supports the diagnosis of abortion and underscores the severity of the uterine bleeding. Additionally,
the presence of bacteria in the urine suggests a concurrent urinary tract infection (UTI). UTIs are
common during pregnancy and can exacerbate symptoms such as fever, chills, and burning on
urination. The detection of bacteria indicates an active infection, which may require antibiotic
treatment to prevent further complications. The absence of proteinuria indicates that kidney function
is not significantly impaired, ruling out potential renal complications contributing to her symptoms.

Beta-human chorionic gonadotropin (b-hCG) Level

• In Mrs. GGG's case, a b-hCG level of 9400.0 mIU/mL may be lower than expected for an 8-week
gestation, suggesting a potential concern for a non-viable pregnancy, such as a miscarriage or
ectopic pregnancy. This finding, along with the presence of heavy vaginal bleeding and non-viable
fetal findings on ultrasound, supports the suspicion of a miscarriage rather than a viable pregnancy.

Blood Typing
• Mrs. GGG's blood type being B-positive is crucial for potential blood transfusions and ensuring
compatibility with donor blood products if needed during the management of acute blood loss.

Lung auscultation
• In Mrs. GGG's case, the auscultation of the lungs was reported as "clear in all fields," indicating the
absence of abnormal respiratory sounds such as crackles, wheezes, or diminished breath sounds.
This finding suggests that there are no apparent respiratory issues requiring immediate intervention
or further evaluation at the time of assessment, which she might possibly have due to the family
health history.

Fluid resuscitation
• Mrs. GGG was administered one liter of normal saline to maintain hemodynamic stability due to
significant blood loss

Pain Management
• To alleviate severe cramping pain, she was administered 2 g of hydromorphone (Dilaudid)
intravenously. This potent opioid analgesic helps to relieve pain associated with conditions such as
miscarriage.
Antiemetic therapy
• Given the presence of nausea and vomiting, Mrs. GGG received 4 mg of ondansetron (Zofran)
intravenously to prevent further nausea and vomiting, which can exacerbate her discomfort.

Consultation with Obstetrician:

• Mrs. GGG's obstetrician was promptly contacted to provide expert guidance and oversight regarding
her condition.

Prescription Medications
• Upon discharge, Mrs. GGG was prescribed methylergonovine (Methergine) at a dosage of one 0.2-
mg tablet every four hours for six doses. Methergine is commonly used to help control uterine
bleeding following childbirth or miscarriage.
• Additionally, she was prescribed ibuprofen at a dosage of one 800-mg tablet three times a day for
pain relief.

Follow-Up Care
• Mrs. GGG was advised to follow up with her obstetrician for further evaluation and management,
ensuring ongoing monitoring of her condition and any potential complications.

Diagnostic Imaging
• Transvaginal ultrasonography was performed, revealing a non-viable fetus and blood within the
uterus. This aided in confirming the diagnosis and guiding subsequent management decisions.

VII.PHYSICAL EXAMINATION AND ASSESSMENT

Body Parts/ Normal Findings Actual Findings Analysis

System
Cardiovascular Clear heart sounds S1 and S2 were Cardiovascular system shows normal
System (S1 and S2 ) no normal with no findings, indicating no acute cardiac
murmurs, gallops, murmurs, gallops, or issues.
or rubs. rubs.
Lungs ( Clear lung fields on Clear on auscultation Respiratory system shows normal
Respiratory auscultation. in all fields. findings, indicating no acute
System) pulmonary issues.
Abdomen Soft, non-tender, Slightly distended, Abdominal tenderness and distention,
non- distended severe tenderness along with heavy vaginal bleeding and
present over lower clots in the pelvic area, indicate
pelvic area. possible intra-abdominal or
gynecological pathology, likely related
to incomplete abortion.
Pelvic Area No heavy bleeding Heavy bleeding The presence of heavy bleeding and
or clots noted accompanied by clots clots in the pelvic area requires further
during examination. noted during evaluation and management to
examination. address the underlying cause and to
prevent complications such as
hemorrhage or infection.
 Skin Intact without signs No specific Signs of pallor due to blood loss is a
of pallor, jaundice, abnormalities concerning finding, particularly given
or cyanosis. mentioned, but likely Mrs. GGG's symptoms of heavy
signs of pallor due to vaginal bleeding and hypogastric pain.
blood loss.
Neurological Alert and oriented, Temperature of The elevated temperature and
Status no signs of 38.5°C signs that the reported headache indicate systemic
headache, patient has a involvement, likely due to an
dizziness or headache. underlying infection or inflammatory
confusion condition.
Extremities No signs of No signs of peripheral The absence of peripheral edema and
peripheral edema, edema, normal normal peripheral pulses indicate that
normal peripheral peripheral pulses. Mrs. GGG's Cardiovascular system is
pulses. functioning within expected
parameters during the assessment.

General Appearance: Mrs. GGG appears awake and responsive.

Vital Signs
• Bp: 110/80 mm Hg
• Heart Rate: 90bpm
• RR: 20 breaths per minute.
• Temp: 101.4°F ( 38.5°C )
• O2 Sat: 100%

VIII.DIAGNOSTIC AND LABORATORY

EXAMINATIONS FINDINGS NORMAL NURSING IMPLICATIONS

VALUES
Transvaginal Non- viable fetus Viable fetus with Monitor for signs of continued bleeding
ultrasonography and blood inside appropriate growth and provide emotional support to the
the uterus and development. patient during this difficult time.
WBCs 12,000/uL 4,500 - 10,000/uL Monitor for infection: The elevated WBC
Elevated WBC count suggests a possible infection.
count
Monitor for signs and symptoms of
infection such as fever, chills, and
increased heart rate.
Hemoglobin 10.7 g/dL 11.5 to 12.5 g/dL Closely monitor her hemoglobin levels
Low and provide appropriate interventions to
Hemoglobin manage and treat any underlying
anemia.

This may include iron supplementation

and dietary counseling to ensure
 adequate iron intake. Additionally,
nurses should assess for signs and
symptoms of anemia, such as fatigue
and weakness, and provide supportive
care as needed.
Hematocrit 39.7% 31% – 41% A hematocrit of 39.7% in the first
within the range trimester of pregnancy may indicate
hemoconcentration, which could be due
to dehydration from blood loss or fluid
shifts.

Monitor the patient closely for signs of

ongoing bleeding, administer fluids as
needed, and assess for signs of anemia
or hypovolemia. Additionally, patient
education on the importance of
hydration and follow-up care is essential.
Urinalysis Positive blood in Urinalysis Further evaluation for hematuria:
Color: Yellow urine parameters within Positive blood in the urine warrants
pH: 7 normal limits. further evaluation to determine the
Specific cause, which could range from urinary
gravity:1.005 tract infection to more serious conditions
like kidney stones or bladder cancer.

Blood: Positive Blood (+) Absent Presence of blood in the urine

(hematuria) could indicate various
conditions such as urinary tract infection,
kidney stones, or in this case, could be
related to the recent heavy vaginal
bleeding.

Continuous monitoring for any signs of

worsening bleeding or urinary symptoms
is essential.
Protein: Negative Protein (-) Absent Absence of protein is normal. However,
if proteinuria is detected, it could indicate
renal issues or preeclampsia in pregnant
patients.

Educate the patient on the significance

of proteinuria and the need for further
evaluation if present.

Bacteria: 3+ Absent or minimal Presence of bacteria suggests a

possible urinary tract infection. Monitor
the patient for symptoms such as
burning sensation during urination or
increased frequency. Proper hygiene
practices and completion of prescribed
antibiotics should be emphasized.

WBC: 2 - 5/hpf WBC count in the Normal values for It's crucial to monitor for signs of urinary
urine is elevated WBC and RBC in tract infection or renal issues due to the
at 2 - 5/hpf (high the urine. elevated WBC count in the urine.
power field) Normal range for
epithelial cells. Educating the patient on maintaining
proper hydration and urinary hygiene is
essential to prevent complications.

RBC: 2/hpf RBC count is Normal RBC count Monitoring the patient for signs of urinary
also elevated at in a microscopic tract infection or kidney dysfunction and
2/hpf. examination of ensuring adequate hydration to prevent
urine is typically further complications.
less than 5 RBCs
per high power field
(hpf).
 Epithelial cells: 0 - The presence of Epithelial cells: 0 - Ensure proper documentation of
5/lpf epithelial cells 5/lpf findings.
falls within the
normal range at 0 Continue to monitor patient's condition
- 5/lpf (low power and vital signs.
field).
Provide emotional support and
education to the patient regarding the
significance of the findings and any
follow-up care needed.

Beta-human b-hCG level is 31,366-149,094 Monitor the patient for signs of continued
chorionic 9400.0 mIU/mL, mIU/mL for 8 bleeding, ensuring adequate pain
gonadotropin (b- weeks AOG management, providing emotional
hCG) support, and educating the patient on
signs of complications post-discharge.
Additionally, the nurse should reinforce
the importance of following the
prescribed medication regimen and
attending follow-up appointments with
her obstetrician.

Blood type B (+) Either + or - Rh (D) Include ensuring appropriate blood

factor product availability in case of further
hemorrhage and monitoring for signs of
Rh sensitization in future pregnancies,
as Rh-negative individuals may develop
antibodies against Rh-positive blood.

IX.DRUG STUDY:

NAME OF DRUG DOSAGE/DOSE INDICATIONS SIDE EFFECTS NURSING

ROUTE RESPONSIBILITIES
Generic Name: 2 g thru IV A potent opioid nausea, vomiting, Monitor vital signs
Hydromorphone Follow - up medication for dizziness,constipation, especially respiratory
dosing as managing sweating rate and blood
Brand Name: needed moderate-to- pressure
Dilaudid severe acute
and severe Assess pain level
chronic pain in before and after
patients administration
 Monitor for signs of
respiratory
depression

Provide education to
the px about potential
side effects and how
to manage them
Generic Name: 4 mg thru IV prevention of headache, Monitor for signs of
Ondansetron nausea constipation, allergic reactions
dizziness, fatigue
Brand Name: Assess effectiveness
Zofran, Zofran in preventing nausea
ODT, and
Zuplenz. Provide education
about potential side
effects and when to
seek medical
attention
Generic Name: 0.2 mg tab q4 hr prevention and nausea, vomiting, Monitor for blood
Methylergonovine for six doses PO treatment of headache, dizziness, pressure closely due
postpartum hypertension to risk of
Brand Name: hemorrhage uterine cramps, hypertension
Methergine allergic reactions
Assess uterine tone
and vaginal bleeding

Educate patient
about potential side
effects and when to
seek medical
attention
Generic Name: 800 mg tab TID a nonsteroidal upset stomach, Monitor for signs of
Ibuprofen anti- nausea, heartburn, gastrointestinal
inflammatory headache bleeding
Brand Name: drug (NSAID)
Advil,Midol, used to treat Assess pain level
Motrin mild to before and after
moderate pain, administration
and helps to
relieve Provide education
inflammation, about taking
swelling, ibuprofen with food to
stiffness, and reduce
joint pain. gastrointestinal
irritation
X. NURSING CARE PLAN (2 NCP’S)

CUES NURSING OBJECTIVES INTERVENTION EVALUATION

DIAGNOSIS

S: Acute Pain Short term: Dependent: The patient

Presence of related to uterine exhibits
hypogastric contraction and The patient will exhibit Administered 2g decreased pain
pain tissue passage decreased pain as Hydromorphone via IV as evidenced by
as evidenced by evidenced by as ordered by the the 3/10 pain
Patient has abdominal subjective statements healthcare provider to scale.
discomfort discomfort and of relief and objective manage acute pain
upon gentle vaginal bleeding assessment findings associated with uterine
palpation of indicating decreased contractions and tissue
the abdomen tenderness upon passage, ensuring
palpation and lighter proper dosage and
O: vaginal bleeding or monitoring for adverse
absence of blood clots effects.
Presence of after 8hrs of
abdominal intervention Independent:
tenderness
upon Long term: Provided comfort
palpation measures: Offer warm
The patient will exhibit blankets, position
decreased pain as changes, and relaxation
evidenced by techniques such as deep
subjective statements breathing exercises to
of relief and objective alleviate discomfort
assessment findings during uterine
indicating decreased contractions.
tenderness upon
palpation and lighter Provided reassurance,
vaginal bleeding or encouragement, and
absence of blood clots empathy to the patient
after 2 days of experiencing pain,
intervention. acknowledging their
feelings and concerns,
and offering a supportive
presence throughout the
process.
 CUES NURSING OBJECTIVES INTERVENTION EVALUATION
DIAGNOSIS

S: Hyperthermia Short term: Independent: The patient’s

The patient related to body
reported: infection as Within 8 hours of Ensured adequate temperature
• fever evidenced by intervention, the ventilation in the lowered to 36.5
• having elevated body patient's temperature patient's room and and therefore in
chills. temperature and will decrease by at provided tepid sponge normal range.
• Fatigue WBC count least 1°F (0.5°C) baths as to aid in
from baseline, temperature reduction
O: indicating a positive
response to Monitored continuously
Body temp : interventions. the vital signs,
101.4F (38.5 C) especially the
Long term: temperature to facilitate
Elevated WBC early detection of fever
(12,000/uL) The patient will trends, allowing for
demonstrate effective prompt intervention if
management of temperature elevations
hyperthermia, with occur.
temperature
consistently within Encouraged increased
normal range, and fluid intake to help
absence of signs of prevent dehydration.
infection after 24
hours of intervention. Encouraged rest or limit
body movements to
minimize energy
expenditure and
support the body’s
healing process.

Dependent:

Administered
antipyretic drug as
ordered by the
physician to lower the
body temperature .
XI.FDAR
DATE FOCUS PROGRESS NOTES
AND TIME
FEB. 14, BLEEDING D:
2024 Heavy bleeding accompanied with clots was noted in the vagina, with
3:00 PM the opening of the cervical os, was seen during the pelvic exam. Low
Hemoglobin count – 10.7 g/dL.

A:
Placed the woman flat on bed on her left side and monitored uterine
contractions.
Measure the intake and output.
Encouraged rest and avoidance of strenuous activities.
Administered 1L of normal saline as ordered by the doctor to keep the
patient hemodynamically stable

R: After 8hrs the bleeding stopped.

XII. ISBAR
I - IDENTIFY
Patient’s name: Mrs. GGG

Age: 35 years of age

Gender: Female

8 weeks AOG
S - SITUATION The patient has cramps on the abdominal area accompanied by vaginal
bleeding and clots passing on the vagina.
B - BACKGROUND
Over the past 2 days, she has experienced light spotting, which has increased
in severity that morning. Mrs. GGG, reported fever, chills, burning on urination,
nausea or vomiting.

Patient took Co-trimoxazole 500 mg once a day but the symptoms did not
relieve.

1 day prior to admission, vaginal bleeding with intermittent fever and headache.
Paracetamol

500 mg was taken to relieve the symptoms, but still she had on and off fever.
Few hours prior

to admission, heavy vaginal bleeding, hypogastric pain, fever with nausea and
vomiting along

with headache that prompted her for hospitalization

 A - ASSESSMENT
S1 and S2 were normal with no murmurs, gallops, or rubs.

Lungs is clear on auscultation in all fields.

The abdomen is slightly distended with severe tenderness present over the
lower pelvic area.

Heavy bleeding is present on the pelvic area accompanied by clots noted during
examination.

Based on the assessment, the patient shows to be experiencing an intra-

abdominal or gynecological pathology, related to incomplete miscarriage.

The patient’s symptoms may worsen if we don’t apply necessary intervention.

R -
RECOMMENDATION As the patient is having heavy bleeding present on the pelvic area, I would
recommend to have the physician order a blood transfusion STAT.

Strictly monitoring of blood volume loss by checking and counting the number of
pads consumed by the patient is highly needed.

Have the physician order a transvaginal ultrasonography to check the status of

the fetus.

Have the physician order a 1-liter normal saline to keep her hemodynamically
stable, as large amounts of blood were lost in the ED.

Have the physician order Hydromorphone for acute pain.

XIII.DISCHARGE PLAN -USE M E T H O D S

MEDICATIONS • Continue taking methylergonovine (Methergine) as prescribed: one 0.2-

mg tablet every four hours for six doses.
• Take ibuprofen (Advil) as prescribed: one 800-mg tablet three times a
day for pain relief.
• Finish any remaining Co-trimoxazole if still prescribed, but instruct the
patient to consult with her doctor if symptoms persist.

ENVIRONMENT/ • Entrust the patient to rest at home and avoid strenuous activities or
EXERCISES heavy lifting for the next few days to allow the body to recover.
• Avoid exposure to cigarette smoke and try to reduce or quit smoking to
improve overall health.
TREATMENT • Instruct the patient to follow the obstetrician as scheduled for further
evaluation and management of any remaining symptoms or concerns.
• Continue monitoring for any signs of infection or complications and seek
medical attention if any new symptoms arise.

HEALTH TEACHING
• Educate the patient importance of attending all follow-up appointments
to ensure complete recovery and to address any potential
complications.
• Provide information on contraception options and family planning to
prevent unintended pregnancies and reduce the risk of future
miscarriages.

OPD • Schedule a follow-up appointment with the obstetrician for a post-

discharge check-up and assessment of recovery progress.
• Ensure to bring any remaining medication or records from the hospital
visit to the follow-up appointment for review.

DIET • Maintain a balanced diet rich in high-fiber foods to support overall health
and recovery.
• Drink plenty of fluids to stay hydrated, especially considering the recent
blood loss.

SPIRITUAL/SEX • Encourage discussing any emotional or spiritual needs with a trusted

religious or spiritual advisor for support during this challenging time.
• Advise abstaining from sexual activity until cleared by the obstetrician to
reduce the risk of complications and allow the body to heal properly.

XIV. LEARNING DERIVED/ INSIGHTS

• This scenario illustrates the importance of prompt medical attention for pregnant women
experiencing symptoms such as vaginal bleeding and abdominal pain, as it could indicate a serious
condition like a miscarriage. Mrs. GGG's history of previous miscarriage highlights the potential for
recurring complications in subsequent pregnancies. The laboratory findings, including elevated white
blood cell count and positive urine blood, indicate a possible infection, emphasizing the need for
thorough evaluation and treatment. The transvaginal ultrasonography confirmed the non-viable fetus,
guiding clinical decision-making. Collaboration between emergency department physicians and
obstetricians ensures appropriate management and follow-up care for patients experiencing
pregnancy-related complications.
 • Gain a comprehensive understanding of the pathophysiology of incomplete abortion, including the
causes, and physiological changes associated with the condition. This includes knowledge of the
factors that may lead to incomplete abortion, such as uterine abnormalities, hormonal imbalances.
• Recognition of signs and symptoms, learn to recognize the signs and symptoms of incomplete
abortion, including vaginal bleeding, abdominal pain or cramping, passage of tissue or clots, and
signs of hemodynamic instability
• Patient education, develop skills in providing patient education regarding the diagnosis, treatment
options, and potential outcomes associated with incomplete abortion. This includes discussing the
risks and benefits of different management approaches, providing emotional support, and addressing
any questions or concerns to empower patients to make informed decisions about their care.

XV.REFERENCES:
Gordon, M. Nursing Diagnosis: Process and application, Third Edition. St. Louis: Mosby, 1994.
https://www.healthcentral.com/womens-health/hcg-levels-during-pregnancy
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4779156/