Threatened / Habitual Abortion

Prepared by: Lailanie C. Caying

Threatened Abortion A threatened miscarriage is a condition that suggests a miscarriage might take place before the 20th week of pregnancy. Some pregnant women have some vaginal bleeding, with or without abdominal cramps, during the first three months of pregnancy. When the symptoms indicate a miscarriage is possible, the condition is called a "threatened abortion." (This refers to a naturally occurring event, not medical abortions or surgical abortions.)Miscarriage occurs in about half of pregnancies with first trimester bleeding. habitual abortion spontaneous abortion occurring in three or more successive pregnancies, at about the same level of development.

Types of Abortion complete abortion one in which all the products of conception are expelled from the uterus and identified. habitual abortion spontaneous abortion occurring in three or more successive pregnancies, at about the same level of development. incomplete abortion that with retention of parts of the products of conception. induced abortion that brought on intentionally by medication or instrumentation. inevitable abortion a condition in which vaginal bleeding has been profuse and the cervix has become dilated, and abortion will invariably occur.

 infected abortion that associated with infection of the genital tract. missed abortion retention in the uterus of an abortus that has been dead for at least eight weeks. septic abortion that associated with serious infection of the uterus leading to generalized infection. spontaneous abortion that occurring naturally. therapeutic abortion that induced for medical considerations. threatened abortion a condition in which vaginal bleeding is less than in inevitable abortion and the cervix is not dilated, and abortion may or may not occur.

 I. Demographic Data
Name Sex Age Birth date Status Religion Race/National Address Occupation Diagnosis Final Diagnosis Admission date Admission time Hospital AOG : Patient E : Female : 25 y/o : May 3, 1987 : Married : Roman Catholic : Filipino : San Pablo City Laguna : Production Operator : Threatened Abortion : Threatened Abortion : January 06, 2012 : 08:40 am
: Community General Hospital

: 20 weeks

II. Source and Reliability of Information The data presented in this case was collected from Community General Hospital in San Pablo City Laguna dated Jan.6, 2012. The source of information was given by the relatives of the patient and the hospital records that borrowed. III. Reason for seeking care Patient E was brought to the hospital because of vaginal bleeding. She brought to the hospital at Community General Hospital which is their preferred and trusted hospital.

IV. History of Present illness According to the Client in the evening of January 4, 2012, 10pm. She just finish washing her husband clothes and preparing herself to sleep, she suddenly felt something coming out on her vaginal part and having pain in her abdomen. She just noticed that she having a bleeding which she think it will just diminish after a day. But the day gone by the bleeding still not stopping and accompanied with pain on her abdominal and inguinal part. on the day of January 6, 2012 she consulted at Community General Hospital and later was ordered to take a UTZ and was seen in Ultrasound that she has a minimal sub chorionic hemorrhage.

V. Past Medical History According to the patient, she experienced vaginal bleeding during her 3rd pregnancy and she was admitted to Community General Hospital at San Pablo city Laguna and her diagnosis was Threatened Abortion/Habitual abortion.

Family history

Legend : - Male

- Female

- Deceased

Grand father: Cancer

Grand mother: arthritis

Grandfather: hypertension

Grandmoth er: MI

Mother

Father: hypertension

Older sister : 42 y/o

2nd sister: asthma

Brother : Patient E :threatened abortion

VII. Functional Assessment A. Health Perception and Health Maintenance According to the mother of the patient, they believe in quack doctor as a superstitious belief but they only direct to the real doctor for the consultation of their children. B. Self- Esteem The client is well love by her family. Her parents is very supportive to the client, because in terms of financial, her parents always helping her for the check-ups .According to the patient, she is a very friendly person, a funny one. They share simple problem to their parents.

C. Sleep and Rest Pattern The mother of patient state that, patient E have a regular time of sleep in the evening around 9:00 oclock after watching T.V. If they have a work she wake-up early in the morning around 6:00 oclock, but in week-ends she dont have a time to wake-up, because they dont have a work to attend. D. Activity and Exercise Pattern The patient said that she is an active person, she likes watching TV. Patient E states that she is a hardworking. If she not busy she wants clean and clean. E. Nutrition and Elimination The patient likes to eat vegetable, meat, fish and fruits. She doesnt have any allergies in different kinds of foods. The patient elimination pattern is normal.

F. Sexuality / Reproductive She is very close to her big brothers. The patient states that she has a crushes in showbiz like Coco Martin, Luis Manzano, Piolo Pasqual and many more.

System

January. 06, 2012

General

Pale looking Weight:58kg Afebrile T= 36.5C

CNS

Conscious

HEENT

Normocephalic Teary eyes Dry lips Nasal flaring

Integumentary

Absence of rashes No lesions Dry skin Warm to touch

Respiratory

RR= 18 cpm Symmetrical chest expansion Have non productive cough Using accessory muscle in breathing

Cardiac

CR=93bpm

Gastrointestinal

Flat abdomen

Genitourinary

Normal urine output

ANATOMY AND PHYSIOLOGY Female Reproductive System General The organs of the reproductive systems are concerned with the general process of the reproduction, and each is adapted for specialized tasks. These organs are unique in that their functions are not necessary for the survival of each individual. Instead, their functions are vital to the continuation of the humans species. In providing maternity gynecologic health care to women, you will find that it is vital to your career as practical nurse and to the patient that you will require a greater depth and breadth of knowledge of the female anatomy and physiology than usual.

 The female reproductive system consists of internal organs and external organs. The inter organs are located in the pelvic cavity and are supported by the pelvic floor. The external organs are located from the lower margin of the pubis to the perineum. The appearance of the external genitals varies greatly from woman to woman since age, heredity, race and the number of children a woman has borne determines the size, shape, and color.

What parts make-up the female anatomy?

The female reproductive anatomy includes 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.

structures of the female reproductive system include: Labia majora: The labia majora enclose and protect the other external reproductive organs. Literally translated as "large lips," the labia majora are relatively large and fleshy, and are comparable to the scrotum in males. The labia majora contain sweat and oil-secreting glands. After puberty, the labia majora are covered with hair.

Labia minora: Literally translated as "small lips," the labia minora can be very small or up to 2 inches wide. 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).
Bartholins glands: These glands are located next to the vaginal opening 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. The internal reproductive organs include: Vagina: The vagina is a canal that joins the cervix (the lower part of uterus) to the outside of the body. It also is known as the birth canal.

Cervix: the lower one-third of the uterus is the tubular "cervix," which extends downward into the upper portion of the vagina. The cervix surrounds the opening called the "cervical orifice," through which the uterus communicates with the vagina.

X. PATHOPHYSIOLOGY
Abdominal Pain

Precipitating Factors *Works 5 days in a week *Work- related stressor

Cervical Dilatation

Predisposing Factors *Age: 25 yrs old *Gender: female *Previuos Abortion

Abdominal Contraction

Vaginal bleeding for 3 days

Passing of small pieces of pregnancy tissue

Dilatation and Curettage

Examination

Actual values

Normal values

Implication

Rationale

Color Transparency/ Appearance pH Specific gravity

Light yellow Clear

Straw yellow to amber in color Clear

Normal Normal

7.5 1.005

4.5-8 1.005-1.025

Normal Normal >to examine the patients urine for sign of renal or urinary tract disease.

Albumin

Negative

In normal condition there should be no protein that can be detected

normal

Sugar

Negative

Blood glucose level should be 160mg/dl

Presence of sugar in >to help discover disease urine may indicate that is not related to renal diabetes, chorionic disorders. kidney disease

RBC/HPF

0.1

Blood in the urine may sometimes indicate serious urinary tract problems May be sign of >demonstrate the swelling in the concentrating and diluting kidney and ability of the kidneys. pelvic region, urethral ulceration and chronic specific inflammatory of the bladder Pus cells and bacteria should be absent in urine

Pus cells/HPF

0.2

Epithelial cells

Rare

A. Phosphate

Rare

>to identify drugs or substances that has been taken.

Name of drug

Date of Route of General Action Ordered/ Administrati Date Started on

Indication

Client response to the medication with actual side effects. >patient response effectively with no side effect noted

Generic Name: Isoxsuprine HCI

>1amp side DO: 01/15/12 drip IVF

DS: 01/15/12 8:00 am Trade name: Duvadilan vasodilan

>stimulates skeletal beta receptors to produce vasodilation ; stimulates cardiac function ( increased contractility heart rate and cardiac output) and relaxes uterus. At higher doses inhibits platelet aggregation and blood decreases blood viscosity

>Uterine hypermotility disorders: Threatened abortion, premature labor & dysmenorrheal an anjunct therapy in the treatment arteriosclerosis obliterans.

XII. Drug Study

Name of Drug

Date Route of General Action Ordered/Da Administr te started ation

Indication

Client Response to the medication with actual side effects < Patient response with effectively with no side effect noted.

Generic Name: Ds:01/15/12 >10mg/tab, 2 Dydrogesteron Tabs TID e

Trade name:
Duphaston

Ds: 02/09/10 1:00pm

>Dydrogesterone is an orally active progesterone which acts directly on the uterus, producing a complete secretory endometrium in an estrogen primed uterus

<treatment of progesterone deficiencies (e,g threatened and habitual abortion associated with proven progesterone deficiency dysfunctional uterine bleeding dysmenorrheal endometriosis secondary amenorrhea irregular cycles premenstrual syndrome due to luteal insufficiency and to the counteract the effect unopposed estrogen on the endometrium in HRT for women with disorders due to natural or surgical induced menopause with an intact uterus.

Problem no.

Problem

Date identified

Date resolved

Excessive Vaginal bleeding

January 02, 2012

January 02,2012

Fever 2

January 02, 2012

January 02, 2012

Body weakness 3

January 02, 2012

January 02, 2012

XIII. PROBLEM LIST

Assessment Subjective

Diagno Planning sis

Intervention

Rationale >changes in blood pressure may be used for estimate of blood loss

Evaluati on

Deficie Dinudugo ako nt humihilab ang fluid( tiyan isotoni ko.Dalawang c) buwan na ang related pag bubuntis ko to as verbalize by excessi the patient. ve blood Objective: loss. >Delayed capillary refilled >Restlessness >Change in mentation > V/S t T:36.9 C P:90 R:19 BP: 110/70

Independent: After 8 hrs of >Monitor vital signs compare nursing with patients normal or intervention previous readings. Take blood the patient pressure when possible. will demonstrate >Note patients individual improved physiological response to fluid balance bleeding such as changes in as evidenced mentation weakness, by stable vital restlessness and pallor. signs good skin tugor >measure central venous and prompt pressure (CVP) if available. capillary >monitor intake and output refill. (I&O) and correlate with weight changes. >maintain bed rest. Dependent: Administer fluids as indicated Administer vit K Monitor HB,Hct,RBC count

Nursing Care Plan

>after 8 hrs of nursing >symptomatology may be useful in interventi gauging severity or lengh of bleeding on the episode patient >reflects circulating volume and cardiac was able response to bleeding and fluid to replacement. demonstr ate >Provides guidelines for fluid improved replacement. fluid balance >fluid replacement with isonotic solutions as depends on the degree and duration of evidence bleeding. d by >promotes hepatic synthesis of stable coagulation factors to support clotting. vital >Aids in establishing blood replacement signs needs and monitoring the effectiveness of good skin therapy. tugors, and prompt capillary refill