VALIDITY OF EMOTIONAL AND

PHYSICAL STRESS AS A CAUSATIVE

FACTOR FOR MISCARRIAGE
ABSTRACT
• Psychological stress was never considered as a factor for
miscarriage, but study suggests that there is a valid
correlation between environmental, sociocultural,
physiological and psychological stress as factors for
abortions. Is stress not a major inevitable characteristic of
pregnancy for it not to be validated as a cause of losing a
child?
CASE DESCRIPTION
• : It's absolutely typical to feel somewhat worried during
pregnancy. All things considered, your body is
experiencing some enormous changes.
• Your hormones change during pregnancy, and this can
affect your dispositions. Parenthood is a major change,
and a few guardians may feel pushed or terrified about
the progress. Stress during pregnancy can likewise be
brought about by troubles in the work environment or
stresses over unnatural birth cycle. You can talk about
these worries with your primary care physician during
your pre-birth arrangements.
CONCLUSION:
• In addition to that physical strain plus environmental
triggers added to the pressure of becoming a mom, not
having enough support a from own system could make a
great declining difference for the mother’s state. Stress
has always been considered a mythical reason for
miscarriages. The results of our case study, highlight the
potential to identify and treat psychological factors which
contribute to adverse pregnancy outcomes in the human
that we could give more justice through scientific
researches.
Introduction
• Spontaneous abortion is noninduced embryonic or fetal death
or passage of products of conception before 20 weeks
gestation .
• Symptoms of spontaneous abortion include crampy pelvic
pain , bleeding , eventually expulsion of tissue. Late
spontaneous abortion may begin with a gush of fluid when the
membranes rupture. Hemorrhage is rarely massive. A dilated
cervix indicates that abortion is inevitable.
• If product of conception remain in the uterus after
spontaneous abortion, vaginal bleeding may occur, after day
or some days . If infection develops it may cause fever and
pain.
Statement of objectives:
• he nursing students will be able to come up with thorough
understanding of complete abortion,and able to come up
with how to care for patients with the said abortion
effectively and efficiently.
Specific objectives:
• 1. Define Complete abortion and its effects to the body as a whole;
• 2. Illustrate the pathophysiology of Complete abortion and in relation
to the signs and symptoms specifically observed in the patient;
• 3. Describe and identify the common signs and symptoms of
Complete abortion;
• 4. Discuss the medical and surgical interventions for the management
of Complete abortion;
• 5. Formulate appropriate nursing care plans suited for the patient
based on the assessment findings;
• 6. Identify care measures to be given to the patient and family to
promote continuity of care and independence after discharge.
Patient Profile:
• Name : Patient X
• Ethnic Background : Filipino
• Civil Status : annulled
• Religion : Roman Catholic
• Occupation : Sales Lady

• Admitting Diagnosis : G3 P2 (2012) 13 2/7 weeks AOG to consider

• spontaneous abortion; non
septic; non-induced

• Final/Principal Diagnosis : Complete abortion

• Date and Time Admitted : February 16, 2020 at 1:00 PM
Chief Complaint:
• Vaginal bleeding and abdominal pain
Present History of Illness
• One day patient X woke up in the morning and then suddenly observed that there is a profuse vaginal
bleeding. She immediately called her obstetrician Dr. Leah Kendrick and her physician wasted no time,
ordered her to present herself to the Emergency Department of Baguio General Hospital and Medical Center
(BGHMC).
• She went to the clinic of her obstetrician to seek medical attention due to reports of abdominal cramping,
sudden onset of hypogastric pain and heavy vaginal bleeding and clots. For the past three days, she had
experienced light spotting, which had increased in severity that morning.
• During interview, she stated having no fever, chills, burning on urination, nausea, or vomiting
• Her sister accompanied her and was subsequently admitted. Upon admission, initial vital signs taken were:
• T = 37.5 0C
• PR = 103 bpm
• RR = 21 cpm
• BP = 130/90 mmHg
• SpO2 = 95%
• Weight = 78 kgs
• Height = 5’ 4’’
Past History of Illness
• Patient X expressed that she had no any personal history
of any disease, for example, Hypertension, Diabetes
Mellitus, Goiter, Pulmonary Tuberculosis (PTB) and
Asthma. This is her third pregnancy on her G3P2, 13 2/7
weeks Age of Gestation. Additionally patient X uncovered
that she had not taken any meds or enhancements during
this pregnancy.
Family Health History
• Medical conditions, for example, Asthma, kidney
sicknesses, diabetes, or psychological maladjustment
were verbalized to be absent. No current sickness is right
now experienced by any individual from the family.
Furthermore, stated that she had no any personal history
of any sickness.
Developmental History
• The patient is the second child out of the other 3 siblings.
Patient X was born on July 05, 1984, a resident of La Trinidad
Benguet, Filipino Citizen and a Roman Catholic. She is a 36
year old early adult with the task of developing his Intimacy
according to Erik Erikson’s Developmental theory. Erikson said
that young adults may have trouble developing and maintaining
successful relationships with others. Also, we must have a
strong sense of self before we can develop successful intimate
relationships
• She has verbalized that her stress increases due to her recent
annulment so she focused more to her work and especially to
her children.
 Social and Environmental History
• The patient is a single mother who work and provide to
her kids in order to send them to school. No verbalized
vices were identified. However, she stated that because
of the increasing hours from her job she worked harder
but she did not know that it would be bad for the baby.
Also, it added to her problem the recent annulment with
her partner.
X. Lifestyle and Health Practices

• The patient stated that due to the increasing hours of her

job, she stands for around 8hours a day and only gets to
sit for half an hour during her break periods. Moreover,
she lacks in sleep and only gets about six to seven hours
of sleep at night. Upon entry at home, she cooks and
attends to her other two children, the firstborn is a boy
and the second is a girl.
• Due to her recent annulment, her stress increased as she
needed to work harder for her kids in order to provide for
them and send them to school. Patient X is giving all she
can to work and provide for her family as a single mother.
. Health
Head
Assessment
Normocephalic, normal contour and no tenderness upon palpation, disheveled hair but well
distributed, no signs of dryness or oiliness noted.

Eyes Eyelids close easily, conjunctiva is translucent and sclera is visible underneath, pupils are equal
in size and are equally round and reactive to light and accommodation, cornea is transparent and
no opacities shown, able to follow smooth and symmetric movement throughout the six field
gaze, no swelling and pain noted.

Ears Able to hear and comprehend verbal language correctly, ear canal is skin-colored and has small
hairs, cerumen is present and eardrum is light-gray in color.

Nose and Sinuses Nasal congestion is evident with thin secretions, septum is in the middle and nasal patency is
minimal, no episodes of epistaxis during the assessment and no lesions and flaring noted, sinuses
are not tender upon palpation.

Mouth Teeth demineralization is evident, with weak teeth and tooth abscess. Gingival enlargement is
present with minimal dental carries. Cracked corners of the mouth are also evident, no lesions
noted. Tonsils are not inflamed and uvula is located midline.

Neck Range of motion intact, able to change direction of head slowly without complaints of pain,
carotid pulses are bilaterally symmetrical, jugular vein is not distended, superficial cervical
lymph nodes are palpable but non tender, trachea is located in the midline, slight thyroid
hypertrophy is observed.
 Chest Shape of the chest is barrel-shaped / increased size from front to back, upward movement
of diaphragm is noted, reduced expansion of lung capacity, no crackles, no wheezes and
stridor noted.

Cardiac Higher apical impulse, displaced to the left, in the fourth intercostal space, normal cardiac
rate, venous hum and systolic mammary soufflé are evident, no visible pulsations in
precordium and palpable apical pulse is shown.

Breast/Chest Larger in size, firmer, more tender and nodular, nipples are elevated and dark colored,
areola is increased in diameter and is also dark colored, Montgomery’s tubercles are
prominent and no lesions or discharges.

Abdomen Purplish striae and linea nigra is present, stomach and intestines are displaced at the back
causing decrease in peristaltic movement. Patient verbalized abdominal pain and lack of
audible fetal heart tone upon auscultation.

Genitals Profuse vaginal bleeding is evident, vaginal discharge is heavy with minimal blood clots
and is more brown than red in color.
Musculoskeletal Ankle edema and varicosities in the lower leg is seen, overall muscle strength is 4/5, no
lesions and swelling noted.
Integumentary Striae gravidarum and linea nigra is present on the sides of the abdominal wall, melasma
is also evident on the cheeks and minimal across the nose, minimal vascular spiders are
seen on the thighs and increased activity of sweat glands is shown.
13 Areas of Assessment

• 1. Psychosocial and Psychological Status

• Patient X is 36 years old, single, and resident of La trinidad Benguet. She is
the 2nd child among her 3 siblings. The patient, together with her family
practices the belief of the religion Roman Catholic. The patient revealed that
she had not taken any medication or supplements during this pregnancy and
she had no any personal history of any illness such as hypertension,
Diabetes, Mellitus, Goiter, Pulmonary Tuberculosis (PTB) and Asthma.
• 2. Mental and Emotional Status
• The Patient responds appropriately to verbal and non-verbal stimuli during
the assessment. She is well oriented to time, place and person. During the
interview that took place, she was able to express her feelings as evidenced
by answering the questions being asked correctly and using clear words.
• 3. Environmental Status
• Patient X is living with her 2 kids. She lives in a house
made up of wood and cement with two bedrooms. The
location of their house is not easily accessible to hospitals
and health centers. During hospitalization, the patient was
placed in the Emergency Department of Baguio General
Hospital and Medical Center (BGHMC) . She was
exposed in a room with adequate lighting, comfortable
room temperature and proper air ventilation.
• 4.Sensory Status
• a. Visual Status
• Upon eye assessment, the patient was then known to have a visual acuity of 20/20, without any presence of irritation,
redness or cataract noted. The patient successfully demonstrated the six cardinal gazes without any abnormalities noted.

• b. Auditory
• During the assessment, she can also distinguish voice using the whisper test even from a distance of 2-3 feet. No corrective
auditory deficits and no auditory device noted being used by the patient.

• c. Olfactory Status
• The patient is able to discriminate pleasant odor such as the soap and food, and unpleasant odor such as rotten food. No
unusual finding was reported by the patient.
•
• d. Gustatory Status
• The patient verbalized that she has a good sense of taste. The patient is able to distinguish sweet, sour, salty and bitter foods
as evidenced by proper description of the food she was taking in.

• e. Tactile Status
• With regards to the patient’s tactile status, she was able to distinguish sharp and dull by us brushing the tip of the pen on to
her skin, light and firm tough, able to perceive heat, cold, pain in proportion to stimulus, and able to differentiate common
objects such as pillow, blanket, bottles and food by touch.
• 5. Motor Status
• Prior to admission, the patient has limited movements due
to abdominal cramping, sudden onset of hypogastric pain
and heavy vaginal bleeding and clots. Patient was able to
walk and balance is quite vulnerable which indicates a
risk for injury or fall. During hospitalization, her movement
is slow paced.
•
6. Thermoregulatory Status
The patient’s temperature ranges from 36.0°C to 37.2 °C (normal range: 36.5-37.5°C). The result is a manifestation of afebrile. There is
no episode of fever during the whole shift.

Date Time Temperature

February 17, 2020 8am10am2pm 36.6 °C36.8 °C

February 18, 2020 8am10am2pm 36.5 °C36.8°C36.6 °C

February 19, 2020 8am10am2pm 36.6 °C37 °C36.8 °C

7. Respiratory Status
The patient’s respiratory rate ranges from 18-22bpm (normal range: 12-20 bpm) and SPO2 ranges from 94%-
98%. The result is a manifestation of normal breathing.

Date Time RR SPO2

February 17, 2020 8am10am2pm 22 bpm22 bpm 95 %97%

February 18, 2020 8am10am2pm 18 bpm22 bpm20 bpm 98 %96 %94 %

February 19, 2020 8am10am2pm 18 bpm18 bpm20 bpm 99 %97 %98 %

8. Circulatory Status
The patient’s cardiac rate ranges from 85- 88 bpm (normal range: 60-100bpm), her capillary ranges from 1-2 seconds - 2-3 seconds (normal range: 1-2 seconds) and
blood pressure ranges from 120/80- 140/100 (normal range: 120/80-140/90).

Date Time CR Capillary Blood

Pressure
February 17, 2020 8am10am2pm 88bpm87 bpm 1-2 seconds 120/90130/901
20/80

February 18, 2020 8am10am2pm 87 bpm87 2-3 seconds 140/100130/90

bpm90 bpm 130/80

February 19, 2020 8am10am2pm 86 bpm85 120/90140/90

bpm88 bpm 130/80
1-2 seconds
• 9. Nutritional Status
• Prior to hospitalization, patient X is having enough nutrients in her body. The patient appetite is good. There is no change in
the appetite during the hospitalization

• 10. Elimination Status

• The patient verbalized having heavy bleeding that doesn't stop, and soaking more than 2 sanitary pads per hour, two hours or
more in a row

• 11. Sleep, Rest and Comfort Status

• She lacks in sleep and only gets about six to seven hours of sleep at night. Upon arrival at home, she cooks and attends to
her other two children.

• 12. Fluids and Electrolytes Status

• Prior to admission the patient’s fluid intake ranges approximately 1000-1200 including coffee and water intake. During
hospitalization, the patient usually drinks 500mL of water every day and she avoided coffee for the mean time as advised by
the healthcare team.

• 13. Integumentary Status

• Patient X has pinkish in color and with good skin turgor. There are no wounds notes or reported by the patient prior
spontaneous abortion
XII. Diagnostics

Date
DiagnosticProcedu Description of the Significance/Purpose of
ofProcedur Findings & Implications
re Procedure the Procedure
e
Ultrasound Ultrasound imaging is An ultrasound scan uses February Pelvic sonogram: normal sized, retroverted
also called ultrasound high-frequency sound 16, 2020 uterus, measuring 6.22 x 5.04 x 2.54cm.
scanning or waves to make an image Midline with smooth boarders and
sonography. It uses a of a person's internal homogenous parenchymal echopattern. No
small probe called a body structures. Doctors focal cystic or solid lesions noted.The
transducer and gel commonly use ultrasound endometrium is thick with vesicular cystic
placed directly on the to study a developing lucencies measuring 2.56cm. There is an
skin. High-frequency fetus (unborn baby), a irregular GS like structure seen within the
sound waves travel person's abdominal and endometrium measuring
from the probe through pelvic organs, muscles 1.4cm.IMPRESSION:Above imaging
the gel into the body. and tendons, or their findings is suggestive of a spontaneous
The probe collects the heart and blood vessels. abortion
sounds that bounce
back.
Diagnostic procedure and Description of procedure
date done
Complete Blood CountJan A CBC may be ordered when a person
3, 2015 has any number of and that may be
related to disorders that affect blood
cells. When an individual has an , ,
bruising, or bleeding, a doctor may
order a CBC to help diagnose the
cause and/or determine its severity.
Significance/ Purpose of the
procedure
To determine general health status,
screen, diagnose, or monitor any one of
a variety of diseases and conditions that
affect blood cells, such as , , , or
cancer.
Significant findings Nursing Implications
WBCNormal Range: 5-10 x High white blood cell may also
10^g/l Result: 13.36 indicate inflammation, tissue
damage, trauma, allergy, chronic
leukaemia, chronic bone marrow
disease, intense exercise,
diverticular disease, and severe
emotional/physical stress.
NeutrophilsNormal Range: Indicates neutrophilia
50%-70%Result: 72%
LymphocytesNormal Range: Within normal range
20%-40%Result: 22%
MonocytesNormal Range: Within normal range
0%-10%Results: 4
EosinophilsNormal Range: Within the normal range.
0%-7%Result: 2
BasophilsNormal Range: Within the normal range.
0%-1%Result: 0 (Normal)
Platelets CountNormal Within the normal range.
Range: 150-400 x
10^g/lResult: 360
UrinalysisFebruary 16, A urinalysis test is performed by collecting
2020 a urine sample from the patient in a
specimen cup. Usually only small amounts
(30-60 mL) may be required for urinalysis
testing. The sample can be either analyzed
in the medical clinic or sent to a laboratory
to perform the tests.
A urinalysis is used to detect (Visual)Color: Findings: Normal
and manage a wide range of YellowAppearance: Clear
disorders, such as urinary tract
infections, kidney disease and
diabetes. A urinalysis involves
checking the appearance,
concentration and content of
urine. Abnormal urinalysis
results may point to a disease
or illness.
 (Dipstick Test)Specific Findings: Normal
Gravity: 7.010 pH: 6.0

Leukocyte Esterase: indicates that a patient does not

Negative have a urinary tract infection.

Nitrites: Negative indicates that a patient does not

have a urinary tract infection.

Protein: Negative A negative test result means

that there is no detectable
amount of protein in the urine at
the time of testing. Protein
detected in a random urine
sample may be temporary due to
an infection, medication,
vigorous exercise, pregnancy,
Glucose: Negative result of a normal blood glucose
level
Ketones: Negative This means no ketones were
found in your blood. If high blood
ketone levels are found, it may
mean you have diabetic
ketoacidosis
Urobilinogen: Normal Findings: Normal

Bilirubin: Negative No indications of liver disease

Elythrocyte: Negative No indications of kidney disease

Microscopic Exam Findings: Normal
Pus Cells: 1-2 / hpf

RBC: none / hpf Findings: Normal

Yeast Cells: none / Findings: Normal

hpf

Bacteria: none / hpf Findings: Normal

Epithelial Cells: Findings: Normal
Few / hpf
Mucus Threads: Findings: Normal
Occasional / hpf
Amorphous Findings: Normal
Materials: none /
hpf
CrystalUric Acid: Findings: Normal
none / hpf
Calcium Oxalate: Findings: Normal
none / hpf
Triple Phosphate: Findings: Normal
none / hpf
CastFine Granular: Findings: Normal
none
Coarse Granular: Findings: Normal
none
Hyaline: none Findings: Normal

Waxy: none Findings: Normal

 XIV. Treatment/Management
DRUG NAME MECHANISM OF INDICATION /
ACTION CONTRAINDICATION
Cephalexin 500mg IV q80 Cephalexin is a For the treatment of upper
bactericidal agent that respiratory tract infections,
acts by the inhibition of including tonsillitis and/or
pharyngitis secondary to
bacterial cell-wall
synthesis. Streptococcus pyogenes
Cephalexin is
contraindicated for use in
patients with
cephalosporin
hypersensitivity.
Cephalosporins cause
hypersensitivity reactions
in <= 5% of patients
receiving them. A variety
of hypersensitivity
reactions ranging from
mild rash to fatal
anaphylaxis may occur.
ADVERSE EFFECT NURSING
RESPONSIBILITIES
interstitial nephritis Watch for seizures; notify physician
seizures hemolytic immediately if patient develops or
anemia anaphylactoid increases seizure activity. Monitor
signs of pseudomembranous colitis,
reactions erythema including diarrhea, abdominal pain,
multiforme vomiting fever, pus or mucus in stools, and
diarrheanausearash other severe or prolonged GI
urticaria problems (nausea, vomiting,
heartburn). Notify physician or
nursing staff immediately of these
signs. Monitor signs of eosinophilia
(fatigue, weakness, myalgia),
neutropenia (fever, sore throat, signs
of infection), thrombocytopenia
(bruising, nose bleeds, bleeding
gums), or hemolytic anemia
(malaise, dizziness, jaundice,
abdominal pain). Report these signs
to the physician.
Mefenamic Acid Mefenamic acid is used for the short- stomach Discontinue drug promptly
500mg PO PRN works by reducing term treatment of mild pain.nausea.vomiting. if diarrhea, dark stools,
hormones that cause to moderate pain from heartburn.constipation hematemesis,
inflammation and pain various conditions. It is .diarrhea.rash.dizzines ecchymoses, epistaxis, or
in the body. also used to decrease s. rash occur and do not use
pain and blood loss again. ...Notify physician if
from menstrual persistent GI discomfort,
periods. Mefenamic sore throat, fever, or
acid is contraindicated malaise occur.Do not
in patients with drive or engage in
salicylate potentially hazardous
hypersensitivity or activities until response to
NSAID drug is known.
hypersensitivity who
have experienced
asthma, urticaria, or
other allergic reactions
after taking aspirin or
other NSAIDs. Severe,
rarely fatal,
anaphylactoid
reactions to
mefenamic acid have
been reported in such
patients.
Paracetamol 500mg IV PRN Temp Paracetamol has a central Paracetamol has good
> 380C analgesic effect that is analgesic and antipyretic
mediated through activation properties. It is suitable for
of descending serotonergic the treatment of pains of all
pathways. Debate exists kinds (headaches, dental
about its primary site of pain, postoperative pain,
action, which may be pain in connection with
inhibition of prostaglandin colds, post-traumatic
(PG) synthesis or through muscle pain). severe renal
an active metabolite impairment. a condition
influencing cannabinoid where the body is unable to
receptors. maintain adequate blood
flow called shock.
acetaminophen overdose.
acute inflammation of the
liver due to hepatitis C virus.
Paracetamol only rarely Check that the patient is not
causes gastrointestinal taking any other medication
problems or allergic skin containing paracetamol.- For
reactions. Blood dyscrasia children who may refuse
(e.g. thrombocytopenia), medicine off a spoon try using
methaemoglobinemia, and
a medicine syringe to squirt
hemolytic anemia are very
rare. A minority of the
liquid slowly into the side of
subjects with so-called the child’s mouth or use
aspirin intolerance soluble paracetamol mixed
responds to paracetamol with a drink.- Some children
with bronchospasms. may be happy to take one
paracetamol product but
dislike the taste of another.-
There are no known harmful
effects when used during
pregnancy.- Small amounts
may pass into breast milk.
However, there are no known
harmful effects when used by
breastfeeding mothers.