P. 1
Incomplete Abortion

Incomplete Abortion

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Published by AJ Dalawampu

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Published by: AJ Dalawampu on Dec 16, 2011
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Chapter I

INTRODUCTION Endometrial Polyp is a condition by which a mass is formed in the lining of the uterine endometrium simultaneous to the growth of uterine lining influenced by the hormone estrogen. It is considered a complication in pregnancy because it may cause a severe harm due to bleeding to the mother and to her fetus and can even initiate miscarriage. A. RATIONALE Our group decided to choose the case, endometrial polyps as a complication during pregnancy because we know that there is just a rare number of its occurrences in our country even in Oriental Mindoro Provincial Hospital which is our training ground. We also wanted to be familiarized and oriented with the rare diseases/complications that will cause a terrifying and complicated effects to mother especially to her fetus. Our goal is also to enhance our knowledge, skills and attitude toward the management of this said complication. B. LEARNING OBJECTIVES 1. Cognitive To have further learning and comprehension about endometrial polyp. To define its meaning. To identify the risk factors that have been linked to this health problem, the signs and symptoms, and its clinical manifestations To learn the treatment and other related management regarding the case.

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2. Psychomotor To become practiced in handling the said condition. To use our skills in performing the nursing process To develop skills in caring endometrial polyp patient. To practiced the application of nursing care plan. 3. Behavioral To develop understanding and appreciation with the client’s condition. To provide rapport and interact client utilizing therapeutic communication.

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Chapter II


GENERAL DATA Name: Unit assignment: Age: Birthdate: Birth place: Gender: Religion: Address: Civil status: Occupation: Educational Background: Date of Admission: Time of Admission: Admitting Physician: Admitting Diagnosis: J.L.T. Labor room 41yrs old April 3, 1970 Victoria, Oriental Mindoro Female Born Again Christian Victoria, Oriental Mindoro Married Teacher Tertiary August 12, 2011 10:59am Dra. Tabudlo Abortion, incomplete 11 weeks AOG induced NS1 G3P2(2001) Previous CS1 2° Transverse

B. CHIEF COMPLAINT Vaginal Bleeding + passage of abortion 7 days ago. C.HISTORY OF PRESENT ILLNESS A 43 year old mother was admitted in Oriental Mindoro Hospital on August 16,2010 at 4:00 am ambulatory, accompanied by her relatives with chief complaint of vaginal bleeding 5 days prior to admission. “Nurse I have sudden hypogastric pain that start intermittently in 3 hours sharp character profuse causing 4 pads/days aggravated with activity relieve by rest and putting tampons to stop or minimize the bleeding “ as verbalized by the client. D. PAST MEDICAL HISTORY

Client states that she has chicken fox and mumps during her childhood years. Two years ago, she was hospitalized during her previous pregnancy, in her 7th month. She attending pre-natal check up in Oriental Mindoro Provincial Hospital , done diagnostic examinations especially complete blood count reveals that the patient suffering from anemia. The Doctor’s order was blood transfusion. She was confined for 24 hours for observation. She doesn’t take any medication during her sicknesses.


husband and other siblings do not have any disease. FAMILIAL HISTORY The father and eldest brother of the client have both a history of asthma and patient and her fifth sibling have urinary tract infection.C. ASTHMA 60 y/o 59y/o ASTHMA ENDOMETRIAL POLYPS LEGEND: Male Female 3 .. but her mother.

equal movement. pinkish conjunctiva. silky. symmetric nasolabial folds. PERRLA Color same as facial skin. no discharge. resilient hair. skin intact.5 C NORMAL FINDINGS SIGNIFICANT FINDINGS INTERPRETATION INTEGUMENTARY SYSTEM HAIR Evenly distributed. no orbital edema.A. pinna recoils after folded. auricle aligned with outer canthus of eye. able to hear on both ears clearly. no infection No deviation SKULL AND FACE Rounded. symmetric facial movements Expressionless face Frequently yawning Due to sleepiness EYES AND VISION Eyebrows’ skin contact. symmetrical. Ptosis of eyelid Due to sleepiness EARS AND HEARING No deviation 4 . white sclera. absence of nodules or masses. hair evenly distributed. minimal amount of dry cerumen. eyebrows symmetrically aligned. 2010 BP:90/70mmHg PR: 108 bpm RR: 19 cpm TEMP:37. PHYSICAL ASSESSMENT VITAL SIGNS: August 16. normocephalic.

coordinated movement without discomforts.NOSE AND SINUSES Symmetric and straight nose. no contractures. presence of carotid pulse. No deviation MOUTH AND Without dentures OROPHARYNX Tongue freely moves. nose bridge intact. air moves freely as the client breathes through the nares. AND presence of brachial and radial pulse Flaccidity or weakness Due to excessive blood loss 5 . maxillary and frontal sinus not tender. good skin turgor. smooth nails Generalized pallor Due to blood loss Pallor nail beds 4 seconds capillary refill Indication of poor circulatory impairment due to excessive blood loss. trachea in midline No deviation UPPER EXTREMITIES SKIN AND NAILS Brown complexion. gag reflex present Lips pallor and dry Due to blood loss NECK Head centered. MUSCLE STRENGHT Muscles equal size on both sides. no lesions. no edema. no palpable lymph nodes. no lesions. no discharge.

spinal column straight. symmetric movements caused by respiration. no masses No deviation LUNGS Effortless respirations No rales No deviation BREAST AND AXILLAE Symmetric . flat. soft abdomen. similar in color. nipple round. skin intact. the body compensates resulting to increase contraction of the heart to supply the whole body. rounded. No deviation 6 . no lesions. skin uniform in color. masses or nodules. equal in size.CHEST AND BACK SPINAL COLUMN Chest symmetric. no discharge. no tenderness. relaxed. no masses. ABDOMEN SKIN Brown complexion. axilla no tenderness. With palpitations No deviation HEART Because of excessive bleeding.

no lesions. no masses. no lesions. No deviation No deviation 7 . presence of pubic hair. PULSE Presence of popliteal and pedal pulse. darkercomplexion of vulva. IE: (+) bleeding (240 mL per day) Due to irritation of polyp ANUS AND RECTUM Brown color No deviation LOWER EXTREMITIES SKIN AND TOENAILS Brown complexion. No deviation MUSCLE Equal in size and length. with cuticle. symmetrical.GENITALS Pubic skin intact.

PATTERNS OF FUNCTIONING Functional Health Patterns Prior to Hospitalization During Hospitalization Day 1 Day 2 Day 3 Analysis& Interpretation *Health PerceptionHealth Management Pattern *The client does not rely on doctors when her feelings of sickness are not too serious. *The client relies on the care given by the health care personnel or doctor . NO CARDIOVASCULAR SYSTEM CHEST PAIN. ORIENTED WITH TIME AND PLACE. DEFECATES AND URINATES GASTROINTESTINAL/DIGESTIVE/METABOLIC GENITOREPRODUCTIVE SYSTEM MUSCULOSKELETAL SYSTEM NEUROLOGIC SYSTEM REGULARLY NO PAIN IN THE GENITAL AREA THE PATIENT HAS NO FEELING OF MUSCLE WEAKNESS. the client really seek on doctors and relied her health unto them. *Prior to hospitalization. REVIEW OF SYSTEMS LEVEL INTEGUMENTARY SYSTEM RESPIRATORY SYSTEM FINDINGS THE CLIENT VERBALIZED OF FEELING COLD NO DIFFICULTY IN BREATHING NO FEELING OF PALPITATIONS. NO HEART BURN.B. ANXIETY C. *The client trust doctors and nurses regarding her health care. *The client still seeks the medical assistance of the doctors. LOSS OF APPETITE. 8 . the client do not manage her health seriously and does not seek doctor`s assistance but when hospitalized.

because of the regular work of the body and so promoting peristalsis. cooking. *The client was moderately anxious. *The client defecate once. *Elimination *The client defecate and void every day. *Sleep Rest Pattern *The client has a regular sleep at 9pm to 4 am and at noon. 9 . *When the client was at home. *Cognitive Perceptual Pattern *The client responds clearly. *The client was ready to do work but she`s still at the hospital. *The client has a regular sleep pattern at home but disturbed when hospitalized. *The client feels better. * The client feels a lot better. *The client has a lot of work when at home but all of them disappears when she was hospitalized. and vegetable farming and “copra`s”. *The client can freely eat what she wants. *The client can`t sleep good *The client can`t sleep good *The client had adjusted to her environment but still can`t sleep good. *When the client was at home. *The client can`t eat because she was under NPO. *The client did not defecate this day. she can eat what she wants w/out limitations unlike when hospitalized. *The client defecates regularly. *ActivityExercise Pattern *The client was doing her regular work like washing of clothes. *The client has no problem at home but a little bit anxious when brought at the hospital but then easily adapted.*Nutritional – Metabolic Pattern *The client eats a lot. *The client can`t still do her work because she`s far at home. *The client can`t do her work. *The client was in the Gyne-Ward so she can eat what she wants. as long as she wanted and her favorite dish was vegetables. she defecates and voids regularly.

*The client was excited to go home to do her responsibilities Her husband has been always comforting her so she feels a good. *The client feels better. the client was confident that she can overcome this problem because her husband has been with her. *The client says that they can`t make sexual relationship because she was confined. *The client was relaxed. ``Basta gumaleng”. *The client feels a lot better. They enjoyed being with each other. *The client was doing her very best to be a good mother and a provider to her children but since her husband was with her. *Now.*Self PerceptionSelf Concept *The client was not sensitive of others situation when they are sick. * The client was not aware of having an illness until she became on that position. she was not alone because her husband has been with her so she feels okay. *The client wanted to go home and do her responsibilities as a good provider with her husband and she was thinking of her children *The client can`t make love but her husband has been so supportive and sweet to her. *Role Relationship Pattern *The client has no ability to do her obligations as a mother because she was sick and confined. 10 . *The client could always cope with her problems by the support of her husband. *Sexuality Reproductive *The client says that their relationship was good and they enjoyed sexual relationship. *The client was a mother and with her husband strived hard for their children. *The client still can`t make love. they can`t do their responsibilities. *Coping-Stress Tolerance Pattern *Whenever the client has problem and stressed. *The client was confident that she will recover immediately. *The client feels that she can do her obligations but she was confined. *The client and her husband has been so sweet and supportive with each other.

Kapag walang nangyari sa ginawa ng albularyo tsaka lang kami pumupunta sa center.” as verbalized by the patient. ANALYSIS Hospitalization affects the daily activities of the patient. DURING HOSPITALIZATION “Nakakapanibago pala kapag nasa ospital. using “tawas” or “tapal”. *The client trust on GOD and verbalizes that she prays. D. It gives a big change in her living. There was also a sleep pattern disturbance. patayu-tayo. If the “albularyo” didn’t treat their disease. She cannot perform her usual activities. Hindi ko na nagagawa mga ginagawa ko dati. She can`t afford to go every Sunday to Church because they are too far from the Church. Gabi lang at pagkakain pahinga ko. nagluluto. minsan pag may mga bali nagpapahilot kami sa mga hilot. 11 . ACTIVITIES OF DAILY LIVING PRIOR TO HOSPITALIZATION “Maaga akong nagigising kasi ako lahat gumagawa ng gawaing-bahay. naglalaba. Mahal kasi pag ospital agad tsaka baka nanununo lang o kaya nadawdaw.*Value Belief Pattern *The client believes on GOD.” as verbalized by the patient. Nakakainip! Lagi na lang nakahiga. Hindi rin ako makatulog kasi maiingay sila minsan. Nagpapatapal muna kami o kaya nagpapatawas. ILLNESS AND HOSPITALIZATION “Kapag nagkakasakit ako o kaya yung mga anak ko at asawa ko sa albularyo muna ako pumupunta. *The client told that GOD is merciful and when she got home. E. Parang ngang napakabagal ng oras. naglilinis tapos naggagamas pa. She also felt boredom because of the long stay in the hospital. Minsan lang ako nakakalabas dito. They believe that their illnesses can be cured by the quack doctors. *The client believes that GOD is the most powerful of all. she will visit the church. *The client seldom go to church because they are too far from the Church but she says that she knows GOD and trust in Him. Buong araw nga may ginagawa ako. PATIENT’S CONCEPT OF HEALTH. Our patient still believes that the cause of the illness of their family is some extraordinary creatures or superstitious actions. paupo-upo. this is the time that they will go to the hospital and seek the doctor’s help. They used to utilize the things that a quack doctor uses when treating them like taking in herbal plants. Kapag walang gamot sa center tsaka pa sa ospital.”as verbalized by the patient. They always tend to go first to quack doctors instead of going straight to hospitals or rural health centers because according to them they can’t afford doing so.

36-0.7 0. it is a sign that you have not been drinking enough liquids Sugar Negative Negative Crystals amorphous Negative Few PREGNANCY TEST: Positive August 16.60 0.0x10L 0.010 6.35 11. LABORATORY AND DIAGNOSTIC EXAM August 16.01-0.20 0.48 Significant finding 95 0.40 0.66 to consider hyperplasia August 17.03 Significant Findings 120 0.8 x 4. 2010 Ultrasound Result Normal anteverted with 7. 2010 Complete Blood Count Diagnostic Exam Normal Value Hemoglobin 120-160 g/l Hematocrit Leukocyte Ct.9 x 4. 2010 Diagnostic exam Hemoglobin Hematocrit Normal Possible to renal failure Normal The patient has vaginal bleeding Urinary Tract Infection Possible to glomerular damage Normal Deviation Normal Value 120-160g/l 0.5 10-15 6-8 Trace Analysis Excess sweating could result in the urine becoming a deeper yellow. type B on August 17 2010.20-0.010-1. Anemia The patient was given packed blood. Renal (kidney) failure Possible to infection Normal Normal Normal Values Pale yellow to amber clear 1.5-8.F.0-11.01 Analysis Normal Slightly decrease.28 Analysis Decreased. Also.36-0. Possible to anemia.4 cm with thick endometrium 1. Anemia Decreased.025 4.79 0. Neutrophils Lymphocytes Eosinophils Blood type = B+ HBsAG – non-reactive August 16.0 Negative or rare Negative or rare Negative Findings Yellow Clear 1.40-0. 2010 Urinalysis Examination Color Character Specific gravity pH RBC WBC Albumin 0.48 4. 3 am 12 .

In providing maternity gynecologic health care to women. CLINICAL DISCUSSION OF THE DISEASE A. The female reproductive system consists of internal organs and external organs. Instead. ANATOMY AND PHYSIOLOGY GENERAL The organs of the reproductive systems are concerned with the general process of reproduction. shape. and color. The external organs are located from the lower margin of the pubis to the perineum. 13 . The appearance of the external genitals varies greatly from woman to woman. Corpus Luteum. their functions are vital to the continuation of the human species. and each is adapted for specialized tasks. See figure 1-1 for the female reproductive organs. you will find that it is vital to your career as a 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. and the number of children a woman has borne determines the size. since age. TERMS AND DEFINITIONS 1. race. These organs are unique in that their functions are not necessary for the survival of each individual.III. The internal organs are located in the pelvic cavity and are supported by the pelvic floor. The yellow mass found in the graafian follicle after the ovum has been expelled. heredity.

14 . The isthmus is the slightly constricted portion that joins the corpus to the cervix. 3. A chemical substance produced in an organ. which. 9. It stimulates development of the graafian follicle. It is suspended in the pelvis by broad ligaments. Fimbriae. 6. These smooth muscle fibers are arranged. fundus. The cervix is the narrow. (2)Divisions of the uterus. The process by which an offspring is formed. The pure hormone contained in the corpora lutea whose function is to prepare the endometrium for the reception and development of the fertilized ovum. Ovum. 12. fully developed ovarian cyst containing the ripe ovum. Reproduction. 2. a functional activity. The follicle stimulating hormone (FSH) is a hormone produced by the anterior pituitary during the first half of the menstrual cycle. the endometrial lining sloughs off about every 28 days in response to changes in levels of hormones in the blood. 8. being carried to an associated organ by the bloodstream excites in the latter organ. fallopian tubes. rounded region above the entrance of the fallopian tubes. a. The major portion of the uterus is called the body or corpus. A pouch like depression or cavity. The generic term for the female sex hormones. When the female is not pregnant. Follicle Stimulating Hormone. Graafian Follicle. The production of milk by the mammary glands. Uterus. Lactation. and the isthmus. 11. INTERNAL FEMALE ORGANS The internal organs of the female consist of the uterus. This process is called menses. The female reproductive cell. A fertilized egg burrows into the endometrium (implantation) and resides there for the rest of its development. The uterus is a hollow organ about the size and shape of a pear. the perimetrium. 5. A mature. The walls are thick and are composed of three layers: 1. Luteinizing Hormone. The uterus consists of the body or corpus. inferior outlet that protrudes into the vagina. 7. Estrogen. 3. It is a steroid hormone produced primarily by the ovaries but also by the adrenal cortex. the myometrium. Fringes. especially the finger-like ends of the fallopian tube. the endometrium. 10. vagina. (1)Location: Between the urinary bladder and the rectum. It serves two important functions: 1. Hormone. and the ovaries. The fundus is the superior. The endometrium is the inner layer or mucosa. (3)Walls of the uterus. The myometrium is the smooth muscle component of the wall.2. 4. Progesterone. Follicle. A hormone produced by the anterior pituitary that stimulates ovulation and the development of the corpus luteum. retains and nourishes it until it expels the fetus during labor. it is the organ of menstruation and during pregnancy it receives the fertilized ovum 2. cervix.

The ovaries are for oogenesis-the production of eggs (female sex cells) and for hormone production (estrogen and progesterone). and are interlaced with connective tissues.In longitudinal. vagina. The fallopian tubes transport ovum from the ovaries to the uterus. fimbriae create fluid currents that act to carry the oocyte into the fallopian tube. When the egg is matured. Ovaries (1) Functions. They are enclosed and held in place by the broad ligament. There is no contact of fallopian tubes with the ovaries. The follicles are tiny sac-like structures that consist of an immature egg surrounded by one or more layers of follicle cells. Vagina. and external genitals. There are compact like tissues on the ovaries. (3) Description. The distal end of each fallopian tube is expanded and has finger-like projections called fimbriae. follicle enlarges and develops a fluid filled central region. which are called ovarian follicles. (2) Location and gross anatomy. (a) Estrogen is produced by the follicle cells. These secondary sex characteristics include the enlargement of fallopian tubes. one on each side. serous membrane that coats the entire uterine corpus except the lower one fourth and anterior surface where the bladder is attached. widening of the pelvis. uterus. which propel the oocyte forward. (b) Progesterone is produced by the corpus luteum in presence of in the blood. and is ready to be ejected from the ovary. and onset of menses or menstrual cycle. During the monthly female cycles and during pregnancy. and spiral patterns. The most desirable place for fertilization is the fallopian tube. Progesterone is important during pregnancy and in preparing the breasts for milk production. Oocyte is carried toward the uterus by combination of tube peristalsis and cilia. The vagina is the thin in walled muscular tube about 6 inches long leading from the uterus to the external genitalia. these layers undergo extensive changes. b. It is located between the bladder and the rectum. 15 . When an oocyte is expelled from the ovary. Each tube is about 4 inches long and extends medially from each ovary to empty into the superior region of the uterus. (3) Process of hormone production by the ovaries. (1) Location. Fallopian Tubes (Two). which partially surround each ovary. The vagina provides the passageway for childbirth and menstrual flow. (2) Function. c. (2) Function. increased deposits of fat in hips and breasts. it is called a graafian follicle. circular. As the developing egg begins to ripen or mature. (1) Location. They lie against the lateral walls of the pelvis. The ovaries are about the size and shape of almonds. breast development. The perimetrium is a strong. which are responsible secondary sex characteristics and for the maintenance of these traits. It works with estrogen to produce a normal menstrual cycle. it receives the penis and semen during sexual intercourse. d.

clammy skin Rubbing off of tissues Exposure of capillaries Anemia Excessive vaginal bleeding or spotting 16 . PATHOPHYSIOLOGY Predisposing factors *age 40-50 *premenopausal Precipitating factors * estrogen ENDOMETRIUM Growth of uterine lining after menstruation Interference to egg and sperm POLYPS AREAS Difficult pregnancy Remained and attached to small stalks Increase chance of miscarriage S/SX *pale lips *generalized pallor *cold.B.

They are usually about the size of a pencil eraser. to look around inside the uterus. If the polyp interferes with the egg and sperm. kind of similar to a bush or a tree. exposing tiny blood vessels These blood vessels bleed. leading to spotting or vaginal bleeding. polyps can grow to the size of an orange! Since most polyps are small. polyps only rarely turn cancerous. Hysteroscopy using small tubes can be performed in the office. Imagine a polyp dangling by a little stalk. If a woman goes to her doctor complaining of spotting between periods or after intercourse. although they can be even smaller. they usually include excessive bleeding during a menstrual period. 17 . After a period. Diagnosing endometrial polyps involves looking inside the uterine cavity. but only slightly. This is a small.Endometrial Polyps The uterus is mostly composed of muscle. However. As they grow. when symptoms do occur. because the pressure inside the uterus flattens the polyps. while the larger part of the polyp is like the branches (see photo below). this may miss the polyp completely. or very heavy bleeding during a menstrual period. Most gynecologists will remove polyps. Finally. If a woman does not become pregnant. However. if they are found in women with a history of miscarriage. causing a menstrual period. It is also possible that they may lead to a slightly higher chance of miscarriage. Polyps are areas that grow a little too much. Unfortunately. The next question is often “how do you remove the polyp?” The old-fashioned way was to perform a D & C (dilatation and curettage). or bleeding in between periods. lighted tube that goes into the vagina then the uterus. this lining sheds. The stalk is like the trunk of a tree. making them very hard to see. Some women report a few days of brown blood after a normal menstrual period. her doctor will usually think of polyps as one of the many possible causes. A regular ultrasound (also called a sonogram) usually does not diagnose polyps. since this procedure is done solely by feel. The risk does increase. As the scraping instrument goes by. but larger tubes (used to remove large polyps or fibroids) usually require anesthesia in the hospital. the inside lining of the uterus is made of “fluffy” endometrial tissue that grows and shrinks during the menstrual cycle. it will likely just push the polyp out of the way without grabbing it. which causes the tissue to rub off. they probably do not often cause symptoms. gynecologists are becoming more skilled at using the hysteroscope to look inside the uterus. it may make it hard to get pregnant. but this is also unknown. This involves a gentle scraping of the uterine lining. Polyps cause these symptoms because they dangle from their stalksand irritate the surrounding tissue. they usually fan out but remain attached to a small stalk. Rarely. the lining grows rapidly under the influence of hormones like estrogen. If a polyp is diagnosed one of the first questions is “could this be cancer?” Fortunately. Nobody knows how common this is. or even spotting after intercourse. as discussed below. as a patient passes age 50.

18 . patient or any carefully for penicillin signs and * symptoms of Phenylketon hypersensitivit uria (some y reaction. fever. skin & soft tissue. *Coamoxiclav GUT. *Instruct patient to immediately report signs or symptoms of hypersensitivit y reaction. . Addition of clavulanate (a betalactam) increases drug's resistance to betalactamase (an enzyme produced by bacteria that may inactivate amoxicillin). products) * Monitor for *History of seizures when cholestatic giving high jaundice or doses. confusion. DRUG STUDY Generic Brand Action Classification Indication Contraindica tion Side Effects/ Adverse Effects Nursing Responsibilities Augmentin Amoxicil lin Clavulan ate acid Amoxicillin prevents cross-linking of bacterial cell wall and leading to cell death. *Hypersensit anxiety. is used to bone & joint treat infections infections caused by bacteria. a penicillintype antibiotic Upper & lower resp tract.C. *Monitor ivity to drug dizziness. hepatic •Check dysfunction patient's associated temperature with this and watch for other signs drug and symptoms of superinfection . such as rash. or chills. fatigue.

vitamin D3.Generic Brand Action Classification Indication Contraindication Side Effects/ Adverse Effects -upset stomach. or Nursing Responsibilities *watch for symptoms of overdosage *assess for proper dosage Multivitamins Vitamins are the building blocks of the body. magnesium oxide. Calcium may make it harder for your body to absorb certain ingredients of the multivitamin. pyridoxine hydrochloride . vitamin D. boron. magnesium sulfate. * Do not take this medication with milk. zinc Avoid taking more than one multivitamin product at the same time unless your doctor tells you to. vitamin K1. other dairy products. antioxidant *multivitami vitamins with n deficiencies minerals. folic acid. multiple vitamins with minerals. -headache. copper. certain illnesses or during pregnancy . calcium carbonate. multiple vitamins. magnesium. vitamin B complex with C and zinc. essential fatty acids. calcium. vitamin C. 19 . Taking similar vitamin products together can result in a vitamin overdose or serious side effects -unusual or unpleasant taste in your mouth. They are used to prevent or treat a vitamin deficiency due to poor nutrition. manganese.or antacids that contain calcium. vitamin E (as tocopherol acetate). calcium supplements.

Folic acid is a B-complex vitamin needed to form healthy cells. kidney dialysis. During pregnancy folic acid deficiency is particularly acute.Generic Brand Action Classification Indication Contraindication Side Effects/ Adverse Effects Nursing Responsibilities Folic Acid Folic acid is used to treat or prevent certain anemias caused by poor diet. Several drugs cause folic acid deficiency. some malabsorption symptoms can lead to manifestations of megaloblastic anemias. so that regular folic acid supplements are recommended. possibly also other antiepileptic agents. alcoholism. certain stomach/intestinal problems. or other conditions.. myelomeningocele. particularly phenytoin. liver disease. anencephaly) Women whohave given birth to a child with one of the above-mentioned anomalies should constantly take relatively high doses of folic acid in view of future pregnancies Hypersens dizziness. itivity to the drug or compone nts *assess for rash or itching *assess trouble breathing for *assess for the proper dosage 20 . B-complex vitamin Folic acid deficiency can have many causes. and methotrexate. Inadequate diet. It has now been safely established that this precaution significantly reduces the incidence of neural tube defects (cleft spine. pregnancy. This medication helps to relieve symptoms such as unusual tiredness and diarrhea that can occur with these types of anemias.In general it is desirable that women who wish to have children start taking a daily dose of at least 400 µg of folic acid even before pregnancy. especially red blood cells. Women of childbearing age should maintain adequate amounts of folic acid either through diet or supplements to prevent infant spinal cord birth defects.

IV. PROBLEM LISTS Date of onset Aug. 17. 17. 16.2010 Aug. 2010 Aug.17. 18. 2010 misinterpretation (inaccurate/incomplete information presented) 21 . 2010 Deficient knowledge related to information Aug. 2010 Date resolve Aug.2010 Aug. 16.2010 Date inactive Aug. 16. NURSING PROCESS A.2010 Aug 17.2010 Nursing problem Ineffective tissue perfusion related to blood loss Self-care deficit related to weakness and environmental barriers Disturbed sleep pattern related to environmental factors Date identified Aug. 18.

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