Com App Leprosy Abortion E. Pregnancy 1

Central Philippines University
College of Nursing
Hansen’s Disease
(Leprosy)
Group 2:
Agraviador, Noel Jr.

Bulauitan, Mia Maricar
Calderon, Krystyn Andrei
Cordero, Ciaren
De Los Reyes, Hannah
Ebron, Gergelae
Table of Contents
Case Scenario…………………………………………………………………………….
Objectives………………………………………………………………………………....
Mini-Lecture of Disease…………………………………………….............................
Pathophysiology………………………………………………………………………….
Levels Of Care…………………………………………………………………………….
Clustering of the Eleven Key Areas of Responsibility…………………………….
Implications/Insights/Lesson Learned……………………………………………….
Bibliography……………………………………………………………………………....
Post Test Questions……………………………………………………………………....
Summary of Topic Assignments
❖ Case Scenario………………………………………………………... Bulauitan, Mia Maricar
❖ Objectives……………………………………………………………... Ebron, Gergelae
❖ Mini-Lecture of Disease…………………………………………….... Agraviador, Noel Jr.
❖ Pathophysiology………………………………………………………. Cordero, Ciaren
❖ Levels Of Care………………………………………………………… Bulauitan, Mia Maricar
❖ Clustering of the Eleven Key Areas of Responsibility
Patient Core Competency
- Nursing Care Plan…………………………………………….. All Members
- Communication………………………………………………... Calderon, Krystyn Andrei
- Health Education………………………………………………. De Los Reyes, Hannah
- Collaboration and Teamwork…………………………………. Agraviador, Noel Jr.
Enabling Competency
- Enabling Competencies……………………………………….. Bulauitan, Mia Maricar
- Records Management…………………………………………. Ebron, Gergelae
Enriching Competency
- Research Proposal……………………………………………... Bulauitan, Mia &
- Quality Improvement………………………………………….... Cordero, Ciaren
Empowering Competency
- Ethico-Moral Responsibilities………………………………….. Calderon, Krystyn Andrei
- Moral Responsibilities (RA 9173)........................................... Cordero, Ciaren
- Personal and Professional Development…………………….. De Los Reyes, Hannah
❖ Implications/Insights/Lesson Learned
Nursing Education………………………………………………………... Ebron, Gergelae
Nursing Practice………………………………………………………….. Agraviador, Noel Jr.
Nursing Research………………………………………………………… Cordero, Ciaren
Nursing Administration…………………………………………………… Calderon, Krystyn Andrei
❖ Bibliography……………………………………………………………….. All Members
❖ Post Test Questions………………………………………………………. De Los Reyes, Hannah

I. Case Scenario
A 39 year old gentleman initially presented to a community health centre in
Malawi’s Lilongwe district with widespread skin lesions on the face, torso and the triceps
aspect of the right arm. He was referred to the neighbouring district hospital with
‘allergies’. The lesions were long-standing and had evolved relatively slowly. He was
otherwise well although concerned about patches of anaesthetic skin on his face and on
the soles of his feet. He denied any past medical history although his blood pressure
was incidentally raised at 150/93 mmHg. He smoked occasionally and drank moderate
amounts of alcohol.
On examination the gentleman had widespread skin nodules and scaly plaques
with characteristically thick dermis on his cheeks and feet. He had thick facial nodules
and there was evidence of eyebrow loss; symptoms consistent with early leonine facies
(Fig. 1). This appearance and the description of lesion anaesthesia and peripheral
neuropathy were highly suggestive of lepromatous disease. He also had slight
discomfort in his right upper quadrant and mild right testicular tenderness and swelling.
Due to limited resources, the only suitable laboratory investigations available
were a full blood count and urea and electrolytes. The only abnormality was a mildly
raised white cell count (12x109 /L). The gentleman was assigned a clinical diagnosis of
leprosy as defined by the World Health Organisation’s (WHO) standard diagnostic
criteria in Table 1 [5]. Consequently, he was referred to Kamuzu Central Hospital for
treatment with multidrug chemotherapy (100 mg Dapsone, 50 mg Clofazimine and 600
mg Rifampicin for 12 months).

Case scenario obtained from the case study, “A case of leprosy in Malawi.
Making the final push towards eradication: a clinical and public”.
II. Objectives
At the end of the discussion, the students will be able to acquire and improve their
knowledge about the disease, develop skills and attitudes on how to formulate an
effective and necessary nursing intervention and plan of care to promote wellness and
prevent any further complications of leprosy.
A. Knowledge
● Identify signs and symptoms of leprosy.
● Learn the definition, causes, risk factors, treatment of leprosy.
● Discuss the anatomy, physiology, pathophysiology and the systems of the body
affected.
● Formulate a nursing care plan relevant to leprosy.
B. Attitudes
● Observe positive behavior in promoting and maintaining wellness among
patients.
● Develop a sense of responsibility and proper attitude in dealing with patients with
leprosy.
C. Skills
● Administer properly the learned skills in actual procedures as part of intervention
in leprosy.
● Enhance critical thinking in formulating nursing care plans.

● Improve nursing skills in implementing nursing interventions.
● Provide significant health teachings that would promote health and wellness to
the patient.
III. Mini-Lecture of Disease
A. Introduction
Hansen’s disease, also known as leprosy is a chronic infectious disease caused
by mycobacterium leprae. It mainly affects the skin, peripheral nerves, mucosal surfaces
of the upper respiratory tract and the eyes. Leprosy is known to occur at all ages ranging
from early infancy to very old age. Leprosy is curable and early treatment is very
effective.
B. Definition of the Disease
Hansen’s disease is a chronic infectious disease caused by Mycobacterium leprae
and usually affects the skin and peripheral nerves, but can have a wide range of possible
clinical manifestations.
C. Causes
The Mycobacterium leprae is the causative bacteria of Hansen’s disease.
In the South America, some armadillos are natural carriers of the Mycobacterium leprae
bacteria which can infect humans.
It is not exactly known how Hansen's disease is transmitted but it is likely
transmitted via droplets, from the nose and mouth, during close and frequent contact
with untreated cases. Insects that are carriers also cannot be ruled out.
D. Risk Factors
- Overall, the risk of contracting hansen’s disease is very low as 95% of all humans
have a natural immunity to the disease.
- Prolonged contact with an untreated infected person.
- Contact with South America armadillos.
- Living in a country where there are many cases. These countries include:
- Africa: Democratic Republic of Congo, Ethiopia, Madagascar,
Mozambique, Nigeria, United Republic of Tanzania
- Asia: Bangladesh, India, Indonesia, Myanmar, Nepal, Philippines, Sri
Lanka
- Americas: Brazil
- Male patients are more prone to have reactions compared to females.
E. Patients History
A 39 year old gentleman initially presented to a community health centre in
Malawi’s Lilongwe district with widespread skin lesions on the face, torso and the triceps
aspect of the right arm.The exact modes of transmission of the disease are unclear but
are likely transmitted via droplets, from the nose and mouth, during close and frequent
contact with untreated cases.
F. Diagnosis and Treatments
Hansen’s disease can be visually diagnosed with the appearance of patches that
look lighter or darker than the patient’s normal skin tone. Affected areas of skin may
appear red-ish. A skin or nerve biopsy is performed and inspected under microscope for
laboratory confirmation.
Treatment consists of a combination of antibiotics known as multidrug therapy to
prevent the development of antibiotics resistance by the bacteria. The drugs commonly
used are dapsone with rifampicin for Paucibacillary or tuberculoid Hansen’s disease, and
clofazimine is added for Multibacillary, or lepromatous types of the disease.
Additionally, once a person has started treatment they are no longer infectious.
IV. Pathophysiology
There is gradual development of leprosy. It affects the nerves, the eyes and the
skin. It may also affect mucosa (mouth, nose, pharynx), cheeks, kidney, voluntary/
smooth muscles, reticulo - endothelial system, and vascular endothelium.
Bacilli typically reach the body through the respiratory system. Bacilli migrate to
the neural tissue after entering the body, and enter the Schwann cells. After entering the
Schwann cells; the bacterium 's fate depends on the individual 's resistance to the
infecting organism. Bacilli begin to multiply slowly (about 12-14 days for one bacterium to
split into two) inside the cells, they become freed from the cells that have been destroyed
and invade other cells that are not affected. One remains free from signs and symptoms
of leprosy until this point. As the bacilli multiply, the bacterial load in the body increases,
and the immune system recognizes infection. Infected tissues are invaded by
lymphocytes and phagocytes. Clinical manifestation at this point may appear as
involvement of the nerves with damaged sensation and/or skin patch.
If it is not diagnosed and treated in the early stages, the strength of the patient's
immune response dictates further development of the disease. Specific and effective cell
mediated immunity (CMI) protects an individual from leprosy. When specific CMI is
effective in eliminating/ controlling body infection, lesions heal spontaneously or it
produces pauci-bacillary disease. If CMI is weak; the disease spreads uncontrolled,
creating multiple-systems involving multi-bacillary (MB) leprosy.
V. Levels Of Care
A. Promotive
● Advocating for healthy living through proper nutrition, adequate rest, sleep and
good personal hygiene
B. Preventive
● Teach clients to avoid prolonged skin-to-skin contact with others.
● Should avoid close contact with active, untreated leprosy case
● BCG vaccination
● Adequate Nutrition
● Health Education of patients, families and the community on the nature of the
disease, symptomatology and its transmission.
C. Curative
● Teach client to follow treatment regimen

D. Rehabilitative
● Help create a congenial atmosphere essential to progressive recovery
● Encourage the patient's participation in occupational activities suited to his
interest, experience and capacity.
● Refers patient to other person/agencies who can help in his/her physical, mental
and social rehabilitation
VI. Clustering of the Eleven Key Areas of Responsibility-
1. Patient Core Competencies
A. Nursing Care Plan (7 columns)
Cues Nursing Outcome Nursing Rationale Evaluation Discharge
Diagnosis Criteria Intervention Planning
Subjective Impaired Short Independent: Short Medicatio

Patient tissue term: > To
> Provide Term: n:
verbalized integrity After 1 provide the
health teaching Met. After 1 Emphasize
concern about related to hour of patient
patches of skin
on the nature hour of the
infection as health of the disease, knowledge importance
on his face and
manifested teaching, of the health
soles. symptomatolog teaching. and
by the patient y, it’s disease and rationale of
widespread will the purpose Patient
Objective: transmission, verbalized taking
- Widespread skin lesions participate and multi-drug of each medication
on the face, in the medication. understandi
skin lesions therapy ng of the as
on the face, torso and multi-drug treatment prescribed.
the triceps therapy disease and
torso and the treatment ( Environm
triceps aspect aspect of the treatment
right arm program multi-drug
of the right > Discuss the treatment).
and and to importance of > To ent:
arm and
widespread widespread lessen the staying on confirm the
skin manifestati patient Long Term
skin nodules, prescribed Maintain a
nodules, and ons of understandi Met. After 2
and scaly regimen well
scaly lesions and ng of year of
plaques on ventilated
plaques on swollen staying on treatment,
his cheeks room with
his cheeks nodules. the regimen the patient
and feet little to no
and feet with is cured
- He also had noise to
an increased from the
facial l provide
white blood Long infection
Labs: > Advocate adequate
Increased white cell count of term: and
healthy living decreased
blood cell count 12 x 109/L. After 2 >
(12 x 109/L). years of through proper Consuming his white rest for
treatment, nutrition, nutritious blood cell client.
the patient adequate rest, foods allows count to
will be sleep and tissues to 4.5 - 11 x Treatment
cured from good personal heal. 103 / Therapy:
the hygiene. Adequate cells/mm3 Client
infection rest will
and lower allow the should
his white body to adhere to
blood cell reduce the
count. inflammatio prescribed
n and assist regimen.
with healing.
Health
Teaching:
Dependent: Teach
Adhere to the clients the
prescribed >To stay on nature and
Physicians’ prescribed symptoms
multidrug dosage and of the
chemotherapy: regimen. disease,in
● 100 mg order to
Dapsone recognize
● 50 mg and prevent
Clofazimine getting the
● 600 mg disease
Rifampicin again.
for 12
months Outpatient
: se ek
Collaborative: consultation/
Collaborate follow up
with other > To assist check up as
team members with advised.
such as the developing
a plan of Diet: Drink
infectious
specialist. care for plenty of
problematic water.
wounds. Consume
nutritious
foods in
order to
allow
tissues to
heal.
Support:
Family
should
provide
support and
give
strength to
client.
Spiritual:
Encourage
client to ask
strength
from the
Lord.
B. Communication
Communication is essential to health care. For a patient-nurse relationship to be
effective, they must be able to communicate to each other therapeutically. Nurses must
understand and help their patient, demonstrate courtesy and kindness. These
techniques may be observed for a useful conversation:
- Asking open ended questions
Asking open ended questions helps with communication because this lets
the client feel in control with the direction of the conversation and this enhances
his/her role in the interaction.
- Attentive, Active Listening
Active listening is an essential part of communication. Active and attentive
listening requires the nurse to listen to the patient. It entails the nurse’s hearing,
processing, and purposefully comprehending the clients words. The nurse must
also process these words in context of the client's situation and actions sent to
the nurse.
- Silence
At times it is useful to not speak it all. This will give the client time to
organize and collect his/her thoughts. Nurses should always let the patient break
the silence.
- Offering self
This type of communication skill is important because the nurses make
themselves available to their patients/ clients which helps build a relationship
between nurse and client.
- Using touch
When using the tactile sensation, one must make sure that it is being
used appropriately. By appropriately using touch, the nurse reinforces a feeling of
care towards the client.
- Accepting
It is important to acknowledge the patient when having a conversation
with them. Patients who feel that his/her nurses are actively accepting and
listening they become more responsive to care.
- Voicing Doubt
Voicing doubt is known to be a gentler way to to call attention to the
incorrect ideas and perceptions of patients. When a nurse voices doubt, it forces
the patient to examine their assumptions.
- Offering Hope and Humor
One of the most important techniques in communication, the hospital is a
stressful place to many. When sharing hope, and using humor to lighten up the
mood and perspective of the patient, the nurse is easily able to establish rapport.
C. Health Education
Objectives Content Outline Teaching Strategy
After 1 hour of discussion, the

patient will be able to:
1. Comprehend the
definition of Leprosy 1. Hansen’s disease,
also known as leprosy
is a chronic infectious
disease caused by
mycobacterium
leprae. It mainly
affects the skin, Discussion
peripheral nerves,
mucosal surfaces of
the upper respiratory
tract and the eyes.
Leprosy is known to
occur at all ages
ranging from early
infancy to very old
age. Leprosy is
curable and early
treatment is very
effective.
2. Recognize the causes
of Leprosy 2. Mycobacterium leprae
is the causative
bacteria of Hansen’s
disease. In South
Discussion
America, some
armadillos are natural
carriers of the
mycobacterium leprae
bacteria which can
infect humans.
3. Learn the treatment
for Leprosy 3. Treatment consists of
a combination of
antibiotics known as
multidrug therapy to
prevent the
development of
antibiotics resistance Lecture
by the bacteria. The
drugs commonly used
are dapsone with
rifampicin for
Paucibacillary or
tuberculoid Hansen’s
disease, and
clofazimine is added
for Multibacillary, or
lepromatous types of
the disease.
D. Collaboration and Teamwork
(Proper Referral such as, Dietician, Cardiologist and Pharmacist)
Dermatologists
Specializes in the prevention, diagnosis, and treatment of conditions affecting hair,
skin, nails, sweat and oil glands, and mucus membranes which can include cancer. The skin is
the largest organ of the body, and reflects the health of the body. It acts as a barrier to injury
and bacteria, such as leprosy caused by Mycobacterium Leprae.
Nurse
Nurse must assist the leprosy patient from the time of diagnosis to post-discharge
follow-up, with an individualized and systematic care, enabling better client interaction,
better adherence to treatment, promoting self-care and reduction of the resulting physical
disabilities caused by the disease. Additionally, nurses should also encourage
client participation in the program, providing opportunities and stimulating the exchange
of experiences and the discussion of the problems, and the values implicit in his/her life
and his/her family.
Medical Technologists
Tests samples of body fluids, cells, or tissues. They examine the samples to
see if they are normal or abnormal. They look for organisms, such as bacteria, that
would indicate an infection such as mycobacterium leprae that causes Leprosy.
2. Enabling Competencies
A. Management of Resources and Environment (ECG, V/S Apparatus)
The nurse explains the Slit skin smear to the patient and assists the physician
during the procedure. The nurse will obtain 70% alcohol, cotton balls, physician specified
local anesthesia medication, #15 Bard-Parker blade scalpel, cleaned microscope slide,
and band-aid.
The nurse will plan the multibacillary leprosy regimen for the client. The nurse will
tell the client the importance of following and completion of prescribed medication. The
nurse will remind if the client should fail to complete treatment within the prescribed
duration, and the patient should continue treatment until he/she has consumed the
blister packs.
B. Records Management
Date/Time Focus Progress Note

(Data-Action-Response)
14-09-2020 Lesions, skin nodules, and Data

9:00am - Assessment of the
facial nodules skin of patient thick
dermis on his cheeks
and feet, eyebrow
loss.
- Patient complains of
painful and red
lesions.
- Patient verbalizes
being insecure about
appearance.
Action
- Comfort measures
9:15am were provided like
9:30am padding the affected
extremities.
- Promote good
personal hygiene,
proper nutrition, and
adequate rest and
sleep.
- Administer topical
medications to relieve
pain and
inflammations as
prescribed.
- Give mental and
emotional support by
encouraging
self-confidence and
self-resilience.
Response
10:00am - Patient verbalized
slight relief but still
expresses discomfort.
3. Enriching Competency
A. Research (Proposal)
“A case of leprosy in Malawi. Making the final push towards eradication: a clinical and
public”
Introduction
Researchers Cieron Roe and Lucy Sarah May, studied the presentation of a
39-year-old gentleman to a district hospital in Malawi with multibacillary, lepromatous
leprosy. Initially, in the community it was managed as an ‘allergy’ which signifies the
inability to detect leprosy in this setting. This study hoped to bring awareness and to
push for more public and professional education to drive eradication in the at-risk
populations. (Roe, 2016)
The gentleman was first presented with skin lesions on the face, torso and triceps
at the community health care in Malawi’s Lilongwe district.
Methodology
This study utilized the case-finding methodology wherein they studied the 39 year
old man with Multibacillary Lepromatous Leprosy.
Results
Even though there have been strides to globally eradicate the disease by WHO,
unfortunately, it requires the help from the national level to detect and treat the early
stages. Overall, there is a need for more effective methods through diagnostic and
epidemiologic tools, vaccine development, and chemoprophylaxis regimens. (Roe, 2016)
Discussion
Clinical Perspective. A detailed travel, social and contact history should be
taken in all settings to correctly predict the risk of exposure. To differentiate for
multibacillary lepromatous skin lesions they look for scleroderma, mycosis fungoides,
pellagra, asteatosis, ichthyosis and eczema or contact dermatitis.
Leprosy is confirmed by the presence of acid-fast bacilli in slit skin smears or skin
biopsies. However, due to the limited resources in the district hospital, they were not
able to perform the slit skin smears or the skin biopsies. The researchers noted, “...this
situation highlights the inadequacy of laboratory provisions in the Lilongwe health
district. To achieve eradication targets, these secondary care institutions require access
to reliable, definitive laboratory investigations.” (Roe, 2016)

Public Health Perspective. The World Health Organization made a commitment
from 2000-2005 to eliminate leprosy with control measures that would be accessible in
all local health facilities. This would highlight the need to diagnose and treat patients with
multidrug chemotherapy, patient and family counseling, education in the community,
rehabilitation and referrals if complications occur.
2nd Research:
“Risk Factors for Leprosy Reactions in Three Endemic Countries”
Introduction
“Reactions” are systemic inflammatory complications often presenting as
medical emergencies. Mycobacterium leprae affects the peripheral nerves
causing inflammation. In the aforementioned reactions, the inflammation may
lead to severe nerve damage with possible paralysis and deformity.
It has been proposed that the endocrine system influences the initiation of
reactions. There are also reports that leprosy reactions are affected by
pregnancy, lactation, and puberty. Interactions between the immune and
endocrine systems are well established. Meaning possible influence of hormones
on immunity in the initiation of suspected leprosy reactions which are
accountable for most of the morbidity and nerve damage in the disease.
Methodology
The study design was a multicenter cohort. Baseline data of all participants were
analysed and comparisons were made between patients who had reactions and those
who didn’t, using a case-control approach.

Patients were registered in four clinics in three endemic countries selected from
having high patient recruitment, “established local expertise and experience in diagnosis,
classification, and management of leprosy by physicians, and experience in clinical
epidemiological research studies” Scollard (2015). Two clinics in Brazil, one in the
Philippines and one in Nepal.
Inclusion criteria: newly diagnosed leprosy patients regardless of age, gender, or
other illnesses. Exclusion criteria: treatment of corticosteroids before registration and
expected lack of follow up.
The Ridley-Jopling scale was used for the classification of leprosy. Skin biopsy
was obtained from each participant for diagnosis, and if unavailable, a skin smear was
obtained to assist in classification. Skin signs are mandatory for classification but nerve
and systemic signs are optional.
Standard protocol was used in all clinics for documentation of demographic
information, height and weight, endocrine, gestational, and menstrual history, past and
present co-morbidity.
Results
In all locations the study obtained their samples, the majority of cases were
detected in patients >15 years of age and there was a statistically significant difference
of mean age for multiple comparisons. There was a predominance of male patients in all
sites with the ratio being more than two in asian countries.
Discussion
This study gave a good picture of the prevalence of reactions and neuritis due to
leprosy from endemic countries. The evidence here indicates that neuritis is a
complication of leprosy and links the occurrence of it with reactions. It is evident that
leprosy reactions are not necessarily caused by treatment. Recent studies suggest some
genetic associations to have a higher risk of reactions. Reactions have been recorded in
both malle and female children, but with the lowest incidence of these complications.
The risk of reaction appears to increase with age. Although many participants were
underweight, nutritional status was not a risk for the development of reactions or neuritis.
To test if endocrine changes may cause reactions, the researchers questioned
whether the timing of reactions in women match up with that of their menstrual cycle. No
such association could be obtained through the study design and methods used.
B. Quality Improvement
I. Institution
- Tertiary hospitals can provide intensive care to patients with leprosy.
- The pharmacy department can provide medication needed for the treatment of
the patients.
- The nutrition and dietetics department can arrange the right type and amount of
food for the patient. This promotes good nutrition and avoids allergic reactions.
II. Process
- Administer prescribed medications to the patient.
- Improve patient’s stay in the hospital and address the patient’s needs.
- Promote safety and comfort of the patient.
- Minimize external stimuli by providing a quiet and hygienic environment.
- Promote rest and relaxation.

III. Outcome
- Patients must recognize the need for care and treatment and maintain the
body 's health to prevent further complications and outbreaks.
4. Empowering Competency
A. Ethico-Moral Responsibilities (What are Ethical Principles and their Clinical
Application)
I. Ethical Principles
1. Beneficence
- This promotes choosing what is good or what will benefit the patient. It is
always choosing to do what benefits or helps the patient.
2. Non-Maleficence
- This principle really means “to do no harm”, it is the duty of the nurse to
not cause or inflict harm to others (maybe it be physical, financial and
social).
3. Autonomy
- This means that the patient has the right/ freedom to decide (the patient
has the right to refuse despite the explanation of the nurse). This also
means that a person is autonomous or is capable of making decisions for
themselves.
4. Confidentiality
- The nurse has a duty to their patients to always keep their privacy. The
nurse has a duty to respect privileged information.
5. Veracity
- This is the act of truthfulness. The patient has the right to ask for the truth
and the nurse is required to tell the truth.
6. Justice
- This promoted fairness and equality in terms of resources and personnel.
II. Clinical Application
1. Beneficence - choosing what is good and choosing something that won”t harm the patient.
- Example: The nurse promotes wellness of the patient by attending to
their needs and and teaching them through healthy education
2. Non-maleficence- “to do harm”
- Example: The nurse performs her best when performing her skills to give
the best care.
3. Autonomy- the patient has the right to make his or her decisions
- The patient must always be informed of their disease and treatments.
They also have the right to refuse treatment, and should know their
treatments.
4. Confidentiality- Duty to respect privileged information.
- The nurse must never disclose or give any information to anyone who is
not an authorized member of the health care team.
5. Veracity- the act of truthfulness
- The nurse informs the patient and his folks regarding his/hers disease
and the possible complications. The nurse must also answer the client’s
questions regarding the treatment of his/hers conditions.
6. Justice- promoted fairness and equality

- The nurse must give the same equal quality of nursing care to the best of
his/hers ability to Leprosy patients regardless of their status in life, age,
and disability.
B. Moral Responsibilities
Republic Act No. 9173 - An Act Providing For A More Responsive Nursing
Profession, Repealing For The Purpose Republic Act No. 7164, Otherwise Known As
“The Philippine Nursing Act of 1991” And For Other Purposes
ARTICLE VI - Nursing Practice
SEC. 28. Scope of Nursing. — A person shall be deemed to be practicing nursing
within the meaning of this Act when he/she singly or in collaboration with another,
initiates and performs nursing services to individuals, families and communities in any
health care setting. It includes, but not limited to, nursing care during conception, labor,
delivery, infancy, childhood, toddler, pre-school, school age, adolescence, adulthood
and old age. As independent practitioners, nurses are primarily responsible for the
promotion of health and prevention of illness. As members of the health team, nurses
shall collaborate with other health care providers for the curative, preventive, and
rehabilitative aspects of care, restoration of health, alleviation of suffering, and when
recovery is not possible, towards a peaceful death. It shall be the duty of the nurse to:
(a) Provide nursing care through the utilization of the nursing process. Nursing
care includes, but not limited to, traditional and innovative approaches, therapeutic use
of self, executing health care techniques and procedures, essential primary health care,
comfort measures, health teachings, and administration of written prescription for
treatment, therapies, oral, topical and parenteral medications, internal examination

during labor in the absence of antenatal bleeding and delivery. In case of suturing of
perineal laceration, special training shall be provided according to protocol established;
(b) Establish linkages with community resources and coordination with the health
team. (c) Provide health education to individuals, families and communities (d) Teach,
guide and supervise students in nursing education programs including the administration
of nursing services in varied settings such as hospitals and clinics; undertake
consultation services; engage in such activities that require the utilization of knowledge
and decision-making skills of a registered nurse; and (e) Undertake nursing and health
human resource development training and research, which shall include, but not limited
to, the development of advanced nursing practice;
REPUBLIC ACT NO. 753 - An act amending section one thousand fifty-eight, one
thousand fifty-nine, one thousand sixty, one thousand sixty-one, one thousand sixty-two,
one thousand sixty-three, one thousand sixty-four, one thousand sixty-five, one
thousand sixty-six, one thousand sixty-seven, one thousand sixty-eight, one thousand
sixty-nine, one thousand seventy, and one thousand seventy-one of article fifteen of act
numbered twenty-seven hundred and eleven known as the revised administrative code,
providing for the control of leprosy and for other purposes
"Art. XV. — Control of Leprosy
"Section 1058. Segregation or isolation of persons with leprosy. — The Director
of Health or his authorized representative is empowered to cause all persons with
leprosy or suspects in the Philippines to be subjected to the medical inspection and
diagnostic procedure necessary to determine the presence or absence of leprosy. If it be
found that the suspected person is positive bacteriologically for mycobacterium leprae,
the Director of Health or his authorized representative shall turn him over to the Director
of Hospitals or his authorized representative for isolation and segregation; and if it be
found that the suspected person does not have leprosy, the Director of Health or his
authorized representative shall assist in his conveyance to the place at which he was
taken, at government expense, unless other satisfactory arrangements are made.
"Section 1059. Verification of diagnosis. — If the diagnosis is questioned, no
person shall be removed to the place of segregation until the diagnosis of leprosy has
been verified positive bacteriologically.
"Section 1060. Security of property of persons with leprosy. — When the
treatment, isolation, or segregation, of persons with leprosy shall involve the security of
property and money belonging to or held by said persons, the provincial treasurer or city
treasurer as the case may be or such person as he may designate shall act as guardian
pending the appointment of a lawful guardian in the province where such person resides.
"Section 1061. Duty to report cases of leprosy. — It shall be the duty of every
police officer or other peace officer or any other person having reason to believe that any
person is afflicted with leprosy to report the fact forthwith to the district health officer or
any health authority of the district in which the case is found.
"Section 1062. Harboring of persons with leprosy. — No person shall knowingly
conceal or harbor in premises under his control, or shall in any manner conceal or assist
in concealing any person afflicted with leprosy, with the intent that such person be not
discovered or delivered to the Director of Health or his authorized representative or shall
support or assist in supporting any person with leprosy living in concealment.
"Section 1064. General regimen of patients. — The Director of Hospitals or his
authorized representative may require from patients such amount of labor as may be
considered reasonable, and the said Director may further make and publish such rules
and regulations as he may deem advisable for the amelioration of the condition of
persons with leprosy.
"Section 1065. Control over living with persons with leprosy. — Voluntary helpers
or friends while living with segregated or isolated persons with leprosy shall be under the
control of the Director of Hospitals and may thereafter be subjected to observation for a
period to be prescribed by him.
"Family of any person with leprosy," as herein used, shall include the parents,
spouse, brothers, sisters, sons, and daughters of any person with leprosy confined as
aforesaid; and it shall be the duty of the chief of the provincial hospital or any authorized
representative of the Director of Hospitals to ascertain and assure himself of such
relationship in every instance before dispatching the articles.
REPUBLIC ACT NO. 4073 - An Act Further Liberalizing the Treatment of Leprosy
by Amending and Repealing Certain Sections of the Revised Administrative Code
Section 1. Sections one thousand fifty-eight and one thousand fifty-nine of the Revised
Administrative Code, as amended, are further amended to read as follows:
Sec. 1058. Persons afflicted with leprosy not to be segregated. — Except when
certified by the Secretary of Health or his authorized representatives that the stage of the
disease requires institutional treatment, no persons afflicted with leprosy shall be
confined in a leprosarium: provided, that such person shall be treated in any government
skin clinic, rural health unit or by a duly licensed physician.
Sec. 1059. Confinement and treatment in sanitarium when necessary. —
Whenever a person afflicted with leprosy shall have developed the disease to such
stage as to require institutional treatment and the leprosy officer shall so certify, the said
person shall forthwith be sent to a government operated sanitarium and be treated
therein until such time as the Secretary of Health or his authorized representative
decides that institutional treatment is no longer necessary.
C. Personal and Professional Development (Attending Seminars/symposium/ updates on
current trends and issues in nursing)
- The nurse must have the initiative to attend certain programs, seminars and training to
enhance understanding of Leprosy.
- Reading and studying updated journals related to Leprosy interventions and management
- The nurse must be open to feedback to improve the delivery of care and to enhance
competency in their field of nursing.
- Attending conferences and updates from the Department of Health to gain further
knowledge and insight regarding modalities and interventions related to Leprosy on a local,
national and global scale.
- The nurse must continue the development of their nursing skills and knowledge.
VII. Implications/Insights/Lesson Learned of the Disease Entity in terms of:
A. Nursing Education
To enhance the nurse’s care of the client with leprosy, the nurse must be aware and
knowledgeable of the responsibilities when it comes to public health teaching and why it
is important. Health education of patients, families, and the community on the nature of
the disease, symptomatology, and its transmission. Advocate healthy living through
proper nutrition, adequate rest, sleep, and good personal hygiene. Encourage and
advise BCG vaccination of infants and children to mothers. Nurses must be able to have
the information needed to make decisions that would empower and benefit the patient’s
wellbeing.
B. Nursing Practice
Keeping up to date on studies and research help improve current understanding
of the disease. With better comprehension, comes better practice of care.
C. Nursing Research
Nurses should always be updated with the current research done on leprosy.
They can be aware of any new improvements being made or any new therapies being
performed. Nurses can apply these new improvements or new therapies to their patient's
care plan.
D. Nursing Administration
Nurses should be in communication with the World Health Organization to
promote development of programs to bring health education to the endemic parts of the
Philippines.
VIII. Bibliography
17 Therapeutic Communication Techniques. (2018, April 06). Retrieved September 14,
2020, 17 Therapeutic Communication Techniques

An Act Amending Sections...Revised Administrative Code, Providing for the Control of
Leprosy and for Other Purposes. (n.d.). Retrieved from
https://thecorpusjuris.com/legislative/republic-acts/ra-no-753.php
An Act Further Liberalizing the Treatment of Leprosy. (n.d.). Retrieved from
https://www.lawphil.net/statutes/repacts/ra1964/ra_4073_1964.html
Bhat, R. and Prakash, C., (2012). Leprosy: An Overview of Pathophysiology. Neglected
Infectious Diseases: Mechanism of Pathogenesis, Diagnosis, and Immune
etrieved from https://www.hindawi.com/journals/ipid/2012/181089/

Response. R
Doenges, M.E; Moorhouse, M.F; Murr, A.C. (2016). Nurse's Pocket Guide Diagnoses,
hiladelphia, Pennsylvania. F.A. Davis.

Prioritized Interventions, and Rationales. P
Republic Act No. 9173. (n.d.). Retrieved from
https://www.officialgazette.gov.ph/2002/10/21/republic-act-no-9173/
Roe, C. (2016, September 2). A case of leprosy in Malawi. Making the final push towards
eradication: a clinical and public health perspective. Infectious Diseases of Poverty.
https://idpjournal.biomedcentral.com/articles/10.1186/s40249-016-0176-z#citeas
World Health Organisation. (n.d). Leprosy elimination. Retrieved form
https://www.who.int/lep/disease/treatment/en/#:~:text=For%20the%20treatment%2
0of%20patients,combination%20of%20rifampicin%20and%20dapsone.
“Risk factors for leprosy reactions in three endemic countries”. Scollard, D. M., Martelli, C.
M., Stefani, M. M., Maroja, M., Villahermosa, L., Pardillo, F., & Tamang, K. B. (2015). The
American journal of tropical medicine and hygiene, 92(1), 108–114. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4347363/?fbclid=IwAR3ycfjhdYvyoAeJt9Sh9OvfKgz_fw2qOpUW2fm
WxQ7KV3xytwvODTkxmR8
IX. Post Test Questions (5 item multiple choice with four choices)
1. What part of the body does Leprosy NOT affect?

a. Skin
b. Upper respiratory tract
c. Eyes
d. Bones
2. What is the pathogen that causes Leprosy?

a. Pseudomonas aeruginosa
b. Bacillus anthracis
c. Escherichia coli
d. Mycobacterium leprae
3. What is another name for Leprosy?

a. Hansen’s disease
b. Bright’s disease
c. Turner syndrome
d. Huntington’s disease
4. Which drug classification is used to treat Leprosy?

a. Benzodiazepines
b. Anticonvulsants
c. Immunostimulants
d. Antibiotics
5. Which animal is known to be a natural carrier of the bacteria that causes Leprosy?
a. Koalas
b. Armadillos
c. Kangaroos
d. Wombats
College of Nursing
Abortion
Group 2:

Cordero, Ciaren
Ebron, Gergelae
Table of Contents
Case Scenario…………………………………………………………………………….
Objectives………………………………………………………………………………....
Levels Of Care…………………………………………………………………………….
Bibliography……………………………………………………………………………....
Post Test Questions……………………………………………………………………..
❖ Case Scenario………………………………………………………... Cordero, Ciaren
❖ Objectives……………………………………………………………... Ebron, Gergelae
❖ Mini-Lecture of Disease…………………………………………….... Cordero, Ciaren
❖ Pathophysiology………………………………………………………. Agraviador, Noel Jr.
❖ Levels Of Care………………………………………………………… De Los Reyes, Hannah
- Communication………………………………………………... Bulauitan, Mia Maricar
- Health Education………………………………………………. Calderon, Krystyn Andrei
- Collaboration and Teamwork…………………………………. Cordero, Ciaren

Enabling Competency
- Management of Resources and Environment……………… Agraviador, Noel Jr.
- Records Management…………………………………………. Bulauitan, Mia Maricar
- Research Proposal………………………………………………Calderon, Krystyn
& De Los Reyes, Hannah
- Quality Improvement………………………………………….... Ebron, Gergelae
- Ethico-Moral Responsibilities………………………………….. Bulauitan, Mia Maricar
- Moral Responsibilities (RA 9173)........................................... Ebron, Gergelae
- Personal and Professional Development…………………….. Agraviador, Noel Jr.
Nursing Education………………………………………………………... De Los Reyes, Hannah
Nursing Practice………………………………………………………….. Cordero, Ciaren
Nursing Research………………………………………………………… Ebron, Gergelae
Nursing Administration…………………………………………………… Bulauitan, Mia Maricar
❖ Post Test Questions………………………………………………………. Bulauitan, Mia Maricar

I. Case Scenario
Talulah, aged 38 years old and 11 weeks pregnant, came to the emergency
department with abdominal cramping and heavy vaginal bleeding with clots. Patient
appeared in distress, restless and had poor eye contact during communication. Patient
said in a quivering voice “I don’t wanna lose my baby, I’m scared because I don’t know
what’s happening”. Over the past two days, she has experienced light spotting. The
severity of spotting has increased that morning. She reported no fever, chills, burning on
urination, nausea, or vomiting. Her past obstetric history is G3P0 3-0-2-0. She stated
that she has been receiving prenatal care from her obstetrician/ gynecologist. However
the patient verbalised that she had drank alcohol in the early weeks of the pregnancy
due to not knowing of the pregnancy at the time.
Laboratory findings showed that her human chorionic gonadotropin (hCG) levels
was 32,000 U/L, which is elevated and suggests a gestational age of about 8 to 12
weeks.
During the physical exam, her abdomen was slightly distended, and mild
tenderness was present over her lower pelvic area. During pelvic examination, moderate
active bleeding was noted in the vaginal canal with the cervical os open. Blood clots
were noted on her napkin. She was also taken in for a transvaginal ultrasound. It
appeared to be an abnormal gestational sac within the cervical canal. The findings were
suggestive of a spontaneous abortion in progress.

II. Objectives
knowledge about abortion, develop skills and attitudes on how to formulate an effective
and necessary nursing intervention and plan of care to promote wellness and prevent
any further complications of abortion.
A. Knowledge
● Identify signs and symptoms of abortion.
● Learn the definition, causes, risk factors, treatment of abortion.
affected.
● Formulate a nursing care plan relevant to abortion.
B. Attitudes
patients.
abortion.
C. Skills
in abortion.

● Render significant health teachings that would promote health and wellness to
the patient.
A. Introduction
Abortion is a medical term for any interruption of a pregnancy before a fetus is
viable. A viable fetus is usually defined as a fetus of more than 20 to 24 weeks of
gestation or one that weighs at least 500 grams. A fetus born before this point is
considered a miscarriage or a premature birth. There are different types of miscarriages
that occur during the first and second trimester -- threatened spontaneous miscarriage,
imminent miscarriage, missed miscarriage, incomplete spontaneous miscarriage,
complete spontaneous miscarriage, habitual miscarriage, and ectopic pregnancy.
B. Definition
Spontaneous misscarriage occur in 15% to 30% of all pregnancies and arise
from natural causes. Spontaneous miscarraige is an early miscarriage if it occurs
between 16 and 24 weeks. Miscarriages can occur because of abnormalities in the
fetus, systemic diseases, hormonal imbalance, or anatomic abnormalities.
Symptoms of spontaneous misscarriage include crampy pelvic pain, bleeding,
and eventually expulsion of tissue. Late spontaneous miscarriages may begin with a
gush of fluid when the membranes rupture. Hemorrhage is rarely massive. A dilated
cervix indicates that abortion is inevitable. If products of conception remain in the uterus
after spontaneous miscarriage, vaginal bleeding may occur, sometimes after a delay of
hours to days. Infection may also develop, causing fever, pain, and sometimes sepsis.
Spontaneous miscarriage can be classified to imcomplete spontaneous
misscarriage and complete spontaneous miscarriage. An incomplete miscarriage
means only some of the products of conception leave the body. A complete
spontaneous miscarriage means that all of the products of conception leave the body.
C. Causes
The most frequent cause of miscarriage is abnormal fetal development, due to
either teratogenic factor or to a chromosomal aberration. In other miscarriages,
immunologic factors may be present or rejection of the embryo through an immune
response may occur. Another cause of early miscarriage involves implantation
abnormalities, as up to 50% of zygotes don’t implant securely because of inadequate
endometrial formation or form an inappropriate site of implantation. Miscarriage may also
occur if the corpus luteum on the ovary fails to produce enough progesterone.
Ingestion of alcohol at the time of conception or during early pregnancy can
contribute to pregnancy loss because of abnormal fetal growth.
Systemic infections such as rubella, syphilis, poliomyelitis, cytomegalovirus, and
toxoplasmosis readily cross the placenta and so may also be responsible. With an
infection, if the fetus fails to grow, estrogen and progesterone production by the placenta
falls and leads to endometrial sloughing. With the sloughing, prostaglandins are
released; uterine contractions and cervical dilatation along with expulsion of the products
of pregnancy begins.
D. Risk Factors
Risk factors for spontaneous miscarriage include:

● women who get pregnant at ages greater than 35 years old
● a history of spontaneous miscarriage
● Lifestyle practices such as cigarette smoking, alcohol consumption, and
the use of drugs
● poorly controlled chronic disorders, like diabetes, hypertension, overt
thyroid disorders in the mother
E. Patient’s History
Patient is 38 years old and 11 weeks pregnant. With an obstetric history of G3P0
3-0-2-0. She experienced light spotting two days prior to admission. Upon admission,
she complained of abdominal cramping and heavy vaginal bleeding with clots. She has
been receiving prenatal care from her obstetrician/ gynecologist.
Ultrasonography is helpful in the diagnosis of spontaneous abortion. During an
ultrasound, the health care provider will check for a fetal heartbeat and determine if the
embryo is developing normally. Pelvic exam may also be performed to check and see if
the patient's cervix has begun to dilate.
Blood tests may be ordered to check the level of the pregnancy hormone, and
human chorionic gonadotropin (HCG). If the pattern of changes in the HCG level is
abnormal, it could indicate a problem. The health care provider might check to see if the
patient is anemic, which could happen if there is significant bleeding. If the expectant
mother has had two or more previous miscarriages the health care provider may order
blood tests for both the client and her partner to determine if the chromosomes are a
factor.
Tissue tests may be done if the patient has passed tissue, it will be sent to a lab
to confirm that a miscarriage has occurred.
Traditional treatment consisting of surgical evacuation of the uterus is the
treatment of choice in unstable patients. Patients with a complete spontaneous abortion
rarely require medical or surgical intervention. For women with incomplete spontaneous
abortion, expectant management is given for up to two weeks. Expectant management
allows the miscarriage to occur naturally without surgical intervention. The patient will be
sent home with prescriptions for methylergonovine (Methergine). Methergine assists with
expectant management by increasing uterine contractions, which helps control blood
loss.
IV. Pathophysiology
The pathophysiology of a miscarriage may be determined by its timing.

Chromosomal defects, genetic etiology, insufficient or excessive hormonal levels is what
likely caused an 11 week pregnancy to fail.
A. Predisposing Factors
● Previous miscarriages
B. Precipitating Factors of the Disease
● >35 years-old
● Unhealthy lifestyle (consumption of alcohol)
V. Levels Of Care
● Promotive
○ Encourage clients to exercise regularly, eat healthy, eat well-balanced meals, and
manage stress.
● Preventive
○ Avoid alcohol, tobacco, or drugs
○ Prevent infections common during pregnancy by avoiding raw or undercooked
Meats, and washing hands regularly.
○ Limit caffeine consumption
○ Follow a healthy diet
○ Maintain an adequate weight
● Curative
○ Clients should follow up with their health providers to assess for surgical or
prescription treatment.
● Rehabilitative
○ Provide sensitive and promotive care for the client after a loss.
○ Encourage client to wait until you have had at least 1 menstrual period
after their abortion before becoming pregnant again.
VI. Clustering of the Eleven Key Areas of Responsibility

Anxiety Short-term: Independent: Short Medication:
Subjective related to Term: Advise
situational After 30 1.Monitor vital > To patient to
>Patient noted crisis as minutes of Met. After take
signs (rapid or identify
“I don’t wanna
manifested nursing irregular pulse, physical 30 minutes prescribed
lose my baby,
I’m scared
by poor eye interaction rapid responses of nursing medications
contact, the patient associated intervention pertaining to
because I don’t breathing/hyper
restlessness will be able with both the patient pain and
know what’s ventilation, medical
gonna happen” and voiced to know changes in was able to post
concern over techniques and know diagnosis
blood pressure, emotional
Objective: the welfare on how to or restlessness) techniques treatment
conditions
of the fetus. lessen on how to
> Poor eye anxiety such 2.Identify the >To assess lessen Environment:
contact as deep anxiety.
client’s the anxiety Maintain a
breathing perception of level of the safe and
>Restlessnes exercises. the threat patient comfortable
s
represented by space for
the situation. recovery.
Long Term: Keep noises
Long-term: 3.Establish a and
>To avoid Partially
therapeutic the stressful
After 8 hours relationship, met. After 8 stimuli to a
of nursing transmissio hours of
conveying n of anxiety minimum in
intervention empathy and nursing the area.
the patient unconditional intervention
will be able positive regard. the patient
relax and was able to
keep anxiety keep Treatment:
at a anxiety at a Patient
manageable Dependent: moderate should
level. > Refer to >Drugs manageabl follow the
physician for that e level. regiment
drug prescribed
often given.
management cause
alteration of symptom
the Health
s of Teaching:T
prescription anxiety. each clients
regimen.
to perform
the proper
aftercare to
prevent any
Collaborative future
: infection
>Refer to >To deal Outpatient:

individual with Consult
and/or group chronic alternative
anxiety health
therapy, as
providers for
appropriate states
promotive
care of
mental and
physical well
being
Diet:Maintai
na
balanced
and healthy
diet
including
food high in
iron and a
complete
fluid intake.
Support:
Significant
others and
family
members
should
provide
support and
care in the
home
setting
Spirituality:
Continuing a
strong
spiritual
connection
with God
and self
throughout
the healing
process.
B. Communication
The student nurse will utilize the following the following techniques when addressing
this patient:
1. Nonverbal communication. Through this technique, the nurse would make eye
contact with the patient and control the tone of her voice. Student nurse would
also be mindful of her body language, posture, and facial expressions during the
interactions with the patient.

2. Active Listening. By actively listening, the nurse would be able to listen and
understand what the patient is trying to communicate. Listening fully before
responding.
3. Cultural Awareness. The student nurse will be culturally aware and sensitive to
the patients and beliefs while also setting aside her own beliefs. The student
nurse will be consciously competent by learning the client's beliefs and
traditions.
4. Verbal Communication. The student nurse will speak clearly, in complete
sentences while also considering tone in speaking. Nurse will elicit open-ended
questions, closed-ended questions, “laundry list” of descriptive words in regards
to patients symptoms and symptoms, and through means of providing
information.
5. Educating Patients. The student nurse educates the patient by explaining the
disease process, the medications that will be used and self-care techniques to
the patient and her family. Will use simple terms to describe what is occurring
and allow patients to ask questions.
C. Health Education
After 1 hour and 30 minutes

of discussion, the patient will
be able to:
1. Understand the 1. Abortion is a medical

definition of abortion. term for any
interrruption of a
pregnancy before a
fetus is viable. A
viable fetus is usually DISCUSSION
defined as a fetus of
more than 20 to 24
weeks of gestation or
one that weighs at
least 500 grams.
Spontaneous
misscarriage occur in
15% to 30% of all
pregnancies and arise
from natural
causes.Miscarriages
can occur because of
abnormalities in the
fetus, systemic
diseases, hormonal
imbalance, or
anatomic
abnormalities.
1. Know the signs and 2. Symptoms of

symptomps of spontaneous misscarriage
abortion. include crampy pelvic pain,
bleeding, and eventually
expulsion of tissue. Late
spontaneous miscarriages
may begin with a gush of fluid
when the membranes
rupture. Hemorrhage is rarely
massive. A dilated cervix
indicates that abortion is DISCUSSION
inevitable. If products of
conception remain in the
uterus after spontaneous
miscarriage, vaginal bleeding
may occur, sometimes after a
delay of hours to days.
Infection may also develop,
causing fever, pain, and
sometimes sepsis.
2. Know and understand 3. Traditional treatment

the treatment for consisting of surgical
abortion. evacuation of the uterus is
the treatment of choice in LECTURE
unstable patients. Patients
with a complete spontaneous
abortion rarely require
medical or surgical
intervention. For women with
incomplete spontaneous
abortion, expectant
management is given for up
to two weeks. Expectant
management allows the
miscarriage to occur naturally
without surgical intervention.
The patient will be sent home
with prescriptions for
methylergonovine
(Methergine). Methergine
assists with expectant
management by increasing
uterine contractions, which
helps control blood loss.
Patient is instructed to follow
up with her obstetrician/
gynecologist in three to five
days.
Doctor (OB): An obstetrician is a doctor who has successfully completed
advanced education and training in pregnancy, labour and puerperium management (the
time-period immediately after childbirth). A gynecologist, is a physician who has
successfully completed advanced education and training in women's reproductive
system health including the diagnosis and treatment of disorders and diseases.
Nurse: An OB-GYN nurse is a registered nurse who provides women, and often
children, with direct treatment. OB-GYN nurses can be working in hospital labor and
delivery, and postpartum wards, as well as in birth centers and pediatric or ambulatory
clinics. Their roles include accepting patients, taking medical records and supporting
doctors during procedures. They can administer medicines, use fetal monitors or perform
ultrasounds. They can also hold preparatory childbirth classes or educate women on
sexually transmitted infections, birth control or maternal care.
Dietician: Dietitians have developed food and nutrition experience, and are
committed to improving the health of their patients and their society. They form an
important part of a systematic, systemic, and multidisciplinary approach to patient care.
They work together with the physicians, clinical and nursing staff to ensure patients
receive sufficient dietary care at all times. Quality treatment focussed on patients is the
center of everything for the Nutrition and Dietetics department.
A. Management of Resources and Environment
The nurse will ensure needs are met. Assess vital signs, bleeding, pain and
monitor for other complications. To try prevent the aboriton, the nurse will obtain
Mifepristone 200mg for an oral single dose, then 36-48 hours after, 800 then 400
micrograms of Misoprostol vaginally then vaginally or sublingual every 3 hours up to 5
doses.
(ECG, V/S Apparatus)

14-09-2020 Vaginal bleeding, abdominal Data
8:00am - Patient verbalized
pain over lower pelvic area abdominal cramping
and experienced
heavy vaginal
bleeding with clots.
Light spotting
occurred two days
prior.
- Patient noted no
fever, chills, burning
on urination, nausea
or vomiting.
- Assessment:
abdomen slightly
distended, mild
tenderness over
pelvic area, moderate
active bleeding in
baginal while cannal
with the cervical os
open
Action
8:30am - Place the woman flat
on her side.
- Vital Signs taken
- Monitor for possible
uterine contractions
and fetal heart rate
- Measure intake and
9:00am output
- Replace sanitary
napkin with small
sized adult diaper
Response
- Patient verbalized
discomfort in the
lower abdominal
region
- No fetal heartbeat
heard
- Continued bleeding
still observed
- Notified Dr. Cruz in
the OB department
A. Research Proposal
Pregnancy Loss In The Philippines
In a cross-sectional study conducted in Thailand, 8,481 women aged 15-49 were
inquired to test the association between domestic violence and pregnancy loss. The
sample was divided into seven groups classified by the number of pregnancies. The risk
factors considered were demographic characteristics, socioeconomic status, domestic
violence, sexual behavior of the partner, whether the pregnancy was wanted, and
disease history. Women’s age, partner’s age, residence, women’s education, partner’s
education, and paid helper at home were significantly associated with pregnancy loss,
they were likely to be confounders rather than risk factors.
Methodology
A total sample of 8,481 Filipino women aged 15-49 who had ever had a
pregnancy outcome from the Safe Motherhood Survey (SMS) was used in this study.
The Safe Motherhood Survey was the first national survey of the Philippines carried out
as part of the global Demographic and Health Surveys program. This survey was
conducted between October and December 1993, to investigate a variety of women’s
reproductive health issues, including pregnancy history, maternal morbidity, pregnancy
outcomes, use of services for health problems, socio-demographic characteristics,
domestic violence and sexual behavior. Pregnancy outcomes included live births and
pregnancy. A pregnancy loss is defined as any non-live birth after pregnancy, either by
spontaneous abortion (miscarriage or fetal loss before full term), induced abortion or
stillbirth (children born dead after a gestation of seven or more complete months). The
outcome, pregnancy loss, was measured by the questions ‘Have you had any
pregnancies that did not result in live births?’ and ‘How many pregnancies did not result
in a live birth?’
Results
The mean age of the women was 34.5 years, with a standard deviation of 8.0
years. The average number of pregnancies was 4.4 and the maximum was 20. One in
three women had at least one pregnancy loss in their lifetime.
Discussion
Their primary objective was to investigate the associations between fetal loss and
demographic, social and medical risk factors. They were particularly interested in the
association between domestic violence and fetal loss. The outcome was whether or not
a subject in the target population had had a fetal loss. They could have carried out a
pregnancy-based analysis to model the risk of a fetal loss as a function of parity and the
risk factors of interest. However, pregnancy outcomes are probably correlated within
subjects, violating the statistical independence assumption, and thus necessitating a
more complex method of analysis.
The Incidence of Induced Abortion in the Philippines: Current Level and Recent
Trends
In the Philippines, abostion is against the law. Nevertheless many woman obtain
abortions-often in unsafe conditions- to avoid unplanned births. This study was
conducted in 2005, to assess and tackle abortion trends in the Philippines from the year
1994 to 2000.
“We provide estimates of the number of women who were hospitalized in 2000
for the treatment of complications following unsafe induced abortions; the total number of
women who had induced abortions each year, including both women who experienced
no complications from the procedure and those who did; and the incidence of induced
abortion at national and regional levels. “ (Juarez, 2005)
Methodology
Data from 1,658 hospitals were used to estimate abortion incidence in 2000 and
to assess trends between 1994 and 2000, nationally and by region. An indirect
estimation methodology was used to calculate the total number of women hospitalized
for complications of induced abortion in 2000 (averaged data for 1999–2001), the total
number of women having abortions and the rate of induced abortion. (Juarez, 2005)
Results
In 2000, an estimated 78,900 women were hospitalized for postabortion care,
473,400 women had abortions and the abortion rate was 27 per 1,000 women aged
15–44 per year. The national abortion rate changed little between 1994 and 2000;
however, large increases occurred in metropolitan Manila (from 41 to 52) and Visayas
(from 11 to 17). The proportions of unplanned births and unintended pregnancies

increased substantially in Manila, and the use of traditional contraceptive methods
increased in Manila and Visayas
Discussion.
The increase in the level of induced abortion seen in some areas may reect the
difculties women experience in obtaining modern contraceptives as a result of social
and political constraints that affect health care provision. Policies and programs
regarding both postabortion care and contraceptive services need improvement
I. Institution
- Tertiary hospitals can provide optimal and immediate care for the patient. This
will have healthcare personnel and equipment that will cater to the needs best
suited for the patient’s condition.
- Pharmacy department can provide medications that can supply relief for the
patient’s signs and symptoms.
- Emergency department can provide immediate and urgent care to the patient.
II. Process
- Assess and record vital signs.
- Assess bleeding and cramping of pain.
- Administer medications as prescribed by the physician.
- Provide client and family teaching
- Address emotional and psychosocial needs.
III. Outcome
- Provide proper interventions of the signs and symptoms manifested by the patient.
- Patient must be able to understand their condition and the need for care and treatment.
A. Ethico-Moral Responsibilities
1. Beneficence. It is the practice of doing acts of goodness, kindness and charity.
Principle of Beneficence says, “Do no harm and produce the good”. Beneficence
suggests acts of “mercy” and charity or actions that benefit others.
2. Non-Maleficence. “Harm or pain should not be inflicted upon others”. This
involves the action of refraining from inflicting harm.
3. Autonomy. It is a form of personal liberty, the individual is free to choose and
implement his own decision, free from deceit, duress, coercion or constraint.
4. Confidentially. Information obtained from the patient should be kept and
secured. Personal privacy is a basic right.
5. Veracity. Defined as being honest and telling the truth and is related to the
principle of autonomy
6. Justice The rendering of what is due or merited. This is also the principle of
equity, related to fairness, impartiality, equal access to health care and allocation
of scarce resources.

1. Beneficence. The nurse will care for the patient to promote health and healing
for the welfare of the patient. Under this application, if a surgery occurs, the nurse
will educate ways to promote healing.
2. Non-Maleficence. The nurse will not inflict intentional pain unto the patient while
conducting her nurses interventions. For example, the nurse will examine the
fetal heartbeat without the placement of more than increased pressure on the
abdomen.
3. Autonomy. The patient and next of kin has the right to decide on the actions to
follow for the patient’s welfare, not the nurse.
4. Confidentially. The records of the patient shall be secured and not be shared to
others than the multidisciplinary team.
5. Veracity. The student nurse will be honest and tell the truth when questions are
being asked. If it is beyond her scope of profession, the nurse will notify the
Doctor of any questioning.
6. Justice. The nurse will not discriminate against the patient’s medical
background, occupational or cultural background, or any political views. The
nurse will treat her impartiality and equally when caring for the patient.
Republic Act No. 9173 - An Act Providing For A More Responsive Nursing Profession,
Repealing For The Purpose Republic Act No. 7164, Otherwise Known As “The Philippine
Nursing Act of 1991” And For Other Purposes

Republic Act No. 8344 - An Act Penalizing The Refusal of Hospitals and Medical Clinics
To Administer Appropriate Initial Medical Treatment and Support In Emergency Or
Serious Cases, Amending For The Purpose Batas Pambansa Bilang 702, Otherwise
Known As "An Act Prohibiting The Demand Of Deposits Or Advance Payments For The
Confinement Or Treatment Of Patients In Hospitals And Medical Clinics In Certain
Cases"
Republic Act 10354 - An Act providing for a National Policy on Responsible
Parenthood and Reproductive Health, Otherwise Known As “The Responsible
Parenthood and Reproductive Health Act of 2012”
● The nurse should have initiative to attend programs, seminars, and training to
enhance understanding of spontaneous abortion.
● Read and study journals and articles related to spontaneous abortion
interventions and management.
● Be open to feedback to reflect on, and improve delivery of care and enhance
competency.
● Keep up to date on the department of health regarding spontaneous abortion to
gain furhter knowledge.

Nurses in the field of education should be well informed on the topic of abortion.
As a common factor in many pregnancies and often seen in most hospital settings, it is
Important for future generation nurses to be educated on the signs and symptoms of
abortions. Nurses should be updated on new readings and conferences involving this
topic to further enhance the experience and knowledge of nursing students and staff.
B. Nursing Practice
This case is important for nursing practice since staff nurses rely heavily on prior
experience learned from similar cases as a guide in rendering care for expectant
mothers who have experienced a miscarriage. Patients may show different or the same
signs; thus, the nurse must be prepared to provide each patient with the quality
treatment they need. They have to be trained in all areas of treatment, and to do the
best they can in these cases .
C. Nursing Research
Nurses should be informed of updated researches to help be advanced in details
concerning abortion in order to offer better patient care. Information like these can help
the nurses be more effective to draw their own conclusion and give greater nursing
interventions. This would improve the knowledge of what the nurse already knows and
improve clinical expertise.
Nurses in the administration role, should be updated on research and gather

data for quality improvements. They should also detect and recognize areas in the
nursing sector that should be updated. Under the administration, they would also
organize and facilitate client care by determining and identifying tasks or activities
needed to be accomplished.
VIII. Bibliography
hiladelphia, Pennsylvania. F.A. Davis.

Prioritized Interventions, and Rationales. P
hCG levels. ( n.d.). Retrieved from
https://www.pregnancybirthbaby.org.au/hcg-levels#:~:text=hCG%20levels%20are%2
0highest%20towards,10%20to%2025%20U%2FL/
Greibel, C. et al. (2005). Management of Spontaneous Abortion. Retrieved form
https://www.aafp.org/afp/2005/1001/p1243.html#:~:text=Ultrasonography%20is%20h
elpful%20in%20the,also%20may%20play%20a%20role.
Hyder, C., (2008). A case of first-trimester vaginal bleeding with abdominal cramping.
Retrieved from
https://www.clinicaladvisor.com/home/features/clinical-challenge/a-case-of-first-trime
ster-vaginal-bleeding-with-abdominal-cramping/
Kuning, M., McNeil, D., & Chongsuvivatwong, V. (2003). Pregnancy loss in the
Philippines. Southeast Asian journal of tropical medicine and public health, 34( 2),
433-442.
https://www.tandfonline.com/doi/abs/10.1080/10937400701873530
Miscariage. (n.d.). Retrieved form
https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/diagnosi
s-treatment/drc-20354304
https://www.doh.gov.ph/sites/default/files/policies_and_laws/RA08344.pdf.
etrieved from
Wolter, J., (2013). The Process of Implantation of Embryos in Primates. R
https://embryo.asu.edu/pages/process-implantation-embryos-primates#:~:text=The%
20lining%20of%20the%20uterus,embryo%20sloughs%20off%20during%20menstrua
tion.&text=If%20the%20zygote%20implants%20in,result%20is%20an%20ectopic%2
0pregnancy.
Juarez, Fatima & Cabigon, Josefina & Singh, Susheela & Hussain, Rubina. (2005). The
Incidence of Induced Abortion in the Philippines: Current Level and Recent Trends.
International family planning perspectives. 31. 140-9. 10.1363/ifpp.31.149.05.
IX. Posttest Questions (10 item multiple choice with four choices)
1. What is the medical term for any interruption of a pregnancy before a fetus is viable?
a. Abortion
b. Missed Miscarriage
c. Incomplete Miscariage
d. Habitual Miscarige
2. All include symptoms of miscarrage EXCEPT:
a. Bleeding
b. Cramping of pelvic region
c. Discharge of Fluid
d. Skin rashes and lesions
3. How do you perform a human chorionic gonadotropin (HCG) test?
a. Blood test or Urine test
b. X-ray
c. Ultrasound
d. MRI
4. Which of the following is NOT a risk factor for spontaneous miscarriage?
a. Women greater than 35 years old
b. History of Spontaneous miscarrage
c. Poorly controlled chronic disorders
d. Healthy lifestyle practices
5. ____________may begin with a gush of fluid when the membranes rupture.
a. Early Spontaneous Miscarriage
b. Late Spontaneous Miscarraige
c. Current Spontaneous Miscarraige
d. Incomplete Miscarriage
College of Nursing
Ectopic Pregnancy
Group 2:
Cordero, Ciaren
Ebron, Gergelae
Table of Contents
Case Scenario…………………………………………………………………………….
Objectives………………………………………………………………………………....
Levels Of Care…………………………………………………………………………….
Bibliography……………………………………………………………………………....
Post Test Questions……………………………………………………………………....
❖ Case Scenario………………………………………………………... Ebron, Gergelae
❖ Objectives……………………………………………………………... Agraviador, Noel Jr.
❖ Mini-Lecture of Disease…………………………………………….... Ebron, Gergelae
❖ Pathophysiology………………………………………………………. Bulauitan, Mia Maricar
❖ Levels Of Care………………………………………………………… Cordero, Ciaren

- Communication………………………………………………... De Los Reyes, Hannah
- Health Education………………………………………………. Calderon, Krystyn Andrei
- Collaboration and Teamwork…………………………………. Calderon, Krystyn Andrei
Enabling Competency
- Management of Resources and Environment………………. De Los Reyes, Hannah
- Records Management…………………………………………. Agraviador, Noel Jr
- Research Proposal……………………………………………... Calderon, Krystyn
Andrei & Bulauitan, Mia Maricar
- Quality Improvement………………………………………….... Agraviador, Noel Jr.
- Ethico-Moral Responsibilities………………………………….. Calderon, Krystyn Andrei
- Moral Responsibilities (RA 9173)........................................... Cordero, Ciaren
- Personal and Professional Development…………………….. Bulauitan, Mia Maricar
Nursing Education………………………………………………………... Cordero, Ciaren
Nursing Practice………………………………………………………….. Agraviador, Noel Jr
Nursing Research………………………………………………………… Bulauitan, Mia Maricar
Nursing Administration…………………………………………………… De Los Reyes, Hannah
❖ Post Test Questions………………………………………………………. Cordero, Ciaren

I. Case Scenario
Talia is a 40-year old woman, G3P1, who conceived naturally, attended the
outpatient with vaginal bleeding for 29 days and mild cramping on both sides of the
pelvic area. Beta-hCG test was done with a result of 250,128 mlU/ml, with an estimated
gestational age of 7 weeks. Transvaginal ultrasound was performed, which revealed
complex adnexal masses measured 25x13 mm on the left side and a similar one
measured 23x17 mm on the other side. No intrauterine gestational sac was identified.
Bilateral ectopic pregnancy was suspected and she was admitted to the hospital. Upon
physical examination, the abdomen was tender without rebound or guarding. Bimanual
examination suggested uterine tenderness and bilateral adnexal tenderness. There were
no obviously palpable masses. She denied syncope, dyspnea, nausea, or vomiting. She
noted smoking 1 pack of cigarettes a day. Upon health history taking, it was revealed
that she has a history of chlamydia and endometriosis. Her vital signs were stable with a
blood pressure of 124/85 mmHg, a pulse of 80 bpm, a respiration of 20bpm, and a
temperature of 37.2°C. Because of the high levels of beta-hCG and for the benefits of
less postoperative pain and fewer complications, a diagnostic laparoscopy was
immediately done to inspect her uterus and adnexa, and masses were observed on both
sides. The patient then indicated no desire to future pregnancy before the operation, a
decision was then concluded to do a salpingectomy bilaterally. Villi were revealed clearly
in resected fallopian tubes. The diagnosis of bilateral tubal pregnancy was confirmed.
After surgery, the patient was admitted in a private room, was assessed and described
her pain as a 4/10 on a scale of 0 to 10. Ten being the highest. Showed no signs of
fever, or tenderness around the surgery site.
II. Objectives
knowledge about ectopic pregnancy, develop skills and attitudes on how to formulate an
effective and necessary nursing intervention and plan of care to promote wellness and
prevent any further complications of ectopic pregnancy.
A. Knowledge
● Identify signs and symptoms of ectopic pregnancy.
● Learn the definition, causes, risk factors, treatment of ectopic pregnancy.
affected.
● Formulate a nursing care plan relevant to ectopic pregnancy.
B. Attitudes
patients.
ectopic pregnancy.
C. Skills
in ectopic pregnancy.

● Provide significant health teachings that would promote health and wellness to
the patient.
A. Introduction
An ectopic pregnancy is one in which an implantation occurred outside the uterine
cavity. An ectopic pregnancy an egg can implant itself in a woman’s ovary, cervix, and
fallopian tube. The most common site is in the fallopian tube. Of these fallopian tube
sites, approximately 80% occur in the ampullar portion, 12% occur in the isthmus, and
8% are interstitial or fimbrial. With ectopic pregnancy, fertilization occurs as usual in the
distal third of the fallopian tube. Unfortunately, because as obstruction is present, such
as the adhesion of the fallopian tube from a previous infection, congenital malformations,
scars from tubal surgery, or a uterine tumor pressing on the proximal end of the tube, the
zygote cannot travel the length of the tube. It lodges at a structured site along the tube
and implants there instead of the uterus. Although a tubal pregnancy is common, a
bilateral tubal ligation is the rarest form of ectopic pregnancy. The incidence is higher in
women undergoing assisted reproductive techniques or ovulation induction. The clinical
presentation is unpredictable and there are no unique features to distinguish it from
unilateral ectopic pregnancy. BTP continues to be a clinician’s dilemma as preoperative
diagnosis is difficult and is commonly made during surgery.
B. Definition of the Disease
With an ectopic pregnancy, there are no unusual symptoms at the time of
implantation. The corpeus luteum of the ovary continues to function as if the implantation
were in the uterus so no menstrual flow occurs. A woman begins to experience the usual
nausea and vomiting of early pregnancy and a test for hCG will be positive. The zygote
grows large enough that it ruptures the slender fallopian tube. Constant, continued
bleeding from this area, may result in a large amount of blood loss over time. A ruptured
ectopic pregnancy is serious regardless of the site of implantation. A woman usually
experiences a sharp, stabbing pain in one of her lower abdominal quadrants at the time
of rupture, followed by a scant vaginal spotting. As soon as the woman becomes
hypotensive from additional vaginal bleeding and blood loss, she will experience
light-headedness and a rapid pulse, signs of hypovolemic shock. If a woman waits
before seeking help, her abdomen gradually becomes rigid from peritoneal irritation. Her
umbilicus may develop a blue-tinged hue or Cullen’s sign.
C. Causes
The cause of an ectopic pregnancy isn’t always clear. In some cases, the following
conditions have been linked with an ectopic pregnancy:
● Inflammation and scarring of the fallopian tubes from a previous medical

condition, infection, or surgery
● Hormonal factors
● Genetic abnormalities
● Birth defects
● Medical conditions that affect the shape and condition of the fallopian tubes and
reproductive organs
D. Risk Factors
All sexually active women are at some risk for an ectopic pregnancy. Risk factors
increase with any of the following:
● Previous ectopic pregnancy. If you've had this type of pregnancy before, you're
more likely to have another.
● Inflammation or infection. Sexually transmitted infections, such as gonorrhea or
chlamydia, can cause inflammation in the tubes and other nearby organs, and
increase your risk of an ectopic pregnancy.
● Fertility treatments. Some research suggests that women who have in vitro
fertilization (IVF) or similar treatments are more likely to have an ectopic
pregnancy. Infertility itself may also raise your risk.
● Tubal surgery. Surgery to correct a closed or damaged fallopian tube can
increase the risk of an ectopic pregnancy.
● Choice of birth control. The chance of getting pregnant while using an intrauterine
device (IUD) is rare. However, if you do get pregnant with an IUD in place, it's
more likely to be ectopic. Tubal ligation, a permanent method of birth control
commonly known as "having your tubes tied," also raises your risk, if you become
pregnant after this procedure.
● Smoking. Cigarette smoking just before you get pregnant can increase the risk of
an ectopic pregnancy. The more you smoke, the greater the risk.
● History of endometriosis and pelvic inflammatory disease (PID)
● Having structural abnormalities in the fallopian tubes that make it hard for the egg
to travel.
E. Patients History
Patient is a 25-year old woman who has an obstetric history of gravida 3 para 1, and
conceived naturally. She has complained of vaginal bleeding for 29 days. She denies
feeling any of the symptoms of syncope, dyspnea, nausea, or vomiting and did not have
a history of pelvic inflammatory diseases or STDs.

A transvaginal ultrasound will demonstrate the ruptured tube and blood collecting in
the peritoneum. Either a falling hCG or serum progesterone level suggests the
pregnancy has ended. If the diagnosis of ectopic pregnancy is in doubt, a healthcare
provider may insert a needle through the posterior vaginal fornix into the cul-de-sac
under sterile conditions to see whether blood can be aspirated. A laparoscopy or
culdoscopy can also be used to visualize the fallopian tube if the symptoms alone do not
reveal a clear picture of what has happened. However, ultrasonography alone usually
reveals a clear-cut diagnostic picture. When an ectopic pregnancy is revealed by an
early ultrasound, she is usually medically treated by the oral administration of
methotrexate. Women are treated until a negative hCG titer is achieved. A
hysterosalpingogram or ultrasound is usually performed to assess that the pregnancy is
no longer present and also whether the tube appears fully patented. A blood sample
needs to be drawn immediately for hemoglobin level, typing and cross-matching, and
possibly the hCG level for immediate pregnancy testing. Intravenous fluid using a
large-gauge catheter to restore intravascular volume and blood will be prescribed. The
therapy for ruptured ectopic pregnancy is laparoscopy to ligate the bleeding vessels and
to remove or repair the damaged fallopian tube. She may have continuing extensive or
dull vaginal and abdominal pain; movement of the cervix on pelvic examination can
cause excruciating pain. A tender mass is usually palpable in Douglas cul-de-sac on
vaginal examination. Some ectopic pregnancies spontaneously end before they rupture
and are reabsorbed over the next few days, requiring no treatment.
IV. Pathophysiology
The patient’s predisposing factors and precipitating factors are the examples of the risks
of having an ectopic pregnancy. Evidence from the signs and symptoms suggests she has an
ovum implanted outside of her uterus. During admission, she presented with vaginal bleeding
and pelvic pain.
V. Levels Of Care
A. Preventive
There's no way to stop an ectopic pregnancy, but there are ways to reduce the
risk. A woman needs to reduce the number of partners she engages sexually. During
sexual intercourse, she must always use a condom to help avoid sexually transmitted
diseases, and reduce the risk of inflammatory pelvic disease. If she wants to become
pregnant she has to stop unhealthy lifestyle practices, like smoking cigarettes.
B. Promotive
Ectopic pregnancies are diagnosed by a physician, who will probably first perform
a pelvic exam to locate pain, tenderness, or a mass in the abdomen (fallopian tube and
ovary).
The physician may test progesterone levels because low levels could be a sign of
an ectopic pregnancy. In addition, the physician may do a culdocentesis. It is a
procedure in which peritoneal fluid is obtained from the cul de sac of a female patient. It
involves the introduction of a spinal needle through the vaginal wall into the peritoneal
space of the pouch of Douglas. The presence of blood in this area may indicate bleeding
from a ruptured fallopian tube.
Blood tests like the human chorionic gonadotropin (hCG) will be ordered by the
doctor to confirm that you're pregnant. Levels of this hormone increase during
pregnancy. An hCG level that is lower than expected is one reason to suspect an ectopic
pregnancy. A complete blood count will be done to check for anemia or other signs of
blood loss.
An ultrasound determines whether the uterus contains a developing fetus. A
transvaginal ultrasound allows the doctor to see the exact location of the pregnancy.
This uses sound waves to create images of the uterus, ovaries and fallopian tubes, and
sends the pictures to a nearby monitor. An abdominal ultrasound may also be used to
confirm your pregnancy or evaluate for internal bleeding.

C. Curative
An ectopic pregnancy may be treated by an injection of Methotrexate. This is
given to allow the body to absorb the pregnancy tissue and may save the fallopian tube,
depending on how far the pregnancy has progressed, which stops cell growth and
dissolves existing cells. If the tube has become stretched or has ruptured and started
bleeding, part or all of it may have to be removed. In this case, bleeding needs to be
stopped promptly, and emergency surgery is necessary.
Laparoscopic surgery under general anesthesia may be performed. This is a
procedure that uses a laparoscope to remove the ectopic pregnancy and repair or
remove the affected fallopian tube to prevent life-threatening complications. If the ectopic
pregnancy cannot be removed by a laparoscopically, a laparotomy may be done.
If the ectopic pregnancy is causing heavy bleeding, emergency surgery through
an abdominal incision may be needed. In some cases, the fallopian tube can be
repaired. Typically, however, a ruptured tube must be removed through a salpingectomy.
D. Rehabilitative
hCG levels are needed to be checked on a regular basis until it reaches zero. An
hCG level that remains high could indicate that the ectopic tissue was not entirely
removed, which would require surgery or medical management with methotrexate.
Follow up visitations to the physician is necessary.
Losing a pregnancy is devastating. A mother should recognize the loss, and to
give herself a time to grieve. She must talk about her feelings and allow her to
experience them fully. Encourage the mother to rely on her partner, loved ones and
friends for support. She might also seek the help of a support group, grief counselor or
other mental health provider. She needs a good support system to help her cope with
what she's going through.
If the patient wishes to try to get pregnant again, regular doctor's checkups are
necessary. Early blood tests and ultrasound testing quickly spot an ectopic pregnancy or
provide peace of mind that the pregnancy is developing normally.
VI. Clustering of the Eleven Key Areas of Responsibility
Krystyn GERGE Gerge CIAREN
Acute pain Short Independent: Short Medications:

Subjective: related to - Assess for Patient may
- Patient
term: - To help Term: be prescribed
surgical referred pain, determine
noted vaginal intervention After 1hr of as Met, after with pain
intervention, possibility successful medications.
bleeding for as appropriate. of
29 days and evidenced the patient's nursing Advice her to
pain scale underlying take the
mild cramping by the condition or intervention
will medications
on both sides patient’s organ the patient as directed by
of the pelvic report of decrease verbalized
from a 4 to a dysfunction her physician.
area. pain: requiring that her
-pain scale Short Term: pain has
treatment. Environment:
-Verbalized 4/10 in a 2. decreased Instruct the
pain scale of scale of 0 to Long from a 4 to patient to stay
4/10. 10. 10 term: a 2. in a calm and
being the After 1 day quiet
- Smokes 1 highest. - Evaluate environment,
of nursing - To assess Long
pack of pain so that she
intervention, pain and can feel
cigarettes a the patient characteristics duration. Term:
relaxed.
day. will be able and intensity. Met. The
to verbalize patient Treatment:
- History of non - Perform pain - To verbalized Advise patient
chlamydia pharmacolo assessment demonstrat relief of pain to adhere to
and gical each time pain e through the
endometriosis methods occurs. improveme non physician’s
. that could Document and nt in status pharmacolo orders and to
provide investigate or to gical return for
changes from methods. follow-up
Objective: relief. identify
previous checkups.
- Beta-hCG worsening
done with a reports and of
evaluate Health
result of underlying Teaching:
21,438 IU/L. results of pain conditions/ Teach patient
interventions. developing proper wound
-Transvaginal complicatio care. Instruct
ultrasound ns. her to
carefully wash
revealed
around the
complex - Monitor skin - Are wound with
adnexal color and usually soap and
masses temperature altered in water. Let the
measured and vital acute pain. soap and
25x13 mm on signs. water gently
the left side run over the
and 23x17 on incision. Dry
the right side. Dependent: the area and
put on new,
- Abdomen - Collaborate - To clean
was tender with physician provide dressings.
without in treatment of relief of
Outpatient:
rebound or underlying pain.
Instruct
guarding. condition or patient to
disease seek care
- Bimanual processes immediately if
examination causing pain blood soaks
suggested and proactive through the
uterine management wound
tenderness of pain. dressings.
and bilateral If she has
adnexal - Administer trouble
tenderness. analgesic - To urinating or
medications maintain cannot urinate
prescribed by level of at all.
the physician. pain and
Diet: Discuss
pain control ways of
goal. promoting
wellness like
taking
vitamins and
eating
healthy.
Support
System:
Instruct family
that the
patient will
need physical
and emotional
support once
she gets
discharged.
B. Communication
Communication is essential to health care. For a patient-nurse relationship to be
effective, they must be able to communicate to each other therapeutically. Nurses must
understand and help their patient, demonstrate courtesy and kindness. These
techniques may be observed for a useful conversation:
- Asking open ended questions
Asking open ended questions helps with communication because this lets
the client feel in control with the direction of the conversation and this enhances
his/her role in the interaction.
- Attentive, Active Listening
Active listening is an essential part of communication. Active and attentive
listening requires the nurse to listen to the patient. It entails the nurse’s hearing,
processing, and purposefully comprehending the clients words. The nurse must
also process these words in context of the client's situation and actions sent to
the nurse.
- Silence
At times it is useful to not speak it all. This will give the client time to
organize and collect his/her thoughts. Nurses should always let the patient break
the silence.
- Offering self
This type of communication skill is important because the nurses make
themselves available to their patients/ clients which helps build a relationship
between nurse and client.
- Using touch
When using the tactile sensation, one must make sure that it is being
used appropriately. By appropriately using touch, the nurse reinforces a feeling of
care towards the client.
- Accepting
It is important to acknowledge the patient when having a conversation
with them. Patients who feel that his/her nurses are actively accepting and
listening they become more responsive to care.
- Voicing Doubt
Voicing doubt is known to be a gentler way to to call attention to the
incorrect ideas and perceptions of patients. When a nurse voices doubt, it forces
the patient to examine their assumptions.
- Offering Hope and Humor
One of the most important techniques in communication, the hospital is a
stressful place to many. When sharing hope, and using humor to lighten up the
mood and perspective of the patient, the nurse is easily able to establish rapport.
C. Health Education KRYSTYN
After 1 hours and 30

minutes of discussion, the
patient will be able to:
1. Understand the 1. An ectopic

definition of ectopic pregnancy is one in
pregnancy. which an implantation
occurred outside the
uterine cavity. The
most common site is
in the fallopian tube.
Of these fallopian
tube sites, DISCUSSION
approximately 80%
occur in the ampullar
portion, 12% occur in
the isthmus, and 8%
are interstitial or
fimbrial. With ectopic
pregnancy,
fertilization occurs as
usual in the distal third
of the fallopian tube.
Unfortunately,
because an
obstruction is present,
such as the adhesion
of the fallopian tube
from a previous
infection, congenital
malformations, scars
from tubal surgery, or
a uterine tumor
pressing on the
proximal end of the
tube, the zygote
cannot travel the
length of the tube. It
lodges at a structured
site along the tube
and implants there
instead of the uterus
2. Know the causes of 2. The cause of an

an ectopic ectopic pregnancy
pregnancy. isn’t always clear. In
some cases, the
following conditions
have been linked with
an ectopic pregnancy:
- Inflammation and DISCUSSION
scarring of the
fallopian tubes from a
previous medical
condition, infection, or
surgery
- Hormonal factors
- Genetic abnormalities
- Birth defects
- Medical conditions
that affect the shape
and condition of the
fallopian tubes and
reproductive organs
3. Know the treatment 3. The therapy for ruptured

of an ectopic ectopic pregnancy is
pregnancy. laparoscopy to ligate the
bleeding vessels and to
remove or repair the
damaged fallopian tube. She
may have continuing LECTURE
extensive or dull vaginal and
abdominal pain; movement of
the cervix on pelvic
examination can cause
excruciating pain. A tender
mass is usually palpable in
Douglas cul-de-sac on
vaginal examination. Some
ectopic pregnancies
spontaneously end before
they rupture and are
reabsorbed over the next few
days, requiring no treatment.
IV. Time Allocation
(Proper Referral such as, Dietician, Cardiologist and Pharmacist)
OB Doctor: An obstetrician is a doctor who has successfully completed
advanced education and training in pregnancy, labour and puerperium management (the
time-period immediately after childbirth). A gynecologist, is a physician who has
successfully completed advanced education and training in women's reproductive
system health including the diagnosis and treatment of disorders and diseases.
OB-GYN Nurse: An OB-GYN nurse is a registered nurse who provides women,
and often children, with direct treatment. OB-GYN nurses work in the hospital labor and
delivery, and postpartum wards, as well as in birth centers and pediatric or ambulatory
clinics. Some of their roles include accepting patients, taking medical records and
supporting doctors during procedures. They can administer medicines, use fetal
monitors or perform ultrasounds.
Dietician: Dietitians have developed food and nutrition experience, and are
committed to improving the health of their patients and their society. Dieticians form an
important part of systematic, systemic and multidisciplinary approach to patients and
their care. Usually, they work together with the physicians, clinical and nursing staff to
ensure patients receive sufficient dietary care.

Pharmacists: Pharmacists are medication experts and play a critical role in
helping people get the best results from their medications. They prepare and dispense
prescriptions to patients.
A. Management of Resources and Environment
The nurse will ensure that appropriate physical needs are addressed and monitor
for complications. The nurse will then assess the vital signs, bleeding, and pain. He or
she will then provide the client and family teaching to relieve anxiety. The nurse will then
explain the condition and expected outcome. The doctor will assess for maternal
prognosis with early diagnosis and prompt treatment, such as laparotomy, to ligate
bleeding vessels and repair or remove the damaged fallopian tube. The nurse will then
administer pharmacologic agents, such as methotrexate followed by leucovorin that may
be given orally when ectopic pregnancy is diagnosed by routine sonogram before the
tube has ruptured. A hysterosalpingogram usually follows this therapy to confirm tubal
patency. The nurse will determine if the client is Rh-negative and then must receive
RhoGAM to provide protection from isoimmunization for future pregnancies. Lastly, the
nurse will explain the self-care measures to the client, which would depend on the
treatment prescribed by the doctor.

14-09-2020 Vaginal bleeding, mild Data
- Patient verbalised
cramping. Abdomen tender mild cramping on
both sides of the
without rebound or pelvic area and
reported vaginal
guarding from the patient. bleeding.
- Patient noted no
syncope, dyspnea,
nausea, or
vomiting. She noted
smoking 1 pack of
cigarettes a day.
- Assessment:
vaginal bleeding,
mild cramping on
both sides of the
pelvic area, tender
abdomen, suggestd
uterine and bilateral
adnexal
tenderness.
Action
- Take vital signs
- Prepare patient for
surgery
- Measure intake and
output
- Assess for pain
post-op
Response
- Diagnostic
laparoscopy was
performed and
bilateral tubal
pregnancy was
confirmed.
- Patient verbalised
discomfort in the
pelvic area
I. Focus Data
Bimanual examination suggested uterine and bilateral adnexal tenderness.

II. Action
III. Response
A. Research Proposal
Title. Clinical Study of Ectopic Pregnancy
Introduction
According to this study, an ectopic pregnancy occurs 1 out of 160 deliveries.
“Clinical presentation is variable from acute to chronic type. Due to its varied clinical
presentation, ectopic pregnancy poses great diagnostic difficulty both to obstetricians,
physicians and surgeons”. (Sharma, 2015)
Objective
To find out incidence in our study population and to evaluate symptomatically and
clinical presentation in these patients.
Methodology
Retrospective study of 34 ectopic pregnancies admitted and treated in Medical
College hospital, Ujjain from 2010 to 2015 are included in the study.
Results
The incidence of ectopic pregnancy is more between the age group of
21-30years (73.52%) and in Multigravida 64.71%. Infertility and previous tubal surgery
are the high risk factors for tubal pregnancy. Pain in the abdomen was present in all 34
cases, amenorrhea in 97.05% and bleeding per vagina in 76.47% cases. Syncopal
attacks, vomiting were detected in 14.70% cases. Acute ectopic pregnancy was detected
in 14.71% and chronic in 85.29% cases. 82.35% cases presented with adnexal mass,
79.41% with cervical motion tenderness, 50% with pallor, 32.35% with abdominal lump
and tenderness.
Discussion
Ectopic pregnancy is the leading cause of maternal mortality in the first trimester.
In spite of advanced diagnostic techniques. It poses great diagnostic difficulties due to
varied signs and symptoms. Previous tubal surgery pelvic inflammatory disease and
infertility are the risk factors of tubal pregnancy.
Title. “Double trouble: A case of bilateral tubal pregnancy”
Department of Obstetrics and Gynecology, Quezon City General Hospital
Introduction.
This is a case study about a 24-year old female who presented to the emergency
room complaining of severe hypogastric pain. She was then admitted with a case of
ectopic pregnancy. Under this study they discussed the risks of developing ectopic
pregnancy, the incidence of bilateral tubal pregnancy, and discussed the diagnosis and
management of bilateral tubal pregnancy
Methodology
The researchers utilized the case study type of research to conduct this study on this.
Results
Tubal surgery was considered because of the patient's acute symptoms instead
of the laparoscopic surgical treatment. “Intraoperatively, the left fallopian tube was
converted to a 4x4 centimeters hemorrhagic mass with a 1.5 centimeter point of rupture
at the ampullary area. The right fallopian tube is converted to a 6x6 centimeters cystic
hemorrhagic mass with no point of rupture. With bilateral salpingectomy, the chances of
having another natural pregnancy is impossible. The only way for her to have another
pregnancy is through assisted reproductive technology such as in vitro fertilization which
cannot be afforded by the patient”.
Discussion
The researchers defined ectopic pregnancy, discussed the pathophysiology of
bilateral tubal pregnancy, the pathophysiology of bilateral tubal pregnancy and the case
of the bilateral tubal pregnancy in the 24-year-old female.
I. Institution
- Tertiary hospitals can provide optimal and immediate care for the patient. Has
healthcare personnel and equipment which can address all of the patient’s
needs.
- Pharmacy department can provide necessary medication.
- Emergency department can provide immediate care if needed.
II. Process
- Assess and record vital signs.
- Assess bleeding, cramping, and pain.
- Provide health teaching to the client and family.
- Address emotional, psychosocial and spiritual needs.
III. Outcome
- Provide correct intervention of signs and symptoms of the patient.
- Patient should be able to understand their condition, situation, and process for treatment.
A. Ethico-Moral Responsibilities
Republic Act No. 9173 - An Act Providing For A More Responsive Nursing
Profession, Repealing For The Purpose Republic Act No. 7164, Otherwise Known As
“The Philippine Nursing Act of 1991” And For Other Purposes
Code of ethics for nurses. Nurses must 1. Respect the Patients' Bill of Rights‖ in
the delivery of nursing care. 2. Provide the patients or their families with all pertinent
information except those which may be deemed harmful to their well-being. 3. Uphold
the patients’ rights when conflict arises regarding management of their care.
The 1987 Constitution Of The Republic Of The Philippines Article XIII - Social
Justice and Human Rights
WOMEN Section 14. The State shall protect working women by providing safe
and healthful working conditions, taking into account their maternal functions, and such
facilities and opportunities that will enhance their welfare and enable them to realize their
full potential in the service of the nation.
In order to be updated with the ongoing medical technology and advances the
nurse should attend training and seminars. This will allow them to be more educated and
effective in providing care to mothers who may be experiencing an Ectopic Pregnancy.

The nurse should continue to become updated with the developments and
improvements to acquire new skills and knowledge as they attend conferences and read
through articles and new journal articles.
This topic is significant for nursing education as this particular case is found in
clinical areas and discussed during classes. With the guidance of teachers and clinical
mentors, student nurses would be able to use critical reasoning to assess the effects of
an ectopic pregnancy on the patient and her family. This shows awareness of the
condition and being able to answer questions about the disease. Nursing educators
should pass on their clinical expertise and knowledge to the students in order to provide
practical lessons that could prepare students towards their own experience.
B. Nursing Practice
Patients may show different or similar signs, so nurses need to be able to assess
the necessary areas to gain a full understanding of the situation to be able to report
correctly to the attending physician. After assessment, the nurse should care for the
needs the patient may have pre-op and post-op.
C. Nursing Research
In research, nurses should become aware of studies being conducted in other
areas rather than here in the Philippines. Since the Philippines is a third world country,
nurses can learn improvements and medical advances in topics related to Ectopic
pregnancies from those more medically advanced countries. Through research, they will
gain more knowledge and skills related to ectopic pregnancies. After gaining knowledge
from studies, nurses have the ability to bring it to their workplace and spread research
based practices to her area.
In nursing administration, the administrative staff should be knowledgeable of
those with this condition. With the organization skills while accomplishing tasks of the
nursing practice, the further expansion of knowledge on ectopic pregnancies would be
beneficial to the world of maternal and child health nursing. Through constant direction
and order within the areas of obstetrics and gynecology of the hospital, the care to the
patients with ectopic pregnancies would not be overlooked. Nursing Administrations
need planning, organizing, staffing, directing, coordinating, reporting and budgeting to
properly attend to clients with this condition.
X. Bibliography
Chang, C. J. (2019, November 19). Double trouble: A case of bilateral ectopic
pregnancy. Gynecology & Obstetrics.
https://www.longdom.org/proceedings/double-trouble-a-case-of-bilateral-ectopic-
pregnancy-45243.html
Prioritized Interventions, and Rationales. Philadelphia, Pennsylvania. F.A. Davis.

The 1987 Constitution Of The Republic Of The Philippines Article XIII - Social Justice
and Human Rights. (n.d.). Retrieved from
https://www.officialgazette.gov.ph/constitutions/the-1987-constitution-of-the-republic
-of-the-philippines/the-1987-constitution-of-the-republic-of-the-philippines-article-xiii/
#:~:text=Section%2014.,the%20service%20of%20the%20nation.
B, Swami & Sharma, Parul & Tyagi, Manvi & Kuswaha, Rinku & Harit, Juhee. (2015).
CLINICAL STUDY OF ECTOPIC PREGNANCY. Journal of Evolution of Medical
and Dental Sciences. 4. 15057-15062. 10.14260/jemds/2015/2136.
Ectopic pregnancy. n.d. Retrieved from
https://www.healthline.com/health/pregnancy/ectopic-pregnancy.
Hoffmann S., Abele H., & Bachmann C. (April 2016). Spontaneous Bilateral Tubal
Ectopic Pregnancy: Incidental Finding During Laparoscopy - Brief Report and
Review Literature. Geburtshilfe Frauenheilkd. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4846403/#:~:text=Bilateral%20tubal
%20ectopic%20pregnancies%20are%20rare%2C%20occurring%20only%20in%20
around,techniques%20(ART)%20were%20reported.
Pilliteri, A. (2014). Volume 1 Maternal and Child Health Nursing Care of the Childbearing
and Childrearing Family Seventh Edition. Philadelphia, Pennsylvania. Lippincott
Williams & Wilkins.

Risks and Causes of Ectopic Pregnancy. Retrieved from
https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-cause
s/syc-20372088.
XI. Posttest Questions (10 item multiple choice with four choices)
1. It is when fertilized egg implantation occurs outside the uterine cavity.

a. Normal Pregnancy
b. Abdominal Pregnancy
c. Ectopic Pregnancy
d. Placenta Previa
2. In an ectopic pregnancy an egg can implant itself in:

a. An ovary
b. The cervix
c. A fallopian tube
d. All of the above
3. What does a woman usually experience first once there is a ruptured ectopic
pregnancy?
a. Sharp, stabbing pain in the lower abdomen
b. Nausea and vomiting
c. Signs of hypovolemic shock
d. Light vaginal spotting
4. During a ruptured ectopic pregnancy, her umbilicus may develop a blue-tinged hue. This
is known as ________.
a. Chvostek’s sign
b. Cullen’s sign
c. Homan’s sign
d. Trousseau’s sign
5. It is a cause that has been linked to ectopic pregnancies.

a. Hormonal factors
b. Genetic abnormalities
c. Birth defects
d. All of the above
6. It is a risk factor that increases the chances of a woman to have an ectopic pregnancy.
a. Previous ectopic pregnancy
b. Lifestyle factors: smoking
c. Fertility treatments
d. All of the above
7. What blood test would be requested by the physician to confirm that a woman is
pregnant?
a. Complete Blood Count (CBC)
b. Human Chorionic Gonadotropin (hCG)
c. C- Reactive Protein Test
d. D-dimer Test
8. It allows the doctor to see the exact location of the ruptured tube and blood that is being
collected in the peritoneum.
a. Abdominal ultrasound
b. Laparoscopy
c. Transvaginal ultrasound
d. Laparotomy
9. It is a treatment for ectopic pregnancy that is injected to allow the body to absorb the
pregnancy tissue and may save the fallopian tube.
a. Methotrexate
b. Dextromethorphan
c. Corticosteroid
d. Mifepristone
10. It is the surgical removal of one or both fallopian tubes.

a. Salpingectomy
b. Laparotomy
c. Colostomy
d. Oophorectomy

Com App Leprosy Abortion E. Pregnancy 1

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Com App Leprosy Abortion E. Pregnancy 1

Uploaded by

Copyright:

Available Formats

Central Philippines University

Agraviador, Noel Jr.

Clustering of the Eleven Key Areas of Responsibility…………………………….

Post Test Questions……………………………………………………………………....

Summary of Topic Assignments

❖ Case Scenario………………………………………………………... ​Bulauitan, Mia Maricar

❖ Objectives……………………………………………………………... ​Ebron, Gergelae

❖ Mini-Lecture of Disease…………………………………………….... ​Agraviador, Noel Jr.

❖ Pathophysiology………………………………………………………. ​Cordero, Ciaren

❖ Levels Of Care………………………………………………………… ​Bulauitan, Mia Maricar

❖ Clustering of the Eleven Key Areas of Responsibility

Patient Core Competency

- Nursing Care Plan…………………………………………….. ​All Members

- Communication………………………………………………... ​Calderon, Krystyn Andrei

- Health Education………………………………………………. ​De Los Reyes, Hannah

- Collaboration and Teamwork…………………………………. ​Agraviador, Noel Jr.

- Records Management…………………………………………. ​Ebron, Gergelae

- Research Proposal……………………………………………... ​Bulauitan, Mia &

Agraviador, Noel Jr.

- Quality Improvement………………………………………….... ​Cordero, Ciaren

- Ethico-Moral Responsibilities………………………………….. ​Calderon, Krystyn Andrei

- Moral Responsibilities (RA 9173)........................................... ​Cordero, Ciaren

- Personal and Professional Development…………………….. ​De Los Reyes, Hannah

Nursing Education………………………………………………………... ​Ebron, Gergelae

Nursing Practice………………………………………………………….. ​Agraviador, Noel Jr.

Nursing Research………………………………………………………… ​Cordero, Ciaren

Nursing Administration…………………………………………………… ​Calderon, Krystyn Andrei

❖ Bibliography……………………………………………………………….. ​All Members

❖ Post Test Questions………………………………………………………. ​De Los Reyes, Hannah

A 39 year old gentleman initially presented to a community health centre in

neuropathy were highly suggestive of lepromatous disease. He also had slight

Due to limited resources, the only suitable laboratory investigations available

leprosy as defined by the World Health Organisation’s (WHO) standard diagnostic

treatment with multidrug chemotherapy (100 mg Dapsone, 50 mg Clofazimine and 600

mg Rifampicin for 12 months).

Making the final push towards eradication: a clinical and public​”.

prevent any further complications of leprosy.

● Identify signs and symptoms of leprosy.

● Learn the definition, causes, risk factors, treatment of leprosy.

● Formulate a nursing care plan relevant to leprosy.

● Observe positive behavior in promoting and maintaining wellness among

● Administer properly the learned skills in actual procedures as part of intervention

● Enhance critical thinking in formulating nursing care plans.

III. Mini-Lecture of Disease

Hansen’s disease, also known as leprosy is a chronic infectious disease caused

B. Definition of the Disease

Hansen’s disease is a chronic infectious disease caused by Mycobacterium leprae

The Mycobacterium leprae is the causative bacteria of Hansen’s disease.

bacteria which can infect humans.

It is not exactly known how Hansen's disease is transmitted but it is likely

have a natural immunity to the disease.

- Prolonged contact with an untreated infected person.

- Contact with South America armadillos.

- Africa: Democratic Republic of Congo, Ethiopia, Madagascar,

Mozambique, Nigeria, United Republic of Tanzania

- Asia: Bangladesh, India, Indonesia, Myanmar, Nepal, Philippines, Sri

- Male patients are more prone to have reactions compared to females.

A 39 year old gentleman initially presented to a community health centre in

contact with untreated cases.

F. Diagnosis and Treatments

Treatment consists of a combination of antibiotics known as multidrug therapy to

clofazimine is added for Multibacillary, or lepromatous types of the disease.

❖ Case Scenario………………………………………………………... Bulauitan, Mia Maricar

❖ Objectives……………………………………………………………... Ebron, Gergelae

❖ Mini-Lecture of Disease…………………………………………….... Agraviador, Noel Jr.

❖ Pathophysiology………………………………………………………. Cordero, Ciaren

❖ Levels Of Care………………………………………………………… Bulauitan, Mia Maricar

- Nursing Care Plan…………………………………………….. All Members

- Communication………………………………………………... Calderon, Krystyn Andrei

- Health Education………………………………………………. De Los Reyes, Hannah

- Collaboration and Teamwork…………………………………. Agraviador, Noel Jr.

- Records Management…………………………………………. Ebron, Gergelae

- Research Proposal……………………………………………... Bulauitan, Mia &

- Quality Improvement………………………………………….... Cordero, Ciaren

- Ethico-Moral Responsibilities………………………………….. Calderon, Krystyn Andrei

- Moral Responsibilities (RA 9173)........................................... Cordero, Ciaren

- Personal and Professional Development…………………….. De Los Reyes, Hannah

Nursing Education………………………………………………………... Ebron, Gergelae

Nursing Practice………………………………………………………….. Agraviador, Noel Jr.

Nursing Research………………………………………………………… Cordero, Ciaren

Nursing Administration…………………………………………………… Calderon, Krystyn Andrei

❖ Bibliography……………………………………………………………….. All Members

❖ Post Test Questions………………………………………………………. De Los Reyes, Hannah

Making the final push towards eradication: a clinical and public”.

Subjective Impaired Short Independent: Short Medicatio

Clinical Perspective. A detailed travel, social and contact history should be