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BSN 2-D - GROUP 16 - Uterine Prolapse PBL
BSN 2-D - GROUP 16 - Uterine Prolapse PBL
COLLEGE OF NURSING
2ND SEMESTER, A.Y. 2020-2021
NCM 0109 RELATED LEARNING EXPERIENCE
Name: Anicete | Baquing | Bautista | Cayanan | Estacio | Jingco | Quiambao | San Pedro | Sanchez | Wakan Date: March 05, 2021
Year & Section: BSN 2-D Group Number: 16
PROBLEM
LEARNING CRITERIA FOR
LEARNING OBJECTIVE LEARNING QUESTION SOURCES/ EVIDENCES
ISSUE EVALUATION
MATERIALS
4. To learn the possible 4. What are the 4. Mayo Clinic. Uterine 4. COMPLICATIONS OF UTERINE PROLAPSE
complications of patient complications of Uterine Prolapse. Retrieved from
with Uterine Prolapse. Prolapse? https://www.mayoclinic.org/dise Difficulty of having bowel movements – a
ases-conditions/uterine- situation wherein there is a weakness of the
connective tissue that separates the rectum
prolapse/symptoms-causes/syc-
and vagina, which can cause the rectum to
20353458#:~:text=Urinary
bulge into vagina
%20problems%2C%20such Urine retention or urine incontinence – uterine
%20as%20urine,tone%20of prolapse can block urinary flow, resulting to
%20your%20vaginal%20tissue urinary problems
Kidney problems and urinary tract infections –
may happen in uterine prolapse when it blocks
the patient’s urine
5. To understand the 5. What are the six 5. Libretexts. (2020, September 5. PELVIC ORGAN PROLAPSE QUANTIFICATION
measurement parameters distinct locations (Aa, Ba, 28). 3.1: 3.1:Physical SYSTEM
of pelvic organ prolapse C, D, Ap, Bp) and three Examination and the POP-Q.
quantification system anatomical markers (GH, Medicine LibreTexts. Anterior vaginal wall:
(POP-Q System) PB, TVL)? https://med.libretexts.org/Books Point Aa
helves/Medicine/Book o Midline anterior vaginal wall 3cm proximal to
%3A_Urogynaecology/03%3A_ the external urethral meatus
Physical_Examination_and_the o -3 to +3
_POP-
-3, -2, -1 = above the vaginal opening
Q/3.01%3A_3.1Physical_Exami 0 = at the vaginal opening
nation_and_the_POP-Q +1, +2, +3 = below the vaginal
Pelvic Organ Prolapse opening
Quantification (POP-Q) System. o Client finding: -1 (1 cm above the vaginal
(n.d.). Physiopedia. Retrieved opening)
March 4, 2021, from Point Ba
https://www.physio- o Most superior location of the anterior vaginal
pedia.com/Pelvic_Organ_Prola wall
pse_Quantification_(POP- o -3 to +3
Q)_System o Client finding: -1 (1 cm above the vaginal
opening)
Madhu, C. (2018, August 1).
How to use the Pelvic Organ Upper vagina:
Prolapse Quantification
(POPâQ) system? Wiley Point C
o Most distal edge of the cervix or the leading
Online Library.
https://onlinelibrary.wiley.com/d edge of the vaginal cuff
oi/full/10.1002/nau.23740#: o -/+ cervix
%7E:text=There%20are%20six o Client finding: -0.5 (0.5 cm above the vaginal
%20defined%20points,vaginal opening)
%20apex%2C%20and Point D
%20posterior%20wall. o Most distal portion of the posterior fornix
o -/+ posterior fornix
o Client finding: -2 (2 cm above the vaginal
opening)
Point Ap
o Midline of posterior vaginal wall 3cm proximal
to hymen.
o -3 to +3
o Client finding: -1 (1 cm above the vaginal
opening)
Point Bp
o Most distal position of any part of the upper
posterior vaginal wall
o -3 to +3
o Client finding: -0.5 (0.5 above the vaginal
opening)
gh (Genial Hiatus)
o Length from the external urethral meatus to the
posterior margin of the hymen.
o No limit
o Client finding: 2 cm
pb (Perineal Body)
o Posterior margin of hymen to the mid-anal
opening.
o No limit
o Client finding: 3 cm
tvl (Total Vaginal Length)
o Posterior fornix to hymen
o No limit
o Client finding: 9 cm
6. To associate the 6. What are the 6. Auwad, W., Freeman, R., & 6. DIAGNOSTIC AND LABORATORY FINDINGS
client’s diagnostic and indications of the Swift, S. (2004). Is the pelvic
laboratory findings to her laboratory and diagnostic 1. Ultrasonography- UTZ is used during pregnancy to
organ prolapse quantification
condition, which can lead findings indicated in the check the baby's development, the presence of a
system (POPQ) being used? A
to certain complications. scenario? multiple pregnancy and to help pick up any
survey of members of the
abnormalities. Sonography revealed the following:
International Continence
Society (ICS) and the American
Urogynecologic Society Ultrasonography (28 weeks AOG)
(AUGS). International
Urogynecology Journal, 15, Normal Results Interpretation
324-327. Retrieved from findings
https://www.semanticscholar.or No fetal No fetal No genetic or
g/paper/Is-the-pelvic-organ- abnormality abnormality physical defect
prolapse-quantification-system- noted from the
Auwad- fetus.
Freeman/5ad9b293f8b974ff852 Approx. Estimated fetal Fetal weight is
d329a637a83afc5949526 1,005-1,152 weight = 1,174 slightly above
g g average
No uterine or No uterine No abnormal
Marple, K. (n.d.). Growth chart:
pelvic mass mass or pelvic growth present near
Fetal length and weight, week present mass was the uterus
by week. BabyCenter. detected
Retrieved from 30-40 mm Short cervix Patient is more
https://www.babycenter.com/pre throughout with 17 mm likely to deliver
gnancy/your-body/growth-chart- pregnancy length and a T preterm
fetal-length-and-weight-week- shape
by-week_1290794
Ultrasonography (30 weeks AOG)
James P. Nott, Elizabeth A.
Bonney, James D. Pickering,
Nigel A.B. Simpson, Normal Results Interpretatio
The structure and function of findings n
the cervix during pregnancy. Approx. 1,319- Estimated fetal Normal fetal
Translational Research in 1,501 g weight = 1,470 g weight
Anatomy, 2 (2016), pp.1-7. 30-40 mm A more Patient is
https://doi.org/10.1016/j.tria.201 throughout shortened cervix more likely to
6.02.001 pregnancy with 10-mm deliver
length and T preterm
shape
3. Vaginal culture
o Helps identify infection in the female genital
tract
o Revealed mycoplasma infection
2. To provide the 2. What are the nursing 2. Doenges, M. E., Moorhouse, 2. The nursing interventions based from each identified
appropriate nursing interventions applicable M. F., & Murr, A. C. nursing diagnosis are the following:
interventions necessary for the listed nursing (2019). Nurse's pocket guide:
for the listed nursing diagnoses? Diagnoses, prioritized 1) Impaired tissue integrity related to infection as
diagnoses. interventions, and evidenced by enlarged and edematous uterine
rationales (15th ed.). cervix
Philadelphia, PA: F.A. Davis.
Assess changes in body temperature,
specifically increased in body temperature.
Assess patient’s nutritional status; refer for a
nutritional consultation and/or institute dietary
supplements.
Discuss relationship between adequate
nutrition consisting of fluids, protein, vitamins B
and C, iron, and calories.
Use a risk assessment tool to systematically
assess immobility-related risk factors.
Educate patient about proper nutrition,
hydration, and methods to maintain tissue
integrity.
Establish rapport
Identify current stressors
Discuss concerns about body image
Observe behavior related to body changes
1
Determine makeup of the family
Identify use of effective communication skills
Help client identify thoughts and feelings when
starting a discussion with partner
Discuss how family as a whole function
Maintain a positive
attitude towards the client
3. To determine the 3. Why are these 3. Garfield, L., & Chin, E. 3. MEDICATIONS
purpose of medications medications given to the (n.d.). Pharmacology for
given in the scenario. patient in the scenario? Preterm Labor. Retrieved March Utrogestan
04, 2021 from Utrogestan is in a form of soft capsules which
https://www.nursingcenter.com/ contains progesterone. It is inserted deep into
ce_articleprint?an=00005237- the vagina. In relation to the client’s case, the
purpose of the utrogestan is to provide
202004000-00013 enough progesterone to maintain pregnancy
and prevent preterm birth, since this is likely
NPS MedicineWise. (2019). to happen to women with singleton pregnancy
Utrogestan 200. Retrieved who have a short cervix.
March 04, 2021 from Nursing Interventions:
https://www.nps.org.au/medicin o Monitor BP periodically during therapy.
e-finder/utrogestan-vaginal- o Monitor intake and output ratios and
capsules weekly weight. Report significant
discrepancies or steady weight gain.
RNpedia. (n.d.). Azithromycin o Advise patient to report signs and
nursing considerations & symptoms of fluid retention.
management. Retrieved March o Emphasize the importance of routine
04, 2021 from follow-up physical exams.
https://www.rnpedia.com/nursin
g-notes/pharmacology-drug- D5LRS
study-notes/azithromycin/ D5LRS is for maintenance of body fluids and
nutrition, and for rehydration.
Nursing Interventions:
RNpedia. (n.d.). D5LRS
o Observe aseptic technique when
(Lactated ringer’s solution) IV
fluid. Retrieved March 04, 2021 administering and changing IV fluid
from o Properly label the IV fluid
https://www.rnpedia.com/nursin o Do not administer unless solution is clear
g-notes/fundamentals-in- and container is undamaged.
nursing-notes/d5lrs-lactated-
ringers-solution-iv-fluid/ Terbutaline (Brethine)
Terbutaline is a beta-adrenergic agonist which
inhibits uterine contractions. This is used to
delay premature labor.
Nursing Interventions:
o Monitor cardiac and respiratory status
frequently.
o Monitor intake and output.
o Monitor fetal heart rate to observe
baseline changes.
o Perform routine blood glucose checks, if
necessary.
Magnesium Sulfate
Magnesium sulfate affects smooth muscle,
leading to decreased uterine contractions and
vasodilation.
Nursing Interventions:
o Monitor vital signs and urine output.
o Observe for signs of magnesium toxicity.
o Promote safety and assist patient out of
bed.
Dexamethasone
Dexamethasone is a corticosteroid which is
administered to pregnant women expecting a
preterm birth. In this case, the purpose of the
medication is to accelerate the maturation of
fetal lungs to prevent respiratory distress
syndrome to happen since the client will most
likely have preterm birth.
Nursing Interventions:
o Before administration, assess the
gestational age of pregnant woman
experiencing labor pain.
o Monitor vital signs, I&O, daily weight and
serum glucose.
o Rotate injection sites to decrease
irritation.
Azithromycin
Azithromycin is a macrolide antibiotic which
binds to ribosomal receptor sites of
susceptible organisms, inhibiting RNA-
dependent protein synthesis. In this case,
azithromycin is given to treat mycoplasma
infection.
Nursing Interventions:
o Administer on an empty stomach 1 hour
before or 2-3 hours after meals.
o Inform patient to report severe or watery
diarrhea, severe nausea or vomiting, rash
or itching, mouth sores, or vaginal sores.
4. To identify other 4. What are the other 4. Modules prepared by the 4. OTHER MANAGEMENT
management given to the managements given to clinical instructors
patient and their the patient and their Vaginal Pessary
corresponding nursing corresponding nursing Atnip, S. & O’Dell, K. (2012).
Vaginal Support Pessaries: - A pessary is a device that fits into your vagina and
interventions. interventions?
Indications for Use and Fitting supports the pelvic organs. It may be used if a pelvic
Strategies. Urologic Nursing, organ sags or moves out of its normal position
32(3), 114-125. (prolapse). For some women, wearing a pessary means
that they may not have to have surgery to fix a
prolapse. A pessary also may help a woman who has
trouble controlling her urine (incontinence). Or a
pessary may be used during a pregnancy to hold the
uterus in place.
Nursing Interventions:
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