ANGELES UNIVERSITY FOUNDATION

COLLEGE OF NURSING
2ND SEMESTER, A.Y. 2020-2021
NCM 0109 RELATED LEARNING EXPERIENCE

PROBLEM BASED LEARNING PLAN

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

KNOWLEDGE KNOWLEDGE To meet the objectives KNOWLEDGE Clinical Instructor to

1. To be knowledgeable 1. What is Uterine and answer the learning 1. Uterine Prolapse in 1. Uterine prolapse happens when the pelvic floor student:
about the Uterine Prolapse? questions, the group Emergency Medicine: muscles and ligaments are strained, distorted and
Prolapse. members must do the Background, Etiology, exhausted, such that they can no longer sustain the  Critical Appraisal
following: Pathophysiology. pelvic organs, causing the uterus to collapse through  Application of Learning
the vagina. Prolapse may be incomplete or, in more resources
(2020). EMedicine. Retrieved
 Attend discussion in  Consultation
March 4, 2021 from serious cases, complete as the uterus slides and drops
NCM 0109 and
participate in group https://emedicine.medscape.co out of the vagina.
Student to student:
discussion about m/article/797295-
Placental overview#:~:text=Uterine  Group cooperation and
Abruption. %20prolapse%20occurs Definition: contribution
 Find and use %20when%20the  Self and peer evaluation
credible Uterine prolapse, also called descensus or  Knowledge and
sources such as procidentia, is when the uterus has descended past
Communication skills
modules, its normal position in the pelvis and into the vagina.
textbooks and Pathophysiology: CRITERIA:
online Participation
journals for Uterine prolapse is usually caused by obstetric trauma.
Placental Abruption This eventually leads to the overstretching weakening  Discussion of the content
including its of the surrounding muscular and connective tissue that
description and supports the uterus, and eventually, the uterus
pathophysiology, Written output
herniates through the pelvic floor. The uterus then
risks factors, signs protrudes into the vagina, known as uterine prolapse,  Identification of the
and symptoms, problem
and may protrude beyond the vaginal opening.
complications,  Content depth
laboratory/
 Integration
2. To determine Uterine 2. How to diagnose the diagnostic 2. WebMD. Uterine Prolapse. 2. Criteria in assessing degrees of Uterine Prolapse:
 Organization
Prolapse criteria in degrees of prolapse in procedures, and 2005 - 2021 WebMD LLC.  First degree: The cervix drops into the vagina.  Discovery
diagnosing the degrees of uterine prolapse? therapeutic and Retrieved on March 4, 2021  Second degree: The cervix drops to the level just  Format compliance
prolapse. medical from inside the opening of the vagina.  Use of grammar
management. https://www.webmd.com/wome  Third degree: The cervix is outside the vagina.  Timeliness
 Search information n/guide/prolapsed-uterus  Fourth degree: The entire uterus is outside the
from the Internet vagina. This condition is also called procidentia.
and use credible This is caused by weakness in all of the supporting Presentation
sources. muscles. Reporting
In the patient’s case, two weeks after her initial
admission, the pelvic examination revealed an enlarged
and edematous uterine cervix and a Second Degree DEADLINE
uterine prolapse.
 Everything shall be
RISK FACTORS accomplished by March
Predisposing factors: 05, 2021

• Family history of weakness in connective tissue

• Being Hispanic or white
• Maternal age between 50-79 years old
• Multiparity
• Obesity
• Chronic cough (bronchitis)
• Chronic obstructive pulmonary disease
(COPD)
• Chronic constipation
• Lower estrogen or progesterone levels
Precipitating factors:

• Weakened ligaments and connective tissues

that hold the uterus in place, which may also be
due to loss of muscle tone from aging
• Extraction of baby before full dilation
• Instrument birth
• Birth of large infant
• Prolonged 2nd stage of labor
• Insufficient prenatal care

Based on the scenario, the causation of the client’s

uterine prolapse was chiefly her pregnancy alone. The
excessive pressure applied to the uterus brought about
by the increasing weight of the fetus and other uterine
contents such as the placenta and amniotic fluid during
the course of pregnancy may result in uterine prolapse.
 Uterine prolapse occurs when pelvic floor muscles and
ligaments stretch and weaken and no longer provide
enough support for the uterus. Which results in the
protrusion of the uterus out of the vagina. Uterine
prolapse during pregnancy most frequently occurs in
multiparous women. This is a very rare case since the
patient is nulliparous. The main cause of the uterine
prolapse of the patient but besides the pregnancy, the
patient had none of the known risk factors for uterine
prolapse such as uterine mass, obesity, or maternal
connective tissue disorder.
However, the following are factors that can increase
the risk the client manifesting uterine prolapse, this
includes:
- Weakened ligaments and connective tissues
that hold the
uterus in place
- Multiparity
- Obesity
- Insufficient prenatal care
- Birth of large baby (macrosomia baby)
- Prolonged 2nd stage of labor
- Extraction of baby before full
dilatation
- Instrument birth
- Poor healing of perineal tissue postpartally
(explain to the patient that postpartum check-
ups are necessary

3. To determine the signs 3. What are the signs 3. Zeng, C., Yang, F., Wu, C., 3. PATIENT’S SIGNS AND SYMPTOMS
and symptoms of the and symptoms present in Zhu, J., Guan, X. & Liu, J.
condition and their the scenario and how do (2018). Uterine Prolapse in Chief complaint
underlying causes. they occur? Pregnancy: Two Cases Report  Intermittent vaginal spotting after voiding
and Literature Review. Hindawi,
vol. 2018. Initial clinical findings
https://doi.org/10.1155/2018/18
05153  Pelvic examination revealed a second-stage
prolapse, with point C as the leading edge
according to the pelvic organ prolapse
quantification staging system uterine prolapse
(Aa -1.0, Ba -1.0, C -0.5, gh 2.0, pb 3.0, tvl
 9.0, Ap -1.0, Bp -0.5, D -2.0).
 Eroded cervix was descended to the level of
the vaginal introitus.

Clinical findings upon referral

 Sonographic examination revealed a short

cervix with 17 mm length and a T-shape.

Clinical findings at 30 weeks of gestation

 Regular uterine contractions

 Pelvic examination revealed an enlarged and
edematous uterine cervix and a second-degree
uterine prolapse.
 Eroded cervix was projecting near the vaginal
introitus
 The cervical orifice was closed.
 Sonographic examination revealed a more
shortened cervix with 10-mm length and a T-
shape.
 Vaginal culture at admission revealed
mycoplasma infection.

Clinical findings at 37 weeks of gestation

 Regular uterine contractions

 Cervix was still prolapsed at the same level and
the cervical orifice was opened to about 3 cm
width.

PATHOPHYSIOLOGY OF SIGNS AND SYMPTOMS

Uterine prolapse is the descent of the uterus and cervix
down the vaginal canal toward the introitus. The
etiology of uterine prolapse during pregnancy could be
multifactorial. Parity, malnutrition, race, vaginal delivery,
short interval between consecutive pregnancies,
increased strain on the support of the uterus, and
previous medical record of prolapse are among the
most common risk factors. However, the patient
presents no risk factors that predisposes her to develop
uterine prolapse. Having said that, it can be considered

4. To learn the possible 4. What are the
complications of patient complications of Uterine
with Uterine Prolapse. Prolapse?
5. To understand the 5. What are the six
measurement parameters distinct locations (Aa, Ba,
of pelvic organ prolapse C, D, Ap, Bp) and three
quantification system anatomical markers (GH,
(POP-Q System) PB, TVL)?
4. Mayo Clinic. Uterine
Prolapse. Retrieved from
https://www.mayoclinic.org/dise
ases-conditions/uterine-
prolapse/symptoms-causes/syc-
20353458#:~:text=Urinary
%20problems%2C%20such
%20as%20urine,tone%20of
%20your%20vaginal%20tissue
5. Libretexts. (2020, September
28). 3.1: 3.1：Physical
Examination and the POP-Q.
Medicine LibreTexts.
https://med.libretexts.org/Books
that her condition could be due to physiologic changes
of pregnancy specifically in hormones. Since the patient
is at her 28th week of gestation or third trimester of
pregnancy, progesterone and cortisol are at its highest
level. These two hormones may contribute to the
relaxation and weakening of the muscles and tissues of
the pelvic floor, which may result to uterine prolapse.
Common symptoms of uterine prolapse manifested by
the patient were intermittent vaginal spotting after
voiding and descent of eroded cervix to the level of the
vaginal introitus.
4. COMPLICATIONS OF UTERINE PROLAPSE
 Difficulty of having bowel movements – a
situation wherein there is a weakness of the
connective tissue that separates the rectum
and vagina, which can cause the rectum to
bulge into vagina
 Urine retention or urine incontinence – uterine
prolapse can block urinary flow, resulting to
urinary problems
 Kidney problems and urinary tract infections –
may happen in uterine prolapse when it blocks
the patient’s urine
• Anterior prolapse (cystocele) also called
prolapsed bladder - Weakness of connective
tissue separating the bladder and vagina may
cause the bladder to bulge into the vagina.
• Posterior vaginal prolapse (rectocele) -
Weakness of connective tissue separating the
rectum and vagina may cause the rectum to
bulge into the vagina. You might have difficulty
having bowel movements.
5. PELVIC ORGAN PROLAPSE QUANTIFICATION
SYSTEM
Anterior vaginal wall:
helves/Medicine/Book
%3A_Urogynaecology/03%3A_
Physical_Examination_and_the
_POP-
Q/3.01%3A_3.1Physical_Exami
nation_and_the_POP-Q
Pelvic Organ Prolapse
Quantification (POP-Q) System.
(n.d.). Physiopedia. Retrieved
March 4, 2021, from
 Point Ba
https://www.physio-
pedia.com/Pelvic_Organ_Prola
pse_Quantification_(POP-
Q)_System
Madhu, C. (2018, August 1).
How to use the Pelvic Organ
Prolapse Quantification Upper vagina:
(POP‐Q) system? Wiley  Point C
Online Library.
https://onlinelibrary.wiley.com/d
oi/full/10.1002/nau.23740#:
%7E:text=There%20are%20six
%20defined%20points,vaginal
%20apex%2C%20and
 Point D
%20posterior%20wall.
 Point Aa
o Midline anterior vaginal wall 3cm proximal to
the external urethral meatus
o -3 to +3
 -3, -2, -1 = above the vaginal opening
 0 = at the vaginal opening
 +1, +2, +3 = below the vaginal
 opening
o Client finding: -1 (1 cm above the vaginal
opening)
o Most superior location of the anterior vaginal
wall
o -3 to +3
o Client finding: -1 (1 cm above the vaginal
opening)
o Most distal edge of the cervix or the leading
edge of the vaginal cuff
o -/+ cervix
o Client finding: -0.5 (0.5 cm above the vaginal
opening)
o Most distal portion of the posterior fornix
o -/+ posterior fornix
o Client finding: -2 (2 cm above the vaginal
opening)

Posterior vaginal wall:

 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)

Three further descriptive landmarks and

measurements:

 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, Normal Results Interpretatio
Nigel A.B. Simpson, findings n
The structure and function of Approx. 1,319- Estimated fetal Normal fetal
the cervix during pregnancy. 1,501 g weight = 1,470 g weight
Translational Research in 30-40 mm A more Patient is
Anatomy, 2 (2016), pp.1-7. throughout shortened cervix more likely to
https://doi.org/10.1016/j.tria.201 pregnancy with 10-mm deliver
6.02.001 length and T preterm
shape

The SHORTENED CERVIX of the patient was due to its

condition, where the uterus falls toward the vagina as a
possible result of weak pelvic floor muscles and
ligaments. As the stage of its condition progresses, the
patient's uterus progressively moves down within the
vagina, which causes the more shortened cervix and a
T-shaped uterus. The patient's cervix was revealed to
descend at the level of vaginal introitus that measures
17-mm in length around 28 weeks AOG, which further
shrank to a span of 10-mm at 30 weeks.

When the CERVIX IS UNUSUALLY SHORT, it is prone

to dilation, and it provides less protection for the fetus
and pregnant woman that may lead to pregnancy loss,
preterm labor, and early delivery.

2. Pelvic examination- Used to assess if the uterus

has descended from its normal position. During this
procedure, the woman is asked to slightly bear down in
order to assess the level of uterine protrusion. This
assessment was done together with POP-Q or Pelvic
organ prolapse quantification system to identify the
 stage of uterine prolapse.

Normal Results Interpretatio

findings n
0- No prolapse  Second The most
demonstrated stage distal portion
prolapse of the
with prolapse is
point C less than 1
or edge cm above or
of the below the
cervix as level of
the hymen.
leading
edge
 Cervix
was
descend
ed to the
level of
vaginal
introitus

3. Vaginal culture
o Helps identify infection in the female genital
tract
o Revealed mycoplasma infection

SKILLS SKILLS SKILLS

1. To identify and 1. What are the nursing 1. Doenges, M. E., Moorhouse, 1. NURSING DIAGNOSES
prioritize possible nursing diagnoses applicable to M. F., & Murr, A. C. The following are the identified nursing diagnoses
diagnoses concerning the client’s condition and (2019). Nurse's pocket guide: concerning client’s condition:
patient with Uterine how are they prioritized? Diagnoses, prioritized
Prolapse. interventions, and 1) Impaired tissue integrity related to infection as
rationales (15th ed.). evidenced by enlarged and edematous uterine cervix
Philadelphia, PA: F.A. Davis.
2) Activity intolerance r/t uterine contractions AEB
secondary degree of uterine prolapse

3) Acute pain related to medications and treatments

4) Impaired comfort r/t pelvic discomfort secondary to

 uterine prolapse

5) Disturbed Body Image R/T trauma secondary to

uterine prolapse AEB enlarged, edematous uterine
cervix and second-degree uterine prolapse

6) Risk for infection related to vaginal pessary use

secondary to uterine prolapse

7) Risk for ineffective coping related to high degree of

threat secondary to uterine prolapse

8) Risk for sexual dysfunction related to change in body

structure secondary to uterine prolapse

9) Readiness for enhance health management

10) Readiness for enhance Relationship

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.

2) Activity intolerance r/t uterine contractions AEB

secondary degree of uterine prolapse
  Assess the physical activity level and mobility of
the patient; noting skin pallor, pulse rate,
respiratory rate, blood pressure, pain scale,
monitor pattern, dyspnea and use of accessory
muscle.
 Explain the reasons of requiring bedrest.
 Provide calm and quiet environment and
provide uninterrupted periods for rest and/or
sleep.
 Cluster nursing care: group activities together
as much as possible, such as medication
administration, vital signs, and assessment.
 Provide comforts measures (e.g., back rubs,
changes of position)
 Use Trendelenburg position and encourage
Kegel’s exercise to strengthen pelvic floor
muscles
 Encourage progressive activity/ self-care when
tolerated. Provide assistance as needed.

3) Acute pain related to medications and treatments

 Assess patient’s vital signs

 Implement comprehensive pain assessment
 Implement history assessment of pain
 Investigate for signs and symptoms regarding
pain
 Evaluate the client’s response to pain and its
management strategies
 Determine factors that can alleviate pain
 Provide comfort
 Encourage patient to do breathing exercises
and relaxation techniques

4) Impaired comfort r/t pelvic discomfort secondary

to uterine prolapse

 Teach techniques to use when client is

uncomfortable, including relaxation techniques,
 guided imagery, and music therapy.
 Assist the patient and her family with identifying
and avoiding irritants
 Evaluate the client's response to non-
pharmacological interventions
 Provide comfort by properly positioning the
patient
 Maintain a calm and quiet environment

5) Disturbed Body Image R/T trauma secondary to

uterine prolapse AEB enlarged, edematous uterine
cervix and second-degree uterine prolapse

 Discuss pathophysiology present and/or

situation affecting the individual.
 Assess mental and physical influence of illness
or condition on client’s emotional state.
 Evaluate the level of client’s knowledge of and
anxiety related to the situation.
 Recognize behaviour indicative of overconcern
with the body and its processes.
 Assist the client in incorporating the therapeutic
regimen into activities of daily living.

6) Risk for infection related to vaginal pessary use

secondary to uterine prolapse

 Observe at-risk client for changes in color

and/or odor of vaginal excretions.
 Explain the procedure to the patient.
 Inform the patient to wash her hands and put
on a nonsterile glove prior to insertion of
pessary.
 Educate the patient regarding the proper
insertion and removal of pessary.
 Inform the patient to regularly perform perineal
care.

7) Risk for ineffective coping related to high degree

of threat secondary to uterine prolapse

 Determine individual stressors such as family,

social, work environment, life changes, or
nursing or health care management.
 Identify development level of functioning.
 Ascertain the client’s understanding of the
current situation and its impact on life and work.
 Explain disease process, procedures, and
events in a simple, concise manner. Devote
time for listening.
 Provide for a quiet environment and position
equipment out of view as much as possible.

8) Risk for sexual dysfunction related to change in

body structure secondary to uterine prolapse

 Establish rapport
 Identify current stressors
 Discuss concerns about body image
 Observe behavior related to body changes

9) Readiness for enhance health management

 Establish rapport with the client.

 Ascertain client’s belief about health and her
ability to maintain health
 Educate the patient about the importance of
postpartum pelvic floor exercises
 Inform patient to avoid lifting heavy objects
 Encourage the patient to maintain one’s weight.
 Acknowledge individual’s efforts to achieve
health goals.

10) Readiness for enhance Relationship

1
 Determine makeup of the family
 Identify use of effective communication skills
 Help client identify thoughts and feelings when

3. To determine the 3. Why are these
purpose of medications medications given to the
given in the scenario. patient in the scenario?
starting a discussion with partner
 Discuss how family as a whole function
 Maintain a positive
attitude towards the client
3. Garfield, L., & Chin, E. 3. MEDICATIONS
(n.d.). Pharmacology for
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
202004000-00013 purpose of the utrogestan is to provide
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
This drug is a soft capsule that is inserted
https://www.nps.org.au/medicin
deep into the vagina and contains
e-finder/utrogestan-vaginal-
progesterone and it is used to support the
capsules
uterus by holding the uterus in place.
This is given to the client since her condition
RNpedia. (n.d.). Azithromycin requires strengthening of the uterus. The
nursing considerations & progesterone helps in preparing the uterus
management. Retrieved March and thickening the endometrium in order to
04, 2021 from contain the fetus.
https://www.rnpedia.com/nursin  Nursing Interventions:
g-notes/pharmacology-drug- o Monitor BP periodically during therapy.
study-notes/azithromycin/ o Monitor intake and output ratios and
weekly weight. Report significant
RNpedia. (n.d.). D5LRS discrepancies or steady weight gain.
(Lactated ringer’s solution) IV o Advise patient to report signs and
fluid. Retrieved March 04, 2021 symptoms of fluid retention.
from o Emphasize the importance of routine
https://www.rnpedia.com/nursin follow-up physical exams.
g-notes/fundamentals-in-
nursing-notes/d5lrs-lactated-  D5LRS
ringers-solution-iv-fluid/  D5LRS is for maintenance of body fluids and
nutrition, and for rehydration.
 Nursing Interventions:
o Observe aseptic technique when
administering and changing IV fluid
o Properly label the IV fluid
o Do not administer unless solution is clear
and container is undamaged.
 Terbutaline (Brethine)
 Terbutaline is a beta-adrenergic agonist which
inhibits uterine contractions. This is used to
delay premature labor. It helps to stop or
prevent preterm labor by slowing down uterus
contractions. It may help delay birth for
several hours or days.
 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. Magnesium sulfate has a slow
onset of action, both magnesium sulfate and
terbutaline drugs have relatively mild effects
on the myometrium, but both are acceptable if
other agents are not available.
 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:

 Review treatment goals and expectations.

 Familiarize the woman with the pessary before
fitting
 Ask the woman to empty her bladder and bowels.
 Ask the woman to assume Semi-Fowler position, a
position that is generally comfortable and offers her
a view of the fitting if desired.
 After amply applying water-based lubricant to the
vaginal introitus, digitally assess vaginal size,
shape, and support, and for any relative
 contraindications to the fitting
 Select the appropriate stocked pessary or fitting kit
model, and clean it with soap, rinsing well with
water.
 Insert the pessary, applying pressure gently toward
the posterior vaginal wall and obliquely in the
largest diameter, avoiding pressure on the sensitive
urethra.
 To check initial fit, ask the woman to Valsalva and
cough (in lithotomy and standing positions)
 Ask the woman to stand, move about the
examination room, and simulate activities she
would normally do
 Ask the woman to sit on the toilet, void, and
Valsalva gently, simulating defecation. For actual
defecation, it may be helpful for her to support the
pessary digitally.
 If the fitting is successful to this point, review
expectations and schedule a return visit. If the
pessary is expelled or uncomfortable, start the
fitting process again.
Whether or not the fitting is successful, document any
shape and size of pessary used to avoid repeat
attempts at subsequent visits.

ATTITUDES/VALUES ATTITUDES/VALUES ATTITUDES/VALUES

1. To develop strategies 1. What are the 1. Utilized past lecture by 1. The essentiality of therapeutic communication
regarding appropriate therapeutic Ma’am Ma. Corazon M. provides rapport between the patient and nurse.
therapeutic communication strategies Tanhuenco, RN, MAN entitled Providing patient education through the use of
communication while appropriate in building “Therapeutic Communication.” therapeutic communication would provide a better
providing care to patients. rapport and trust during outcome by encouraging the patient to comply with
patient-nurse interaction? regimen, enable participation with medical procedures
Bradley University. (n.d.). needed and alleviate negative emotions regarding the
Therapeutic Communication in situation the client is facing by giving emotional support.
Nursing: Definition, Techniques Listed below are the strategies that can be applied to
and Resources. Retrieved the 32-year-old client experiencing uterine prolapse.
March 04, 2021 from ● Attentive Listening
https://onlinedegrees.bradley.ed - This is the most significant technique given to the
u/nursing/msn-fnp/theraputic- client because this enables the nurse to listen
communication-in-nursing/ actively and concentrate on the client.
● Physical Attending
 - Maintaining eye contact, facing the client, showing
an open posture are ways of physical attending
that show concern to the client.
● Giving broad openings
- These statements will encourage the client to
express and open up.
● Offering self
- Gestures like these will show interest and concern
to our client.
● Giving information
- A nurse’s responsibility is to give health teachings
to the client to be able to understand the situation
and how she can participate with the care.
● Using silence
- Silence is a part of communication because these
will signal a time for contemplation or processing
of thoughts.
● Accepting messages
- It is necessary to show to our clients that we agree
with them.
● Empathy
- Being able to empathize will give recognition,
acknowledgement and putting ourselves in their
shoes.
● Giving general leads
- These simple statements will give the client
assurance that the nurse is interested and is
actively listening to her.
● Exploring
- This technique will help the nurse understand and
get more details on the client’s concern.

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