I.

Introduction
The term abortion is defined as pregnancy that ends less than 20 weeks of gestation. There are two types of abortion, spontaneous
abortion and therapeutic/elective abortion. Spontaneous abortion is a type of abortion where by the termination of the pregnancy is
done without action taken by the woman or the doctor, it occurs due to natural causes. As for therapeutic/elective abortion, it is
where the pregnancy is terminated purposely with the aid of taking a medicine or surgical procedures. There are various reasons as
to why abortions happen, for instance, poor implantation of the fertilized ovum, incompetent cervix, mental illness, age, stress, drug
induce/abuse, and others. With abortion, there are also 6 categories, they are: threatened abortion, inevitable abortion, incomplete
abortion, complete abortion, habitual abortion, death in utero abortion, induced abortion, and septic abortion. Threatened abortion
is where there was a chance of losing the pregnancy but got saved instead due to interventions implemented. Inevitable abortion is
a type of abortion that precipitated from threatened abortion where all products of consumption are expelled. As for incomplete
abortion, it is where some products of consumption or tissues were not expelled, for example, only the fetus and placenta, but the
amniotic fluid remained. Therefore, dilation and curettage must be done. Complete abortion is where all of the tissues or products
of consumption has been totally expelled. Habitual/recurrent abortion is where two or more abortions occur. Whereas, death in
utero / “missed abortion”, happens when the fetus inside the womb is found dead. While induced abortion is done for safeguarding
the health of the mother due to genetic disorders. Lastly, the septic abortion is done due to the development of infection/infections
towards the mother or fetus.

II. Objectives
To attain knowledge and further understanding of:

1. The nature of abortion

2. The holistic effects after the abortion occurs on a woman
3. Reasons why pregnant women go through abortions

III. Nursing Health History

 Biographic data
 Name: J.M.
 Age: 24 years’ old
 Sex: Female
 Sources of information: The patient
 Admitting impression / final diagnosis (if admitted in the hospital): Incomplete Spontaneous Abortion
 Chief complaint
 The patient went to the Emergency Department complaining of abdominal cramping and heavy vaginal
bleeding with blood clots.
 History of present illness
 Prior to consultation, the patient has been experiencing light spotting with an increase in severity in the
morning that she visited the Emergency Department.
 The patient does not experience any pyrexia, chills, dysuria, nausea or vomiting
 Obstetric history
 Gravida: 4
 Para: 2
 Abortion: 1
 Past medical history
 The patient has only been receiving prenatal care from her Obstetrician
 She also had one abortion prior to her present diagnosis
 Lifestyle
 Sexually active

IV. Physical Examination

Vital signs of the patient were taken:

 Blood pressure: 110/60 mmHg

 Heart rate: 83 bpm
 Respiratory rate: 18 cpm
 O2 saturation of 100%
 Temperature: 37.1 degrees Celsius

Auscultation of the lungs were done, and the findings were clear, no abnormal sounds were found. Palpation of the abdomen of the
patient was also done, and it was found that her stomach is slightly distended or bloated, and mild tenderness was felt on her lower
pelvic area.
A pelvic examination was done to the patient whereby a doctor inspects the reproductive organs of a woman. The findings were that
bleeding was active, and the cervical os is open. Presence of blood clots were also seen on the perineal pad.

V. Symptoms Manifested
 Abdominal cramping
 Heavy vaginal bleeding with blood clots
 Cervical os opened

(Possible signs and symptoms):

 Disappearance of early symptoms of pregnancy (morning sickness or breast tenderness)

 Back ache

VI. Pathophysiology

Incomplete Spontaneous Abortion Schematic Diagram

Predisposed factors: Precipitated factors:

o Abnormal uterine shape o Exposure to environmental

o Hormonal irregularities and workplace hazards
o Improper implantation o Smoking
o Incompetent cervix o Drinking alcohol
o Previous occurrence of abortion o Drugs

Improper development of the fetus

inside the womb of the mother would
begin.

Delivery of minerals and nutrients to

the fetus would start to become
insufficient.

The fetus would lead to being under-

developed and weak.

Abdominal cramps with vaginal bleeding may occur along

with clots of blood, and cervical os would begin to open.

Incomplete spontaneous abortion occurs

Some products of consumption are

expelled, while some may remain.
VII. Diagnostic and Laboratory
 White blood count of the patient was 10,000 uL
o The normal reference value of white blood cells of a pregnant woman is around 5,600-16,000 uL and patient M is
within the normal findings.
 Hemoglobin of 12.3 g/dL
o A pregnant woman must have the normal value of 12.06-16 g/dL of haemoglobin. The patient showed that her
results are slightly lower, this might be a sign of anemia that could lead to iron deficiency and low supply of oxygen
around the body of the mother, and the fetus.
 Hematocrit of 39.5%
o 35%-44% is the normal findings a pregnant woman must have and patient M is within those normal values.
 Chemistries and urinalysis were found with normal results
 Transvaginal ultrasonography revealed that the patient has an abnormal abdominal sac within the cervical canal, this is a
cervical ectopic pregnancy. Cervical ectopic pregnancy is a rare type of pregnancy where the gestational sac has developed
on the endocervical canal just under the closed internal os. This occurs because the implantation of the fertilized ovum
occurred in the cervix instead of the uterine cavity.

VIII. Medical/Surgical Management

 Dilation and curettage – a type of procedure used to evacuate or remove tissue from inside the uterus of the woman. It
helps clear the uterine lining after a miscarriage or abortion. D&C is surgically performed by a doctor whereby the cervix is
dilated so that the endometrium lining is scraped with a curette (a spoon-shaped instrument) to remove the abnormal
tissues.
 Psychological therapy – the patient may begin to experience extreme sadness or depression after losing a child, especially if
they have planned this pregnancy. Talking to a therapist or counsellor will help the woman explore her feeling about the
abortion, and it will be explained to her that she is not alone. Therapy can prevent Post-Traumatic Stress and other
psychological symptoms.

IX. Drug Study

Drug Name Classification Indication and Side Effects and Special Nursing
and Mechanism contraindications Adverse Effects Precautions responsibilities
of Action
Generic Name: Classifications: Indications:  Headache The drug Check and
Hydromorphone A class of It is an indication for  Dry mouth Hydromorpho understand the
medications moderate to severe  Drowsiness ne can cause doctor’s order
Trade/Brand called opiate acute pain and severe  Heavy drowsiness,
Name: Dilaudid (narcotic) chronic pain sweating therefore the Assess vital signs of
analgesics  Muscle, patient must the patient before
Dosage: 2 mg Contraindications: back, or joint not drive or administration.
Actions:  Allergic pain operate
Route: IV It is an opioid reactions to  Flushing machinery. Documentation
agonist that the drug,  Itching after administering
binds to several sulphites or  Depression the drug
opioid any other Adverse Effects:
receptors. It has components of  Palpitation Monitor patient’s
an analgesic the drug  Tachycardia reaction to the
characteristic  Patients with  Urinary drug because it
through its bronchial retention might cause CNS
effect on the asthma, other  Coma depression.
mu-opioid respiratory  Seizures
receptors. It disease  Constipation Decrease the rate
acts mainly at  Patients with  Nausea and of administration
the level of GI obstruction, vomiting of the drug
medulla, hypomotility through the IV to
depressing the  Patients with prevent the
respiratory genitourinary development of
drive and obstructions, the symptoms of
suppressing CNS CNS depression.
cough. depression,
hypotension, Observe for
and adverse effects of
hypovolemia the medication.
 Careful
administration
of concomitant
psychiatric
 illness
Generic Name: Classifications: Indications:  Sedation Patient must Assess vital signs of
Ondansetron Antiemetic drug Nausea and vomiting  Headache be hooked on the patient before
 Constipation a cardiac administering the
Trade/Brand Actions: Contraindications:  Transient monitor and medication.
Name: Zofran Blocks the  Children under blindness to be
effects of the age of 4-  Diarrhea observed as it Observe the
Dosage: 4 mg serotonin at 5- years-old  Transient may cause patient’s fluid and
HT3-receptor  Patients with dizziness prolong QT electrolyte levels
Route: IV sites (selective Parkinson’s after IV interval because there is a
antagonist) disease administratio and/or side effect of
located in the receiving n Torsade de diarrhea, which
vagal nerve apomorphine  Prolonged Pointes. can cause an
terminals and QT interval imbalance in the
the and/or patient’s body.
chemoreceptors Torsade de
trigger zone in Pointes Monitor the
the CNS  Transient cardiovascular
oculogyric status with
crisis and patients who have
dystonic coronary heart
reactions disease for signs of
tachycardia and
angina.
Generic Name: Classifications: Indications:  Nausea and Can increase Provide health
Methylergonovine Belongs to a After the delivery of the vomiting the risk of teaching to the
class of drugs placenta, to manage  Stomach developing a patient and/or
Trade/Brand called ergot uterine atony, pain heart attack, family on how to
Name: Methergine alkaloids haemorrhage, and  Diarrhea especially if take BP before
subinvolution of the  Leg cramps the patient administering
Dosage: 0.2 mg Actions: uterus.  Increased in has diabetes, medication.
Acts directly on It is a vasoconstrictor sweating high
Route: Orally the smooth used to control bleeding  Skin rash cholesterol Call the doctor if
muscles of the after a delivery or  Headache levels, a BP increases or if
Frequency and uterus, and spontaneous or induced  Dizziness smoker, or the patient is
Timing: 4 hours for increases the abortion  Ringing in overweight. experiencing
six doses tone, rate, and the ears This frequent periods of
amplitude of Contraindications:  Stuffy nose medication uterine relaxation.
rhythmic  Blocked/narro  Unpleasant must not be
contractions. It w mitral heart taste in the taken with Explain that the
stimulates a valve mouth other drugs patient must
rapid and  Hypertensive unless report if she is
sustained patients discussed with experiencing
uterotonic  Coronary the doctor. severe cramping or
effect to artery disease increased bleeding.
shorten the  Patients who
third stage of had a stroke or
labor and a heart attack
reduce blood  Patients with
loss. arteriosclerosis
obliterans
 Liver diseases
 Epileptic
patients
Generic Name: Classifications: Indications:  Dizziness Always as Know the patient’s
Ibuprofen Belongs to the Minor aches and pains,  Drowsiness patient first if history, if allergic
drug class of such as, headache,  Thirst and they are to the drug, as well
Dosage: 800 mg nonsteroidal backache, common sweating allergic to the as other diseases
anti- cold, minor pain of  Tingling or type of drug that the patient is
Route: Orally inflammatory arthritis, toothache, numbness or or to its experiencing
drugs (NSAIDs) menstrual cramps, and hands or feet components. (hypertension,
Frequency and muscle aches  Ringing in Special peptic ulcer, GI
Timing: 3 times a Actions: the ears precautions to bleeding).
day Acts by blocking Contraindications:  Blurry vision patients with
the body’s  Hypertensive  Fluid asthma, blood Teach the patient
production of patients retention disorders, that the
certain natural  Patients with and ankle heart medication must
substances that idiosyncratic swelling diseases, GI be taken after
cause reactions to  Abdominal problems, and meals.
inflammation, the drug pain kidney
 hence,  Asthma  Nausea and diseases. This Warn patient to
decreases  Active GI vomiting medication discontinue with
swelling, pain, bleeding or  Diarrhea can cause administration if
or fever. peptic ulcers  Constipation drowsiness, so she notices
 Frequent it would be changes in the
urination best if the eyes, or symptoms
client would of hepatic
not drive after impairment
administration

X. Nursing Care Plan

Assessment Diagnosis Objective/Planning Intervention Rationale Evaluation

Subjective: The patient is at Short-term goal: Teach the client This will help After 8 hours of
The patient has risk for acute pain After an hour of the reason/s why expand the applying the
reported that she due to the after nursing pain or discomfort knowledge of the nursing
had been effects of interventions, the is felt after the patient and interventions, the
experiencing light procedure of patient will be procedure. understand the patient will notice
spotting over the Dilation and well-educated on different after a reduction of pain
past few days prior Curettage. what methods to effects of the sensation. She will
to admission, with use in order to procedure. be well-equipped
the severity relieve the pain. of methods or
increasing. Educate her about Comfort techniques to use
The patient Long-term goal: comfort techniques can in order to
explains that there After 8 hours of techniques, such increase the minimize the pain.
was no fever, implementation, as heating pads, patient’s well- She will also know
chills, burning on the patient will feel importance of being and ease the importance of
urination, nausea a decrease of pain hydration, and from her recent a strong support
or vomiting and discomfort, as strong support situation. Heating group to help with
present. well as have the system/people. pads can help her coping abilities.
ability to control or relieve cramps,
Objective: minimize the pain increase in fluid
BP 100/60 mmHg felt. intake can restore
HR 83 bpm fluid balance from
RR 18 cpm vomiting or
O2 saturation of diarrhea. And a
100% strong support
Temperature of people can help
37.1 degrees prevent any
Celsius mental health
problems.
Moderate active
bleeding, and Educate the This will help the
cervical os opened. medications that patient fully
Presence of blood the patient’s comprehend which
clots. doctor prescribed drugs to take,
to her to help with when to take
pain management. them, the dosage,
and any side
effects of it, all in
all to relieve pain.

Assessment Diagnosis Objective/Planning Intervention Rationale Evaluation

Subjective: The client is at high Short-term goal: Describe each This will help her After applying all
It was shared by risk for developing In the first hour of psychological identify the type of nursing
the patient her psychological conducting the health problem disorder that may interventions, and
obstetric history of health disorders, nursing that may arise begin to develop. health teachings,
G4, P2, and A1 such as, interventions, the after the the client will be
depression, client can treatment of the able to accept the
Objective: anxiety, or PTSD. enumerate the second abortion of event that
At the end of this different the mother. happened to her,
case, the patient’s psychological cope with it
obstetric history of disorders that she List and educate to This will further effectively with the
abortion will now is at risk for. the patient, and identify and assist of her strong
become 2 her family the confirm the type of support system,
Long-term goal: possible signs and problem. As well as and be fully aware
Within 3 hours, the symptoms for each her family will of the different
client will fully disorder that may know the different psychological
 comprehend the occur. warning signs. health problems
different that may arise.
psychological Explain the The patient will be
disorders, its signs importance on able to stop the
and symptoms, when to seek help psychological
when to ask for before the disorder from
help to prevent it condition developing.
from developing deteriorates.
further.
Examine if the It is necessary for
patient has a her to have a
strong support strong support
system before system to help
discharging her. with her coping
strategies.

Educate the client This will help her

as to why understand the
incomplete nature of the
spontaneous event, and how to
abortions happen, prevent it in the
and how they can future.
be avoided.

XI. Discharge Plan / Health Teaching

 Medications:
1) Methylergonovine (Methergine) of 0.2 mg of tablet, taken every 4 hours for six doses
 Educate the client that the medication is used to help shrink the uterus to its normal size, or to
stimulate the involution phase so that the body of the client will return back to its non-pregnant
state.
2) Ibuprofen of 800 mg of tablet, 1 tablet is taken 3 times a day only for pain
 Teach the importance of this medication, which is only taken if pain is felt. As well as there is a
4-6 hours’ interval time before taking another Ibuprofen tablet. So, for example, if Mrs. M took
one tablet at 8 am, the next one should be taken around 12-2pm.
 Health teachings:
o Educate the importance of rest as the body needs to heal from the procedure
o Help her understand that there might be some pain after the procedure, as well as vaginal bleeding
which is experienced for a few weeks
o Introduce perineum pads, and that they must be change 4-6 hours
o Educate that personal hygiene is crucial to prevent any infections from occurring, therefore, every time
the client changes pads, she must thoroughly wash her perineum with unscented soap and dried with a
clean washcloth
o Advise the client to have her next pregnancy at least 6 months to allow her body to recover from the
trauma
o Teach the patient that after taking her oral medications, she must not drive a vehicle
 Out-patient follow-up (call the doctor if any of the following occurs):
o Severity of the bleeding has been increasing for 2 days
o Fever or chills
o Abdominal cramps that cannot be relieved by Ibuprofen
o Foul-smelling vaginal discharge
 Lifestyle:
o Abstain from any sexual activity for the time being, until the next follow-up when the doctor has cleared
the client
o Avoid using tampons or inserting anything inside her vagina
o Follow a healthy diet, consisting with a lot of protein to allow the muscles of the body to heal
o Perform moderate exercises 4 weeks after procedure for a healthy body
o Get enough sleep
o Surround self with friends and family