ERA UNIVERSITY / ERA COLLEGE OF NURSING

LESSON PLAN ON- ABNORMAL UTERINE BLEEDING

SUBMITTED TO: SUBMITTED BY

Firoz mam Ms. Shreya Sinha
Assistant Professor MSc. Nursing 1st Year
Era College of Nursing

Submitted on- 30 / 06 / 2021

 LESSON PLAN

 Subject : Medical Surgical Nursing

 Topic
 Group
 Size
 Duration
 Date of presentation
 Place
 Name of student teacher
 Name of the supervisor
 Method of teaching
 Previous knowledge
: Abnormal Uterine Bleeding
: BSc. Nursing 3rd year students
: 80 students
: 1 hour
: 30 June 2021
: BSc Nursing 3rd Year Classroom
: Ms. Shreya Sinha
: Firoz mam
: Lecture cum discussion
: The students are having basic knowledge regarding Abnormal uterine bleeding.
General Objective:-
At the end of the class the students will gain knowledge regarding Abnormal uterine bleeding. The students intellectual skills regarding
Abnormal uterine bleeding will be increased, students will have positive attitude towards the management of Abnormal uterine bleeding and
they will be able to provide the competent care to those suffering from Abnormal uterine bleeding.

Specific objective- At the end of the class the students will be able to-:
 Introduce Abnormal Uterine Bleeding.
 Define Abnormal Uterine Bleeding.
 Discuss the incidence of Abnormal Uterine Bleeding.
 Enlist the etiology of Abnormal Uterine Bleeding.
 Classify the Abnormal Uterine Bleeding.
 Describe the nursing management of Abnormal Uterine Bleeding.
Sr.N TIME SPECIFIC CONTENT TEACHING A.VAIDS EVALAUTION
O OBJECTIVE LEARNING
ACTIVITY

1- 1min Self Self-Introduction:- -------------- -------- ------------

-Introduction I am Shreya Sinha, student from M. Sc. Nursing 1st year.

2- 1min Announcemen Announcement of Topic:- ------------ ----------- ------------

t of the topic I am going to present the topic on “Abnormal Uterine
Bleeding.”

3- 2min Introduce Introduction:- Teacher activity- PPT What is

Abnormal Abnormal vaginal or uterine bleeding is a common gynecologic Lecture cum Abnormal
Uterine concern. Abnormalities include Oligomenorrhea, Amenorrhea, discussion. Uterine
Bleeding. Menorrhagia, and Metrorrhagia. Bleeding?
Students activity-
Listening.

4- 2min Define Definition:- Teacher activity- PPT What is the

Abnormal Abnormal uterine bleeding is the bleeding from the uterine Lecture cum definition of
Uterine corpus that is abnormal in regularity, volume, frequency or discussion. Abnormal
Bleeding. duration, and occurs in absence of pregnancy. Uterine
Students activity- Bleeding?
Listening

5- 2min Discuss the Incidence :- Teacher activity- PPT What are the
incidence of It is usually common in adolescents and women approaching Lecture cum incidence rate of
Abnormal menopause. 20% cases occur in adolescent females, and as discussion. Abnormal
Uterine many as 50% of women aged 40-50 years experienced Uterine
Bleeding. Abnormal Uterine Bleeding. Students activity- Bleeding?
Listening
6- 10min Enlist the Causes : Teacher activity- PPT What are the
etiology of  The cause of abnormal bleeding may vary from Lecture cum causes of
Abnormal anovulatory menstrual cycles to more serious conditions discussion. Abnormal
Uterine such as ectopic pregnancy or endometrial cancer. Uterine
Bleeding.  Age- The woman’s age provides direction for Students activity- Bleeding?
identifying the cause of bleeding. For example- a Listening
postmenopausal woman with abnormal bleeding must
always be evaluated for endometrial cancer but does not
need to be evaluated for possible pregnancy. For a 20-
year-old woman with abnormal bleeding, the possibility
of pregnancy must always be considered, and
endometrial cancer would be unlikely.
 Abnormal bleeding may be caused by dysfunction of the
hypothalamic-pituitary-ovarian axis such as a pituitary
adenoma.
 Another cause is infection.
 Changes in life-style such as marriage, recent moves, a
death in the family, financial stress, and other emotional
crises can also cause irregular bleeding. Because
psychologic factors can influence endocrine function,
they should be considered when the patient is evaluated.

7- 30min Classify the Types of Irregular Bleeding: Teacher activity- PPT What are the
Abnormal Lecture cum types of
Uterine OLIGOMENORRHEA discussion. Abnormal
Bleeding. Oligomenorrhea is defined as irregular and inconsistent Uterine
menstrual blood flow in a woman. It occurs in women of Students activity- Bleeding?
childbearing age. Some variation in menstruation is normal, but Listening
a woman who regularly goes more than 35 days without
menstruating may be diagnosed with oligomenorrhea.
Etiology:
 Most often, this condition is a side effect of hormonal
birth control. Some women experience lighter periods
for 3-6 months after they begin taking the birth control.
Sometimes, their periods stop completely.
 Young women who participate in sports or engage in
heavy exercise can develop this condition.
 Oligomenorrhea is common in adolescent girls and
perimenopausal women due to fluctuating hormone
levels.
 Oligomenorrhea can also occur in women who have
diabetes or thyroid problems.

Symptoms:
The symptoms of oligomenorrhea include-
 Going longer than 35 days without a period.
 Having fewer than nine periods in a year.
 Menstrual cycles that are irregular.
 Periods that are lighter than usual

Diagnostic evaluation:
 Menstrual history
 Physical examination
 Ultrasound
 Blood test to detect cause of bleeding, infections and
other findings.
 Thyroid function test
 Pap smear to test for cervical cancer
Treatment:
Treatment of oligomenorrhea is depends on the cause of
abnormal bleeding.
 Lifestyle changes- if oligomenorrhea is relates to
lifestyle, such as weight gain, exercise routine, or stress
levels, new work schedule should be follow to change
the lifestyle pattern.
 Birth control or Hormonal Therapy- due to the
certain medicine if oligomenorrhagia occurs, other type
of birth control method should be used to manage the
periods.
 Treating underlying health conditions- if sexually
transmitted infection is causing oligomenorrhea,
antibiotics should be given and abstain from having sex
to prevent the spread of the infection.

AMENORRHEA
Amenorrhea is a term describing the absence of a woman’s
menstrual period.

Types:
There are two types of Amenorrhea-
1) Primary Amenorrhea
2) Secondary Amenorrhea

 Primary Amenorrhea- It refers to the failure of

menstrual cycles to begin by age 16 years or by age 14
years if secondary sex characteristics are present.
 Secondary Amenorrhea- It refers to the cessation of
menstrual cycles once they had been established.
Etiology:
Natural Amenorrhea-
 Pregnancy
 Breastfeeding
 Menopause
Hormonal Imbalance-
 Polycystic ovary syndrome
 Premature menopause
 Pituitary tumors
Structural Problems-
 Uterine scarring
 Structural abnormalities of vagina
 Damage to ovaries or uterus from radiation
Medications-
 Antipsychotics
 Chemotherapy
 Antidepressants
Lifestyle-
 Stress
 Excessive exercise
 Low body weight
 Acute and chronic illness

Diagnostic Evaluation:
 History of etiological factors.
 Physical examination
 Ultrasound
 Pregnancy Test
 Thyroid function test
 Hormonal test
 CT
Treatment:
 Correct the underlying cause.
 Estrogen Replacement Therapy
 If pituitary tumour- treatment with surgical resection,
radiation and drug therapy.
 Cyclic progesterone
 Thyroid Hormone Replacement

MENORRHAGIA
The excessive bleeding associated with menorrhagia can be
characterized as an increased duration (more than 7 days),
increased amount (more than 80 ml), or both.

Etiology:
 Anovulatory uterine bleeding
 Uterine fibroids
 Endometrial polyps
 Hormonal imbalance
 Dysfunction of the ovaries
 Polyps
 Adenomyosis

Signs and symptoms:

 Soaking through one or more sanitary pads or tampons
every hour.
 Needing to use double sanitary protection to control the
menstrual flow.
 Bleeding for longer than a week.
 Presence of blood clots with menstrual flow for more
than one day.
 Restricting daily activities due to heavy menstrual flow.
  Symptoms of anemia, such as tiredness, fatigue or
shortness of breath.

Diagnostic Evaluation:
 History collection
 Physical examination
 Blood test to evaluate for iron deficiency and other
conditions, such as thyroid disorders or blood-clotting
abnormalities.
 Pap test- cells from cervix are collected and tested for
infection, inflammation or cancerous changes.
 Endometrial biopsy- is the removal of a small piece of
tissue from the endometrium (the lining of the uterus).
 Ultrasound
 Hysteroscopy- this exam involves inserting a tiny
camera through vagina and cervix into the uterus, which
allows to see the inside of uterus.

Treatments:
 Iron supplements- If have iron deficiency anemia,
recommend iron spplements regularly.
 Tranexamic acid- is an antifibrinolytic. It works by
preventing blood clots from breaking down too quickly.
This helps to reduce excessive bleeding.
 Combined oral contraceptives- stabilize the
endometrium and thereby reduce the incidence of
breakthrough bleeding, it helps to regulate menstrual
cycles and reduce episodes of excessive or prolonged
menstrual bleeding.
 Oral progesterone- the hormone progesterone can help
correct hormone imbalance and reduce menorrhagia.
Surgical treatment:
 Dilation and curettage (D&C)- refers to the dilation
(widening/opening) of the cervix and surgical removal
of part of the lining of the uterus and/or contents of the
uterus by scraping and scooping (curettage).
 Uterine artery embolization- menorrhagia caused by
fibroids, the goal is to shrink any fibroids in the uterus
by blocking the uterine arteries and cutting off their
blood supply.
 Endometrial resection- this surgical procedure uses an
electro-surgical wire loop to remove the lining of the
uterus. Endometrial resection benefit women who have
very heavy menstrual bleeding. Pregnancy is not
recommended after this procedure.
 Endometrial ablation- permanently destroying the
lining of uterus (endometrium).
 Hysterectomy- surgery to remove the uterus and
cervix- is a permanent procedure that causes sterility
and ends menstrual periods.

METRORRHAGIA
Metrorrhagia, also referred to as spotting or breakthrough
bleeding, is bleeding between menstrual periods. Metrorrhagia,
now commonly called intermenstrual bleeding, is vaginal
bleeding that occurs at irregular intervals not associated with
the menstrual cycle. While the blood comes from the uterus as
it does during menstruation, the bleeding does not represent a
normal period.

Etiology:
  Pregnancy complications such as spontaneous abortion
or ectopic pregnancy.
 Cervical or endometrial polyps
 Infection
 Cancer

Signs and symptoms:

Spotting is common during the first three cycles of oral
contraceptives. If spotting continues beyond that, a different pill
formulation can be prescribed. Spotting with progestin-only
pills (medroxyprogesterone) is also common. For
postmenopausal women, endometrial cancer must be
considered whenever spotting is experienced.

Diagnostic evaluation:
 Health history
 Physical examination
 Blood test to check for disorders that cause bleeding.
 Hormonal levels
 Thyroid function test
 Urine sample to check for pregnancy, STDs.
 Ultrasound
 CT scan or MRI
 Pap smear for cervical cancer
 Tissue biopsy to detect type of cancer

Treatment:
 Dilation and curettage
 Malignancy should be excluded
 Treatment to the underlying cause
8- 10min Describe the Nursing Management: Teacher activity- PPT What is the
 nursing  The nurse should teach women about the characteristics Lecture cum nursing
management of the menstrual cycle to identify the normal variations discussion. management of
of Abnormal  Instruct the women to discuss with the health care Abnormal
Uterine provider if the menstrual cycle pattern does not fall Students activity- Uterine
Bleeding. within the normal range. Listening Bleeding?
 Encourage patient to comply the medication to reduce
discomfort and pain.
 Explain the importance of iron-rich foods to supplement
iron.
 Explain methods to quantifying blood loss and reporting
to health care provider.
 Encourage the women for menstrual hygiene.

9- 1min ----- ----- -----

SUMMARY:
Abnormal uterine bleeding is bleeding from uterus that is
longer than usual or that occurs at an irregular time. In this
condition, we have discussed about the introduction of
abnormal uterine bleeding, definition, incidence, etiology,
types and nursing management of Abnormal Uterine Bleeding.

10- 1min ----- ---- ------

CONCLUSION:
Functional bleeding from the uterus is abnormal bleeding
which is due to hormonal changes rather than injury,
inflammation, pregnancy or tumor. Dysfunctional bleeding
usually occurs at the beginning and end of reproductive years:
20% of cases occur in adolescent and more than 50% in
women over the age of 45.
 BIBLIOGRAPHY

Book Referrences:
 Chintamani, Mani Mrinalini, “Lewis’s Medical Surgical Nursing” 2nd Edition, US Editors.
 McKinney Slone Emily, “Textbook of Maternal-Child Nursing”, Saunders Elsevier, Third Edition.
 Suddarth’s & Brunner, “Textbook of Medical Surgical Nursing” 13th Edition, Wolters Kluwer.

Net Referrences:

 https://www.slideshare.net/MononitaBhattacharje/menorrhagia-70220093
 https://www.ncbi.nlm.nih.gov/books/NBK532913/
 https://www.slideshare.net/ChanakTrikhatri/dysfunctional-uterine-bleeding-63299939

Journal Referrences:

 https://journals.lww.com/jaapa/Citation/2018/09000/Abnormal_uterine_bleeding.9.aspx#:~:text=Defined%20as%20bleeding
%20from%20the,have%20fallen%20out%20of%20favor.
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970656/
 https://www.ajog.org/article/S0002-9378(96)80086-X/abstract