CASE REPORT 3: ECTOPIC PREGNANCY (Surgical)

A 38-yr. old Filipino patient, presented G3P2 presented to the ER, complaining of acute onset of lower
abdominal pain and associated with history of amenorrhea for 3 months. LMP- 12/8/21, had no previous
antenatal follow up. Past medical history cesarean section performed 4 yrs. ago, family history known with
Diabetes Mellitus. She had no know allergies and was not taking any medication or contraception. Upon
admission, noted pale looking and distressed. Vital signs taken and recorded, Temp. 37.1C, PR- 110 bpm, RR-
24 bpm, BP- 90/60mmhg. Her abdomen was generally distended and tender on both superficial and deep
palpation. Positive deep tendon reflex.

LABORATORY/DIAGNOSTIC FINDINGS:

 HGB- 3.2g/L

 WBC- 7.5g/L
 Pelvic UTZ showed and empty uterine cavity as well as a live fetus floating in a moderate amount of
free fluid.
Patient consented for emergency laparotomy with possible salpingectomy. Hooked O2 inhalation 6L
via face mask. IVF 0.9 NACL 1L to run @ 30gtts/min. Started Ketorolac 1-amp IVTT ANST (-) STAT.
On post op day 3 the patient, the patient was transferred back to the Gyne ward. Electrolytes were
balanced and double antibiotic medication given and wound dressing done. She was discharged home in a
stable condition five days after surgery.
CASE PRESENTATION:

Anemia
Anemia is the most common hematologic disorder. Anemia predisposes the client to postpartum infection. The hemoglobin level is lower than normal,
reflecting a decrease in number in the function of red blood cells within the circulation. As a result, inadequate amount of oxygen delivered to body tissues is also
lessened.

Iron deficiency anemia is a common type of anemia — a condition in which blood lacks adequate healthy red blood cells. Red blood cells carry oxygen to the
body's tissues. As the name implies, iron deficiency anemia is due to insufficient iron.

Types of Anemia:
o Iron deficiency anemia – is a condition that develops as a result of an inadequate amount of serum iron.
o Aplastic anemia - caused by damage to hematopoietic stem cells and the bone marrow.
o Pernicious anemia - caused by faulty absorption of vitamin B12 from the GI tract.
Assessment:
o Fatigue
o Headache
o Pallor
o Tachycardia
o Low Hemoglobin value
o Hematocrit lower than 30%
Risk Factors for Anemia in Pregnancy:
o Are pregnant with multiples (more than one child)
o Have had two pregnancies close together
o Vomit a lot because of morning sickness
o Are a pregnant teenager
o Don't eat enough foods that are rich in iron
o Had anemia before you became pregnant
 Risks of Anemia in Pregnancy
o A preterm or low-birth-weight baby
o A blood transfusion (if you lose a significant amount of blood during delivery)
o Postpartum depression
o A baby with anemia
Tests for Anemia
o Hemoglobin test. It measures the amount of hemoglobin -- an iron-rich protein in red blood cells that carries oxygen from the lungs to tissues in the body.
o Hematocrit test. It measures the percentage of red blood cells in a sample of blood.
Treatment for Anemia
If you are anemic during your pregnancy, you may need to start taking an iron supplement and/or folic acid supplement. The doctor may also recommend that
you include more animal foods in your diet, such as:
o meat
o eggs
o dairy products

Your OB may refer you to a hematologist, a doctor who specializes in anemia/ blood issues. The specialist may see you throughout the pregnancy and help your
OB manage the anemia and prenatal vitamins. Your doctor may also suggest that you add more foods that are high in iron and folic acid to your diet.
Preventing Anemia
o lean red meat, poultry, and fish
o leafy, dark green vegetables (such as spinach, broccoli, and kale)
o iron-enriched cereals and grains
o beans, lentils, and tofu
o nuts and seeds
o eggs
 NURSING CARE PLAN
PLANNING
ASSESSMENT OBJECTIVE OUTCOME INTERVENTION RATIONALE IMPLEMENTATION EVALUATION
SUBJECTIVE: 1. Assess client’s Influences choice of 1. Assessed client’s After 8 hours of
“mabilis akong ability to perform interventions and ability to perform nursing
mapagod. Parang After 8 hours of duty
wala po akong normal task and needed assistance. normal task and interventions.
the client will report
ganang kumilos, ADL’s noting ADL’s noting Client was able
and
minsan hinahapo reports of reports of to report and
din po”. demonstrate a
weakness, fatigue weakness, fatigue demonstrate a
OBJECTIVE: decrease in
and difficulty in and difficulty in decrease in
pale conjunctiva, physiological signs of
mild spooning of intolerance – pulse,
accomplishing accomplishing task. physiological
task. Cardiopulmonary 2. Pulse and signs of
nails, and heart
and respirations manifestations result
rate of 110bpm 2. Monitor pulse and respirations taken intolerance –
remain within from attempts by the
respirations during and recorded pulse, and
NURSING client’s normal heart and lungs to
and after activity. during and after respirations
DIAGNOSIS: range. supply adequate activity. remain within
Activity amounts of oxygen client’s normal
Intolerance r/t to the tissues. range.
imbalance
between oxygen
supply and
demand (anemia)

DRUG STUDY
GENERIC NAME: Ferrous Sulfate MECHANISM OF ACTION: SIDE EFFECTS / ADVERSE REACTION NURSING RESPONSIBILITIES

Provides elemental iron, an essential

BRAND NAME: Feratab component in the formulation of  GI: nausea, epigastric pain,  Tell patient to take tablets with
hemoglobin. vomiting, constipation, black juice or water but not with milk.
DRUG ILLUSTRATION: stools, diarrhea, anorexia  Instruct patient not to chew or
 OTHER: Temporarily stained teeth crush.
from liquid forms.  Advise patient to report
constipation and change in stool
color or consistency.
INDICATION:

1. Iron deficiency
CLASSIFICATION: 2. As a supplement during
Hematinic pregnancy

DOSAGE / FREQUENCY / ROUTE CONTRAINDICATION:

Iron deficiency – adults 150-300mg P.O  Contraindicated in patient with

elemental iron daily in three divided hemosiderosis, primary
doses. hemochromatosis, hemolytic
Pregnancy supplements- adults 15-30mg anemia (unless patient also has
elemental iron P.O daily during last two iron deficiency anemia), peptic
trimesters. ulceration, ulcerative colitis, or
regional colitis, and in those
Onset-4days receiving repeated blood trans
Peak- 7-10 days fusions.
Duration- 2-4months  Use cautiously in long term basis.

STUDY OF ILLNESS CONDITION

ILLUSTRATION OF ORGAN / BODY
SYSTEM AFFECTED / ACTUAL SIGN NORMAL PHYSIOLOGY
AND SYMPTOMS
Red blood cells, also
known as
erythrocytes, deliver
oxygen to the tissues in
your body. Oxygen turns
into energy and your
tissues release carbon
dioxide. Your red blood
cells also transport carbon
dioxide to your lungs for
you to exhale
Red Blood Cells
FAMILY NURSING CARE PLAN
PATHOPHYSIOLOGY
Iron deficiency anemia is a
common type of anemia — a
condition in which blood
lacks adequate healthy red
blood cells. Red blood cells
carry oxygen to the body's
tissues. As the name
implies, iron deficiency
anemia is due to insufficient
iron.
ASSESSMENT PARAMETER ANALYSIS
OBJECTIVE CUES:  Hg 7.1 gm/dl,
NORMAL VALUES:
11.6 to 15 grams per
Physical examination is deciliter.
positive for pale conjunctiva,
mild spooning of nails, and heart Low Hgb is also known
as anemia, which means
rate of 110bpm.
that you don't have
enough red blood cells in
LABORATORY FINDINGS:
your body
 Complete blood count
(CBC) - Hg 7.1 gm/dl,
HCT 23%, WBC 5,400/mm3
(differential is normal),
 Occult blood test negative.
HEALTH FAMILY GOAL OF OBJECTIVES OF INTERVENTIONS RATIONALE METHOD OF RESOURCES IMPLEMENTATION EVALUATION
PROBLEM NURSING CARE CARE FAMILY
PROBLEM CONTACT

HEALTH TEACHING PLAN

  Subject Matter: Iron Deficiency Anemia
 Time Allotment: 8am- -8:30am
 T.P.O.:
 Date: March 4, 2022
Assessment Teaching Objectives Content Teaching strategies Time Resources Evaluation
allotment
At the end of 30 minutes Iron deficiency 30 minutes Client was able to
SUBJECTIVE: health teaching. The anemia Power Point Presentation report and
“mabilis akong patient will be able to: Discussion
mapagod. Parang
demonstrate a
is a common type of
wala po akong anemia — a condition decrease in
 demonstrate a Manila Paper
ganang kumilos, in which blood lacks physiological signs
minsan hinahapo decrease in adequate healthy red of intolerance –
din po”. physiological blood cells. Red blood
OBJECTIVE: signs of cells carry oxygen to the
pulse, and
pale conjunctiva, intolerance – body's tissues. As the respirations remain
mild spooning of pulse, and name implies, iron within client’s
nails, and heart deficiency anemia is due normal range.
respirations to insufficient iron.
rate of 110bpm
remain within
client’s normal Symptoms include: Patient
range. o Fatigue acknowledged
Nursing o Headache teachings.
Diagnosis: o Pallor
o Tachycardia
Activity Intolerance o Low
r/t imbalance Hemoglobin
between oxygen
value
supply and demand
o Hematocrit
(anemia)
lower than 30%

Treatment for Anemia

If you are anemic during
 your pregnancy, you
may need to start taking
an iron supplement
and/or folic acid
supplement. The doctor
may also recommend
that you include more
animal foods in your
diet, such as:
o meat
o eggs
o dairy products

Preventing Anemia
o lean red meat,
poultry, and fish
o leafy, dark
green
vegetables
(such as
spinach,
broccoli, and
kale)
o iron-enriched
cereals and
grains
o beans, lentils,
and tofu
o nuts and seeds
o eggs

DATE AND TIME FOCUS DATA / ACTION / RESPONSE

March 4, 2022
8am
DATA:
Fatigue “mabilis akong mapagod. Parang wala po akong ganang kumilos, minsan hinahapo din po” as
verbalized by the patient.

ACTION:
10 am  Assess client’s ability to perform normal task and ADL’s noting reports of weakness, fatigue
and difficulty in accomplishing task.
 Monitor pulse and respirations during and after activity.

RESPONSE:
4pm
Client was able to report and demonstrate a decrease in physiological signs of intolerance – pulse,
and respirations remain within client’s normal range. Patient acknowledged teachings. Endorsed.

D- Noted pale looking. Complete blood count (CBC) - Hg 7.1 gm/dl, No active bleeding. G3P2 18 weeks
8am Pallor
AOG.
A - Advised to report any signs of bleeding, severe dizziness and shortness of breathing.
- Vital signs taken and recorded.
- Advised intake of rich iron foods.
9am
- Feratab given 1 tab per orem as ordered.
- Provided rest periods.
10 am
- Carried out Doctor’s order for repeat CBC.
4pm
R- No complaints made. With minimal paleness noted. For repeat CBC tomorrow. Lab request made.
Endorsed.
CASE REPORT 4: Gestational Diabetes Mellitus/ Diabetes mellitus (non-Surgical)
A 31-year-old woman, a housewife, presented to your hospital at six weeks of gestation of her first pregnancy.
Claimed to have excessive thirst and hunger. Her body mass index was 23 and blood pressure was 124/78 mm
Hg, temp-36.5C, PR- 80bpm, RR-19bpm. There was a strong family history of type 2 diabetes as both her
parents were diabetic
The fasting value was 108 mg/dl and 2-h value were 210 mg/dl. The result of the glycated hemoglobin (HbA 1c)
testing done at the same time was 6.6% (reference range 6.6–8.3%). The diagnosis of gestational diabetes
mellitus was made and insulin therapy in the form of twice daily injections of insulin apart and once daily
injection of HUMALOG (insulin lispro) was started. Follow ups were done at intervals of 2–4 weeks depending
on the glycemic control achieved.