“Nursing Care Management for

Client with Induced Abortion”

Case Presentation

Abarro, Jellaine
Bernardo, Ruth Amielle
Ebuna, Shannah Louise
Mallari, Jaleen
Montero, Ma. Cecilia
Reyes, Leslie Anne
Santos, Gina Grace

BSN ll-B
Batch 2024
OVERVIEW
Mrs. B went to the hospital on July 28, 2020, with the chief complaints of foul-
smelling vaginal discharge accompanied by fever and chills. She had an induced abortion at
about six weeks of pregnancy to a hilot because of her job and upcoming promotion.
Abdominal massage was performed to her abdomen. A catheter also inserted to her cervix
and ask to take 2 tablets of Cytotec. 2 days after that she experienced severe vaginal bleeding
and passed out meaty materials. 7 days after, she has slight bleeding that is foul smelling.

SCOPE AND DELIMITATION

SCOPE:
The case presentation is about the following data:
 Presentation of Biographical Data, Health History and Physical Assessment
 Discussion of the Definition of the disease, Anatomy, and Physiology of the
Respiratory System, Pathophysiology, Laboratory, and Diagnostic Tests, and the
Medical and Nursing Management for Septic (Incomplete) Abortion
 Drug Studies that include Paracetamol, Ampicillin, Gentamicin, Metronidazole,
 Presentation of 2 Actual and 1 Risk Nursing Care Plan

DELIMITATION:
 All the data are limited to the case scenario given

DEFINITION OF TERMINOLOGIES

 Abortion - the termination of a pregnancy by removal or expulsion of an embryo or

fetus. An abortion that occurs without intervention is known as a miscarriage or
"spontaneous abortion"
 Catheter - flexible tube that can put fluids into your body or take them out.
 Cervix - The lower, narrow end of the uterus that forms a canal between the uterus
and vagina
 Dilation and curettage - A dilation and curettage procedure, also called a D&C, is a
surgical procedure in which the cervix (lower, narrow part of the uterus) is dilated
(expanded) so that the uterine lining (endometrium) can be scraped with a curette
(spoon-shaped instrument) to remove abnormal tissues.
 Disseminated intravascular coagulation (DIC) - is a rare and serious condition that
disrupts your blood flow. It is a blood clotting disorder that can turn into
uncontrollable bleeding. DIC can affect people who have cancer or sepsis.
 Fibrinogen - is a protein produced by the liver. This protein helps stop bleeding by
helping blood clots to form.
 Foul smelling vaginal discharge - An abnormal smelling vaginal discharge that's
worse after sex or menstruation. A discharge that's thin and milky and can be
described as having a “fishy” odor.
 Hemoglobin - is a protein in your red blood cells that carries oxygen to your body's
organs and tissues and transports carbon dioxide from your organs and tissues back to
your lungs
 Induced Abortion - When deliberate steps are taken to end a pregnancy, it is called
an induced abortion, or less frequently "induced miscarriage".
 Menarche - The first occurrence of menstruation.
 Neutrophils - are a type of white blood cell (leukocytes) that act as your immune
system's first line of defense.
 Partial thromboplastin time (PTT) - test measures the time it takes for a blood clot
to form
 Prothrombin time (PT) - test measures how long it takes for a clot to form in a blood
sample.
 Septic (Incomplete) Abortion - serious uterine infection during or shortly before or
after an abortion.
 Transvaginal ultrasound - is a test used to look at a woman's uterus, ovaries, tubes,
cervix, and pelvic area. Transvaginal means across or through the vagina.
 Uterus - hollow muscular organ located in the female pelvis between the bladder and
rectum.
 Vagina - It’s a powerful passage that plays a role in sex, menstruation, pregnancy and
childbirth.
 HEALTH HISTORY AND PHYSICAL ASSESSMENT

I. BIOGRAPHICAL DATA
Name of the Client: Mrs. B
Address: Sta. Maria Bulacan
Age: 32 years old
Sex: Female
Religion: Roman Catholic
Civil Status: Married
Provider of History: Client
Chief Complain: Foul smelling vaginal discharge accompanied by fever and chills
Obstetric Score: G2, P1
Admitting Diagnosis: Septic (Incomplete) Abortion

II. REASON FOR SEEKING HEALTH CARE

The Client consulted to the hospital due foul-smelling vaginal discharge accompanied by
fever and chills.

III. HISTORY OF PRESENT HEALTH CONCERN

She had an induced abortion at about six weeks of pregnancy to a hilot. Because of her job
and upcoming promotion, she decided to abort the baby, as verbalized by the client. She went
to a hilot and performed abdominal massage to her abdomen. A catheter also inserted to her
cervix and ask to take 2 tablets of Cytotec. 2 days after that she experienced severe vaginal
bleeding and passed out meaty materials. 7 days after, she has slight bleeding that is foul
smelling. She doesn’t have any consultation to a physician after she aborted her baby.

Upon consultation, the patient presents to clinic feeling very ill. She complains of fatigue and
weakness. Her vital signs were as follows: BP- 80/50mmhg, PR-120 beats/min. RR-30
Breaths /min. Temp-40.5 degrees centigrade. Her height is 62 inches (157 cm), and her
weight is 148 lbs. (67 kg). Transvaginal ultrasound was done with the result of Incomplete
Abortion. Blood exam also requested. Investigations revealed hemoglobin - 8 gm/dl, White
blood cell count of 21,000/ mm 3 with 80% neutrophils, blood urea-52 mg/dl, serum
creatinine-1.7mg mg/dL. Serum electrolytes, markers of disseminated intravascular
coagulation, prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen were all
normal.

IV. PAST HEALTH HISTORY

A. Childhood illnesses
The patient said that she only had fever, cough, and colds as her childhood illness

B. Immunization
The client stated that she also completed all her vaccination
C. Medication
According to client, she takes OTC drugs such as paracetamol for fever, and Mefenamic for
body pain

D. Allergies
The client does not have allergies to any foods and drugs

E. Accident
The client also stated that she never got involved in any accident

V. FAMILY HEALTH HISTORY

The client stated she is living with her husband. The patient stated that they have no history
of hypertension, DM, asthma.

VI. OBSTETRIC HISTORY

Mrs. B had her menarche when she was 12 y/o. She has a menstrual cycle of 5 days interval
consuming 2 pads a day, but she is not experiencing dysmenorrhea. Her menstruation delayed
for almost 3 weeks, and she suffered dizziness, nausea and vomiting so she decided to have a
Pregnancy test at home which revealed to be positive. Her Ob score is G2P1. Her 1st child
was 7-year-old already and no complication during birth.

VII. PHYSICAL ASSESSMENT

A. Skin, Hair, Nails
N/A

B. Head and Neck

N/A

C. Eyes
N/A

D. Ears
N/A

E. Mouth, Throat, Nose, and Sinuses

N/A

F. Thorax and Lungs

Lungs are clear to auscultation

G. Breasts
The Client nipples are everted bilaterally with no discharge
H. Heart and Neck Vessels
N/A

I. Peripheral Vascular
N/A

J. Abdomen
N/A

K. Genitalia
The client had her menarche when she was 12 y/o. She has a menstrual cycle of 5 days
interval consuming 2 pads a day, but she is not experiencing dysmenorrhea. She has slight
vaginal bleeding that foul-smelling

L. Anus/Rectum
N/A

M. Musculoskeletal
N/A

N. Neurologic
N/A

VIII. LIFESTYLE AND HEALTH PRACTICES

A. DESCRIPTION OF A TYPICAL DAY
N/A

B. NUTRITION AND WEIGHT MANAGEMENT

N/A

C. ACTIVITY LEVEL AND EXERCISE

N/A

D. USE OF MEDICATION AND OTHER SUBSTANCES

She takes OTC drugs such as paracetamol for fever, and Mefenamic for body pain.

E. SLEEP AND REST PATTERN

N/A

F. SELF - CONCEPT AND SELF - CARE RESPONSIBILITIES

N/A

H. RELATIONSHIPS
The patient stated she is living with her husband and with her 7-years-old child
I. VALUES AND BELIEF SYSTEM
N/A

J. EDUCATION AND WORK

N/A

K. STRESS LEVEL AND COPING STYLES

N/A

L. ENVIRONMENTAL
N/A
 ANATOMY AND PHYSIOLOGY OF FEMALE REPRODUCTIVE SYSTEM

The female reproductive system functions to

produce gametes and reproductive hormones,
just like the male reproductive system;
however, it also has the additional task of
supporting the developing fetus and delivering
it to the outside world. Unlike its male
counterpart, the female reproductive system is
located primarily inside the pelvic cavity.
Recall that the ovaries are the female gonads.
The gamete they produce is called an oocyte.
We’ll discuss the production of oocytes in
detail shortly. First, let’s look at some of the
structures of the female reproductive system.
The external female reproductive structures are
referred to collectively as the vulva. The mons pubis is a pad of fat that is located at the
anterior, over the pubic bone. After puberty, it becomes covered in pubic hair. The labia
majora (labia = “lips”; majora = “larger”) are folds of hair-covered skin that begin just
posterior to the mons pubis. The thinner and more pigmented labia minora (labia = “lips”;
minora = “smaller”) extend medial to the labia majora. Although they naturally vary in shape
and size from woman to woman, the labia minora serve to protect the female urethra and the
entrance to the female reproductive tract.

The superior, anterior portions of the labia minora come together to encircle the clitoris (or
glans clitoris), an organ that originates from the same cells as the glans penis and has
abundant nerves that make it important in sexual sensation and orgasm. The hymen is a thin
membrane that sometimes partially covers the entrance to the vagina. An intact hymen cannot
be used as an indication of “virginity”; even at birth, this is only a partial membrane, as
menstrual fluid and other secretions must be able to exit the body, regardless of penile–
vaginal intercourse. The vaginal opening is located between the opening of the urethra and
the anus. It is flanked by outlets to the Bartholin’s glands (or greater vestibular glands).

The female reproductive system

includes all the internal and
external organs that help with
reproduction. The internal sex
organs are the ovaries, which
are the female gonads, the fallopian tubes, two muscular tubes that connect the ovaries to
the uterus, and the uterus, which is the strong muscular sack that a fetus can develop in. The
neck of the uterus is called the cervix, and it protrudes into the vagina. At the opening of the
vagina are the external sex organs, and these are usually just called the genitals and they’re in
the vulva region. They include the labia, the clitoris, and the mons pubis.

The ovaries are a pair of white-ish organs

about the size of walnuts. They’re held in
place, slightly above and on either side of
the uterus and fallopian tubes by
ligaments. Specifically, there’s the broad
ligament, the ovarian ligament, and the
suspensory ligament. And the suspensory
ligament is particularly important because
the ovarian artery, ovarian vein, and
ovarian nerve plexus pass through it to
reach the ovary. If you slice the ovary
open and look at it (don’t try this at home)
there’s an outer layer called the cortex, which has ovarian follicles scattered throughout it,
and an inner layer called the medulla, which contains most of the blood vessels and nerves.
 OVERVIEW OF A DISEASE
Abortion is the expulsion or extraction of an embryo or fetus weighing 500 g or less from its
mother when it is not capable of independent survival. It is the medical term for any
interruption of a pregnancy before a fetus is viable.

Types of Abortion
 Spontaneous - refers to pregnancy loss at less than 20 weeks' gestation in the absence
of elective medical or surgical measures to terminate the pregnancy. Synonymous to
the term "miscarriage".
 Induced - refers to when a procedure is done intentionally, or medication is taken to
end a pregnancy.

Induced abortion ends a pregnancy with medical or surgical procedure. This is brought about
intentionally and is also called an artificial or therapeutic abortion.
 Elective: performed because the mother chooses or desires to end the pregnancy.
 About 20 in every 1000 U.S. women will elect to terminate a pregnancy in
their lifetime (one half of unintended pregnancies end with elective
termination) (CDC. 2009). The majority of these procedures are done when
the pregnancy is less than 12 weeks. The maternal mortality rate of elective
terminations is 0.6 per 100,000 procedures performed. This makes elective
termination about 11 times safer for women than childbirth, for which the
mortality rate is closer to 6 per 100,000 births (Stubblefield, Carr-Ellis, &
Kapp, 2007).
 Therapeutic: performed for reasons of maintaining the health of the mother.

POTENTIAL RISKS OF MEDICAL ABORTION

 Incomplete abortion, which may need to be followed by surgical abortion
 Digestive or GI problems
 Heavy and prolonged bleeding
 Infection

POTENTIAL RISKS OF SURGICAL ABORTION

 Damage to the cervix
 Prolonged heavy bleeding
 Scar tissue on the uterine wall
 Perforation of the uterus

COMPLICATION OF INDUCED ABORTIONS

Complication is rare with legal abortion. Complication rates increase as gestational age
increases. Overall complications are higher than those with contraception; however, rates are
14 times lower than those after delivery of a full-term infant, and rates have decreased in the
last few decades.
Serious early complications include:
 Perforation of the uterus (0.1%) or, less often, of the intestine or another organ by an
instrument
 Major hemorrhage (0.06%), which may result from trauma or an atonic uterus
 Laceration of the cervix (0.1 to 1%), which are typically superficial tenaculum tears
but can be more serious and require repair
The most common delayed complications include:
 Bleeding and significant infection (0.1 to 2%)
Psychologic complications do not typically occur but may occur in women who:
 Had psychologic symptoms before pregnancy.
 Had significant emotional attachment to the pregnancy.
 Have limited social support or feel stigmatized by their support system.
Incomplete abortion is a pregnancy that is associated with vaginal bleeding, dilatation of the
cervical canal, and passage of products of conception. Usually, the cramps are intense, and
the vaginal bleeding is heavy. Patients may describe passage of tissue, or the examiner may
observe evidence of tissue passage within the vagina. Ultrasound may show that some of the
products of conception are still present in the uterus.
Incomplete abortion happens when some pregnancy tissue remains in your womb. This
causes painful symptoms that need medical attention as soon as possible.
It happens more often with a medication abortion (the abortion pill) due to less interaction
with a medical professional and user error. There is, however, still a chance of the abortion
being incomplete in both types of procedures.
There are several other complications that can arise after the management of incomplete
abortion including:
 uterine rupture,
 uterine perforation
 subsequent hysterectomy,
 multisystem organ failure
 pelvic infection
 cervical damage
 vomiting
 diarrhea
 infertility
 and/or psychological effects.
 Death
 PATHOPHYSIOLOGY

Non-modifiable Factors Modifiable Factors

 Age: 30 years or more at  unwanted pregnancy
conception and family  fear to society
 Previous miscarriages. ABORTION  Taking medication
 Uterine or cervical (Cytotec)
problems  Catheterization

INDUCED
(Cytotec, Catheterization,
Abdomen massage)

Complete Incomplete

All the pregnancy tissue has Some pregnancy tissue

left from the uterus remains in the womb.

 Bleeding Infection
 Abdominal Pain
 Tissue passage
 Foul-smelling vaginal
Discharge
 Fever and chills
Uterus contracting to empty

Probable septic abortion

Stabilizes

Ultrasound shows that some of the

products of conception are
still inside the uterus D&C
 LABORATORY EXAMINATION/DIAGNOSTIC TEST
HEMATOLOGY RESULT
BLOOD Description NORMAL RESULTS INTERPRE INDICATION
COMPONENTS VALUES TATION
Hemoglobin is a
Hemoglobin protein in your red 11.5- 8gm/dl Low hemoglobin levels lead
blood cells that 13.0gm/dl LOW to anemia.
carries oxygen to
your body's organs
and tissues and
transports carbon
dioxide from your
organs and tissues
back to your lungs
White blood cells
White Blood are part of the 4,500 to 21,000/ HI High white blood cells
Cell body’s immune 11,000/mm3 mm3 GH count that may indicate that
(WBC) system. They help the immune system is
the body fight working to destroy an
infection and other infection.
diseases. Types of
white blood cells
are granulocytes
(neutrophils,
eosinophils, and
basophils),
monocytes, and
lymphocytes (T
cells and B cells).
Test measures the
Blood Urea amount of urea 7-12mg/dl 52 mg/dl HI High levels in your blood
Nitrogen nitrogen found in GH sample usually mean your
(BUN) your blood. Urea kidneys aren't working
nitrogen is a waste normally. They can be a
product made when sign of kidney disease or
your liver breaks failure.
down protein.

A creatinine test is
Serum Creatine a measure of how 0.4 to 0.8 1.7mg HI Moderate to severe CKD
Level well your kidneys mg/dL mg/dL GH results in an increased risk
are performing their for pregnancy
job of filtering complications and neonatal
waste from your morbidity
blood.

TEST
Transvaginal Ultrasound
Prothrombin time (PT)
DIAGNOSTIC TEST
DESCRIPTION STATUS
Transvaginal ultrasound is a
test used to look at a woman's
uterus, ovaries, tubes, cervix,
and pelvic area. Transvaginal DONE
means across or through the
vagina. The ultrasound probe
will be placed inside the vagina
during the test.
Measures how long it takes
for a clot to form in a blood
sample. An INR DONE
(international normalized
ratio) is a type of calculation
based on PT test results.

Partial thromboplastin time Measures the time it takes DONE

(PTT) for a blood clot to form.

Hematology tests include tests on the blood, blood proteins and blood-producing organs.
These tests can evaluate a variety of blood conditions including infection, anemia,
inflammation, hemophilia, blood-clotting disorders, leukemia and the body's response to
chemotherapy treatments. It’s part of the routine hospital admission test, and as part of
physical examination for the patient.
The patient complete hematology results yielded with slightly low hemoglobin level, higher
level of WBC, higher level of blood urea and also a higher level of serum creatine level. The
result may have an infection of Anemia in pregnancy. During pregnancy, the volume of blood
increases. This means more iron and vitamins are needed to make more red blood cells.
Nursing Responsibilities
 Verify that an informed consent is obtained, as needed.
 Explain the procedure to the woman to ensure both are well informed.
 Prepare the woman physically and psychologically.
 Obtain necessary equipment for the procedure.
 Accompany a woman to a treatment room or hospital department where the procedure
will be performed.
 Coordinate and collaborate with other healthcare providers to ensure the safety and
efficacy of all procedures.
 Ensure adherence to standard infection precautions.
 Assess the woman’s response to the procedure.
 Document the outcome of the procedure and the child’s reaction to the procedure.
 MEDICAL/SURGICAL MANAGEMENT
MEDICATION RATIONALE STATUS
Commonly used medicine
Paracetamol that can help treat pain and
reduce a high temperature
(fever). It's typically used to DONE
relieve mild or moderate
pain, and reduce fevers
caused by illnesses such as
colds and flu.
The Dextrose 5% in
IVF D5LR 1 Liter Lactated Ringers Solution
(D5LRS) is useful for daily
maintenance of body fluids DONE
and nutrition, and for
rehydration.

This solution is used to

PNSS 1 Liter (Normal Saline)
supply water and salt
(sodium chloride) to the
body. Sodium chloride
solution may also be mixed DONE
with other medications
given by injection into a
vein.

Ampicillin is used to treat

Ampicillin certain infections that are
caused by bacteria such as
meningitis (infection of the
membranes that surround DONE
the brain and spinal cord);
and infections of the throat,
sinuses, lungs, reproductive
organs, urinary tract, and
gastrointestinal tract.
Gentamicin injection is used
Gentamicin to treat serious bacterial
infections in many different
parts of the body.
Gentamicin belongs to the DONE
class of medicines known as
aminoglycoside antibiotics.
It works by killing bacteria
or preventing their growth.

Metronidazole is an
Metronidazole antibiotic that is used to treat DONE
 a wide variety of infections.
It works by stopping the
growth of certain bacteria
and parasites. This antibiotic
treats only certain bacterial
and parasitic infections.

2 Units of FWB (fresh whole A blood transfusion

blood provides blood or blood
components if you've lost DONE
blood due to an injury,
during surgery or have
certain medical conditions
that affect blood or its
components. The blood
typically comes from
donors. Blood banks and
healthcare providers ensure
transfusions are a safe, low
risk treatment.

SURGICAL MANAGEMENT
SURGICAL MANAGEMENT RATIONALE STATUS
This is most performed for incomplete
Dilatation and Curettage (D&C) abortions to remove the remainder of the
products of conception from the uterus. DONE
Since the uterus would not be able to
contract effectively, the contents might be
trapped inside and could cause serious
bleeding and infection.
 NURSING MANAGEMENT
NURSING MANAGEMENT RATIONALE STATUS
 The vital signs must be  Taking of Vital Signs provides baseline
frequently monitored. of client data for the nurse, early DONE
detection of complications can be
found through Vital Signs.
 Perform a  History taking is a key component of
comprehensive nursing patient assessment, enabling the
history delivery of high-quality care. DONE
Understanding the complexity and
processes involved in history taking
allows nurses to gain a better
understanding of patients' problems.
 Assess emotional state.  Anxiety and depression are common
Note cultural beliefs and reactions to losses associated with DONE
expectations. abortion or pregnancy loss. Personal
expectations may affect response to
change.
 Assist client with using  Relaxation techniques help to decrease
relaxation techniques, of anxiety and fear, enhancing feelings
such as muscle of control DONE
relaxation, breathing,
and music
 Encourage expressions  This encourages the patient to talk
of feelings, accepting the freely without fear or judgment
client's view of the DONE
situation without
confrontation
 Perform abdominal  The abdominal examination helps
examination (Look for determine whether or not the state of an
peritoneal signs, absent acute abdomen is present. Note the DONE
bowel sounds, palpable following: In a complete abortion, the
masses, or severe abdomen is benign, with no distension,
tenderness.) no rebound, normal bowel sounds, no
hepatosplenomegaly, and mild
suprapubic tenderness
 Perform pelvic  Assess for the severity of vaginal
examination bleeding, look for obvious vaginal or
cervical injury, determine whether the DONE
cervical opening to the uterus is open
or closed, and note the size and tonus
of the uterus as well as uterine
tenderness and/or adnexal tenderness.

 Determined as to what  To provide appropriate care.

stage is the client in DONE
grieving.
 Teach client about the  Improves consistency of medication
administration of administration and the recognition of DONE
medications prescribed. its adverse effects.
 Provide health education  For them to be knowledgeable
to the patient regarding regarding abortion and to be more DONE
abortion conscious to the action that they will
take.
 Counseling regarding  Contraceptive counseling has great
contraceptive potential as a strategy to empower DONE
women who do not desire pregnancy to
choose a method of birth control that
she can use correctly and consistently
over time, thereby reducing her
individual risk of unintended
pregnancy.
 Counseling regarding  It is important to realize that counseling
psychological and mental health treatment is a healthy DONE
action for everybody. A little
counseling can help everyone to
improve in their everyday life.

 Educate the patient  A blood transfusion is a routine

regarding blood medical procedure in which donated
transfusion blood is provided to you through a DONE
narrow tube placed within a vein in
your arm. This potentially life-saving
procedure can help replace blood lost
due to surgery or injury. A blood
transfusion also can help if an illness
prevents your body from making blood
or some of your blood's components
correctly.
 Provide health education  Family planning is important for every
regarding Family sexually active adult to consider birth DONE
Planning control issues. This is not only for the
purpose of preventing unwanted
pregnancies, but also to plan the timing
of conception for unwanted
pregnancies.
 DRUG STUDY 1
Medication Classification/ Indications Contraindication Side effects Adverse Nursing Responsibilities
Action effects
Generic name: Classification: Acetaminophen ● Contraindic ● abnorm CNS: headache, Before:
Acetaminophen Antipyretics, Analgesics injection is ated in al breath drowsiness, ● Check for the doctor’s order
indicated for the patients sounds stimulation. ● Follow the 10 Rs of medication
Brand Name: Action: management of hypersensiti ● bloating GI: Vomiting, administration.
Paracetamol Paracetamol exhibits mild to moderate ve to drugs. or abdominal pain ● Do not administer unless the
analgesic action by pain, the ● Use swelling Hepatic: solution is clear, and the
Usual Route: peripheral blockage of management of cautiously of the hepatotoxicity, container is undamaged.
IV pain impulse generation. moderate to in patients face, hepatic seizure
● Make a medication card with
It produces antipyresis severe pain with with long- arms, Skin: erythema,
the complete doctor’s order,
Drug Order: by inhibiting the adjunctive opioid term hands, flushing,
Paracetamol 300 mg hypothalamic heat- analgesics, and alcohol use lower pruritus. name of the patient, bed number
TIV regulating center. Its the reduction of because legs, or Renal: Renal and room/ward
weak anti-inflammatory fever. therapeutic feet failure ● Obtain and record vital signs.
activity is related to doses cause ● difficult Hematology: ● Secure a copy of the client’s
inhibition of hepatotoxici of leukopenia, health history for
prostaglandin synthesis ty to these labored neutropenia, contraindications and drug
in the CNS. patients. breathin hemolytic interactions (notify the
g anemia (long physician if any).
Therapeutic Effects: ● dizzines term use) ● Ask the client’s full name to
Analgesia. Antipyresis s thrombocytopen verify his identity.
● muscle ia, ● Educate and explain the
Pharmacodynamics: pain or pancytopenia. medication to the client, how it
Onset: within 30 cramps works, why it is given to him,
minutes ● sweatin and the possible side effects
Peak: 30 minutes g
Duration: 4-6 hrs. ● tightnes
s of the
Pharmacokinetics: chest
Absorption: ● unusual
Intravenous tirednes During:
administration results in s or ● Paracetamol 300 mg as per
complete bioavailability. weaknes doctor’s order
s ● Assess the patient's fever or
Distribution: pain, type of location, intensity,
Widely distributed. duration, temperature,
Crosses the placenta; diaphoresis.
enters breast milk in low ● Assess allergic reactions: if
concentrations rash, urticaria occur, drug may
have to be discontinued.
Metabolism: ● If hypersensitivity occurs, stop
85–95% metabolized by the administration immediately.
the liver

Excretion: After:
Excreted in the urine ● Monitor the effect of the drugs
that are administered to the
Half-Life: patient
1-3 hrs. ● Check for any signs of
hypersensitivity.
● Observe acute toxicity and
overdose.
● Evaluate patient knowledge of
therapy.
● Obtain vital signs.
● Advise patient that although it
is common to feel better early
during therapy, the medication
should be taken exactly as
directed.
● Emphasize the importance of
complying with the drug
regimen, which may take
months or years
 ● Document the time, location,
dose, and medication given to
the client.

DRUG STUDY 2
Medication Classification/ Indications Contraindication Side effects Adverse effects Nursing
Action Responsibilities
Generic Name: Classification: ● Treatment of ● Contraindicated ● nausea CNS: Lethargy, Before:
Ampicillin infections with allergy to ● vomiting hallucinations, ● Check doctor’s
Pharmacologic caused by penicillins, ● diarrhea seizures order
Brand Name: Classification: susceptible cephalosporins, or ● stomach/ ● Follow the 10
Omnipen Aminopenicillins strains of other allergens. abdominal CV: Heart failure Rs of
Ampicin Shigella, pain medication
Principen Salmonella, S. Precaution: ● yellowing GI: Glossitis, administration
Therapeutic typhosa, E. ● Use cautiously with eyes or skin stomatitis, gastritis, ● Assess for
Usual Route: Classification: Anti- coli, renal disorders. easy bruising sore mouth, furry allergies to
IV infectives Haemophilus or bleeding tongue, black hairy penicillin,
influenzae, tongue, nausea cephalosporins,
Drug Order: Action: Proteus vomiting, diarrhea, or other
Ampicillin 1gram Bactericidal action mirabilis, abdominal pain, allergens.
q 6 hours against sensitive Neisseria bloody diarrhea, ● Assess for renal
organisms; inhibit gonorrhoeae, enterocolitis, disorders,
synthesis of bacterial enterococci, pseudomembranous lactation
cell wall, causing cell gram- positive colitis, nonspecific ● Culture infected
death. organisms hepatitis. area; skin color,
(penicillin G- lesion;
Therapeutic Effect: sensitive GU: Nephritis adventitious
Bactericidal action; staphylococci, sounds.
spectrum is broader streptococci, Hematologic: ● monitor renal
than penicillin pneumococci) anemia, function test.
● Prevention of thrombocytopenia, ● Make a
Pharmacodynamics bacterial leukopenia, medication card
: endocarditis neutropenia, with the
Onset: rapid following prolonged bleeding complete
Peak: end of infusion dental, oral, or time. doctor’s order,
Duration: 4-6 hrs. respiratory name of the
procedures in Hypersensitivity:
patient, bed
Pharmacokinetics: very high-risk rash fever,
number and
Absorption: patients wheezing,
Moderately absorbed anaphylaxis room/ward
from the duodenum ● Obtain and
(30–50%). Local: pain, record vital
phlebitis, signs.
Distribution: thrombosis at ● Secure a copy
Diffuses readily into injection site of the client’s
body tissues and health history
fluids. Others: for
superinfections-oral contraindication
Metabolism: and rectal s and drug
Variably metabolized moniliasis vaginitis interactions
by the liver.
 (notify the
Excretion: physician if
Excreted in the urine. any).
● Ask the client’s
Half-Life: full name to
1-1.5 hrs. verify his
identity.
● Educate and
explain the
medication to
the client, how
it works, why it
is given to him,
and the possible
side effects

During:
● Administer the
right drug in the
right route and
dosage at the
right time
● explain the
purpose and
importance of
the drug to the
patient.
● Administer oral
drugs on the
empty stomach,
1 hour before or
2 hours after
meals with a
 full glass of
water.
● avoid fruit juice
and soft drinks.

After:
● Monitor the
effect of the
drugs that are
administered to
the patient
● Check for any
signs of
hypersensitivity
.
● Observe acute
toxicity and
overdose.
● Evaluate patient
knowledge of
therapy.
● Obtain vital
signs.
● Advise patient
that although it
is common to
feel better early
during therapy,
the medication
should be taken
exactly as
directed.
● Emphasize the
importance of
 complying with
the drug
regimen, which
may take
months or years
● Document the
time, location,
dose, and
medication
given to the
client.

DRUG STUDY 3
Medication Classification/ Indications Contraindication Side effects Adverse effects Nursing Responsibilities
Action
Generic Classification: ● Parenteral use Contraindicated with ● Dizziness, CNS: lethargy, visual Before:
name: Aminoglycoside restricted to allergy to any ● headache, disturbances, ● Assess the patient's
Gentamicin treatment of aminoglycosides. ● vomiting headache, numbness, infection and hearing
Sulfate Action: serious ● weight loss tingling, tremor, before starting therapy
Bactericidal infections of Precaution: paresthesia’s, muscle and regularly
Brand name: inhibits protein GI, Use cautiously with twitching, seizures, thereafter.
Garamycin synthesis in respiratory, renal or hepatic disease; muscular weakness, ● Follow the 10 Rs of
Septopal susceptible strains and urinary preexisting hearing neuromuscular medication
Cidomycin of gram- negative tracts, CNS, loss; active infection blockade. administration
bacteria; appears to bone, skin, with herpes, vaccinia, ● assess patient for
Usual dosage/ disrupt functional and soft varicella, fungal GU: Leukemoid previous sensitivity
frequency: integrity of tissue infections, reaction, reactions.
10 mg bacterial cell (including mycobacterial agranulocytosis ● assess patient for signs
Frequency: membrane, causing burns) when infections (ophthalmic and symptoms of
Q12 cell death. other less preparations); Hypersensitivity: infection including
toxic myasthenia gravis; purpura, rash, characteristics of
Usual route: Therapeutic antimicrobial parkinsonism; infant urticaria. wound, sputum, urine,
IV Effect: agents are botulism; burn patients; and fever.
Bactericidal action ineffective or lactation; pregnancy. Others: ● Make a medication
Drug order are hypersensitivity card with the complete
Gentamicin 80 Pharmacokinetics contraindicate reactions doctor’s order, name
mg TIV : d, has been of the patient, bed
Absorption: well- used in number and
absorbed combination room/ward
with other
● Obtain and record
Distribution: antibiotics.
vital signs.
widely distributed also used
throughout topically for ● Secure a copy of the
extracellular fluid primary and client’s health history
crosses the secondary for contraindications
placenta; small skin and drug interactions
amounts enter infections and (notify the physician if
breast milk for superficial any).
Metabolism and infections or ● Ask the client’s full
Excretion: >90% external eye name to verify his
renal and its identity.
onset: rapid adnexa. ● Educate and explain
peak: unknown the medication to the
Duration: 45 mins client, how it works,
half- life: 2-4 why it is given to him,
hours and the possible side
effects

During:

● Administer
Gentamicin 80 mg in
the right route
● Observe for any
hypersensitivity skin
reactions
● Weigh patient and
review baseline renal
function studies before
therapy.
● instruct to move
slowly and to have
assistance in rendering
activities.
● provide ice chips.
● place the basin beside
the bedside.

After:
● Monitor the effect of
the drugs that are
 administered to the
patient
● Check for any signs of
hypersensitivity.
● Observe acute toxicity
and overdose.
● Evaluate patient
knowledge of therapy.
● Obtain vital signs.
● Advise patient that
although it is common
to feel better early
during therapy, the
medication should be
taken exactly as
directed.
● Emphasize the
importance of
complying with the
drug regimen, which
may take months or
years
● Document the time,
location, dose, and
medication given to
the client.

DRUG STUDY 4
Medication Classification/ Indications Contraindication Side effects Adverse effects Nursing Responsibilities
Action
Generic name: Classification Treatment of Contraindicated in ● Dizziness CNS: The most Before:
Metronidazole Metronidazole serious infections patients with a prior ● headache serious adverse ● Verify and check the
belongs to the class caused by history of ● stomach upset reactions reported in doctor's order.
Brand name: of medicines known susceptible hypersensitivity to ● nausea patients treated with ● Follow the 10 Rs of
Flagyl IV as antibiotics. It anaerobic metronidazole or other ● vomiting metronidazole have medication
works by killing bacteria and is nitroimidazole ● loss of appetite been convulsive administration
bacteria or preventing effective in derivatives ● diarrhea seizures, ● Ensure the 10 rights of
Usual route: their growth. Bacteroides ● constipation encephalopathy, medication are
IV fragilis infections ● pain with aseptic meningitis, followed.
Action: resistant to urination and optic and peripheral ● Monitor the vital signs
Drug order: Metronidazole works clindamycin, metallic taste in neuropathy, the latter including B/P, pulse,
Metronidazole by stopping the chloramphenicol, your mouth characterized mainly for hypotension before
500 mg TIV growth of certain and penicillin may occur by numbness or administration.
every 6 hrs bacteria and paresthesia of an ● Determine history of
ANST parasites. This extremity. hypersensitivity to the
antibiotic treats only medication.
certain bacterial and GI: nausea, ● Educate the patient and
parasitic infections. It sometimes the parents on the side
will not work for accompanied by effects to be
viral infections (such headache, anorexia, familiarized.
as common cold, flu). and occasionally ● Make a medication
vomiting, diarrhea; card with the complete
Therapeutic Effects: epigastric distress; doctor’s order, name
Bactericidal, abdominal cramping; of the patient, bed
trichomonacidal, or and constipation. number and
amebicidal action. room/ward
Skin: erythematous ● Secure a copy of the
Pharmacodynamics rash and pruritus. client’s health history
: for contraindications
Onset: rapid Renal: Dysuria, and drug interactions
Peak: end of infusion cystitis, polyuria, (notify the physician if
Duration: 6-8 hrs. incontinence, a sense any).
of pelvic pressure.
● Ask the client’s full
Pharmacokinetics:
name to verify his
Absorption:
80% absorbed after identity.
oral administration. ● Educate and explain
Minimal absorption Other: Proliferation the medication to the
after topical or of Candida in the client, how it works,
vaginal application. vagina, dyspareunia, why it is given to him,
decrease of libido, and the possible side
Distribution: proctitis, and fleeting effects
Widely distributed joint pains sometimes
into most tissues and resembling "serum
fluids, including sickness”.
CSF. During:

Metabolism: ● Give drugs with meals

Partially metabolized to minimize GI
by the liver (30– distress.
60%) ● Do not use aluminum
needles or hubs, color
Excretion: will turn orange/rust.
Partially excreted ● Follow the directions
unchanged in the on the medicine label.
urine, 6– 15%
eliminated in the
feces. After:

Half-Life: ● Tell the patient that

6-12 hrs. metallic taste and dark
or red brown urine
may occur.
● Instruct to complete a
full course of therapy.
● Tell the patient not to
use alcohol or drugs.
● Inform the significant
others to report any
dizziness the patient
 may feel.
● Obtain vital signs.
● Advise patient that
although it is common
to feel better early
during therapy, the
medication should be
taken exactly as
directed.
● Emphasize the
importance of
complying with the
drug regimen, which
may take months or
years
● Document the time,
location, dose, and
medication given to
the client.
 NURSING CARE PLAN
(Actual Diagnosis)

Assessment Cues Nursing Diagnosis Nursing Objectives Nursing interventions Rationale Evaluation
Subjective Cues: Hyperthermia After 3 hours of Independent After 3 hours of
 Patient related to an dependent and Interventions: dependent and
infectious process as independent nursing  Building trust independent nursing
complains of
evidenced by the interventions, the  Establish rapport can help interventions, the goals
fatigue and facilitate
client’s: client will be able to: with the client were fully met as
weakness. effective patient evidenced by the
Objective Cues:  Body  Decrease body care and enable client:
 Patient has temperature of temperature them to willingly
fever and 40.5 degrees from 40.5 °C express their  Decrease body
chills. centigrade concerns. temperature
to 37.5 °C
Vital Signs  Fever and from 40.5 °C to
 Decrease  Monitor vital  To determine
chills 37.5 °C
 Body white blood signs, especially appropriate
 Fatigue and
Temperature: cells from temperature. interventions.  Decrease white
weakness
40.5 °C 21,000/mm3 blood cells
 Raise side rails  To promote from
 BP: Scientific to all times safety of the
80/50mmhg Explanation: 10,000/mm3 21,000/mm3 to
Hyperthermia - patient 10,000/mm3
 PR: 120
Core body  Eliminate excess
beats/min  To promote
temperature above the clothing.
 RR: 30 comfort and
normal diurnal range
Breaths /min increase heat
due to failure of loss.
Laboratory findings: thermoregulation.
Complete Blood Reference:
Count:  Increase fluid
Nurse’s Pocket Guide intake if not  Additional fluids
 White blood Diagnoses, Prioritized can help to
contraindicated.
cell: prevent elevated
21,000/mm3 Interventions, and  Place or promote  Clear flow of air
Rationales 15th the place of the can promote
Edition client in a well- natural heat loss
ventilated area

 Administer  Tepid sponge

Tepid Sponge bath with the use
Bath (Don’t use of tepid water
alcohol) can promote heat
loss by means of
evaporation and
conduction.
Alcohol cools
skin rapidly that
can cause
shivering

Dependent
Intervention:

 Administer  Medication such

medication as as paracetamol
prescribed by the reduces fever
Physician and antibiotics
which treat the
underlying
bacterial
infection
 NURSING CARE PLAN
(Actual Diagnosis)

Assessment Cues Nursing Nursing Objectives Nursing intervention Rationale Evaluation

Diagnosis
Subjective Cues: Ineffective Denial After 2 hours of Independent After 2 hour of
 Abortion due related to independent and Interventions: independent and
to job insufficient sense of collaborative collaborative nursing
promotion control as evidenced interventions, the client  Establish  Building trust interventions, the goals
 Used hilot as by: will be able to: rapport with the can help were fully met as
a treatment to patient. facilitate evidenced by the client:
induce  Delay in  Acknowledge the effective
pregnancy. seeking reality of patient care  Acknowledging the
 Delay in healthcare. situation. and enable reality of the
seeking  Use of  Express realistic them to situation.
professional treatment not concerns or willingly  Expressing realistic
help. advised by a feelings about express their concerns or
healthcare the situation. concerns. feelings about the
professional.  Seek appropriate  Identify situation.
assistance for  Although  Seeking
situational client may
Scientific related health crisis or appropriate
Explanation: problem. deny or assistance for
problem and minimize her
Ineffective Denial – client’s related health
Conscious or statements, problem.
perception of healthcare
unconscious attempt the situation.
to disavow the provider can
knowledge or open the door
meaning of an event to obtaining
to reduce anxiety help for client
and/or fear, leading by asking
to the detriment of broad
health. questions in
initial
Reference:  Determine the interview.
Nurse’s Pocket stage and
Guide degree of  Treatment
Diagnoses, denial. needs to begin
Prioritized where the
Interventions, and client is and
Rationales 15th progress from
Edition  Use therapeutic there.
communication
skills of active
listening and I-  To develop a
messages. trusting nurse-
client
 Provide a safe, relationship.
nonthreatening
environment.
 This
encourages the
client to talk
 Encourage freely without
expressions of fear of
feelings, judgment.
accepting the
client’s view of  This
the situation encourages the
without client to talk
 confrontation. freely without
fear of
judgment.

Collaborative
Interventions:

 Encourage the
client to talk
with significant
other(s)/friends

 Involve the
 This may
client in group
clarify the
sessions.
concerns and
reduce
isolation.
 The client can
hear other
views of
reality and test
her own
perceptions.
 NURSING CARE PLAN
(Risk Diagnosis)

Assessment Cues Nursing Diagnosis Nursing Objectives Nursing intervention Rationale Evaluation
Risk Factors: Risk for complicated
grieving related to After 1 hour of health ● Establish rapport ● To gain trust After 30 minutes of
 Abortion due elective abortion as teaching to the with the patient. and establish a health teaching to the
to job evidenced by: patient, the following nurse-patient patient, the following
promotion.  Decrease in goals will be met: relationship. goals have met as the
functioning in patient was able to:
● Demonstrate ● Provide a ● A well cleaned
life roles. pleasant ● Display
progress in and therapeutic
dealing with environment for environment progress in
the patient. reflects a level dealing with
stages of grief
Scientific of compassion stages of grief
at own pace. at own pace.
Explanation: for patient
Risk for Complicated welfare that is ● Participate in
● Participate in work and self-
Grieving – as important as
work and self- any other aspect care activities
susceptible to a
disorder that occurs care activities of of competent of daily living.
after the death of a daily living. health care.
significant other, in  Identify stage of
which the experience grief being ● Stages of grief
of distress expressed: may progress in
accompanying denial, isolation, a predictable
bereavement fails to anger, manner or
follow normative bargaining, stages may be
expectations and depression, or random or
manifest in functional acceptance. revisited.
impairment.
  Communicate
● Doenges, therapeutically ● Sharing feelings
Marilynn E., Mary with patient and with a
family members healthcare
Frances provider may
and allow them
Moorhouse, and to verbalize help the patient
Alice C. Murr. feelings find
significance in
2006. Nurse's
the experience
pocket guide: of loss.
diagnoses,
 Encourage
prioritized
verbalization ● This helps to
interventions, and without begin resolution
rationales. confrontation and acceptance.
Philadelphia, PA: about realities.
F.A. Davis.(p.652-  Have the client
653) identify familial,  This may help
religious, and bring loss into
cultural factors perspective and
that have promote grief
meaning for her. solution.

 Encourage
resuming  Keeping life to
involvement in a somewhat
usual activities, normal routine
exercise, and can provide
socialization individual with
within physical some sense of
and control over
 psychological events that are
abilities. not controllable.

● Teach the patient

about family ● This helps in
planning. avoiding
unwanted
pregnancies.
References:
Anatomy and Physiology
https://www.osmosis.org/learn/
Anatomy_and_physiology_of_the_female_reproductive_system#:~:text=The%20internal
%20sex%20organs%20are,it%20protrudes%20into%20the%20vagina.

Laboratory/Diagnostic Test
https://pubmed.ncbi.nlm.nih.gov/1284711/#:~:text=The%20normal%20physiologic%20range
%20for,is%20quite%20common%20in%20pregnancy.
https://www.glowm.com/article/heading/vol-8--maternal-medical-health-and-disorders-in-
pregnancy--hematological-normal-ranges-in-pregnancy/id/413403#.Yo18VKhBzIU.
https://www.perinatology.com/Reference/Reference%20Ranges/Urea.htm.
https://jasn.asnjournals.org/content/20/1/14#:~:text=The%20physiologic%20increase%20in
%20GFR,0.4%20to%200.8%20mg%2Fdl.

Pathophysiology
https://www.enj.eg.net/article.asp?issn=2090-
6021;year=2016;volume=13;issue=3;spage=169;epage=177;aulast=Khalifa

Overview of the Disease and Pathophysiology

https://www.msdmanuals.com/professional/gynecology-and-obstetrics/family-planning/
induced-abortion
https://www.mywtmf.com/documents/Women-s-Health-Library/broch-Abortion-ACOG.pdf

Medical/Surgical Management
https://www.urmc.rochester.edu/encyclopedia/content.aspx?
ContentTypeID=167&ContentID=blood_type_crossmatch&fbclid=IwAR31-
gvxCLEaBG1MdFlA9ypvzuCsPTzc0WXB-tJD19UJjr3npMo_JAez3oU#:~:text=The
%20goal%20of%20blood%20typing,be%20safe%20to%20give%20you

Drug study
https://www.rxlist.com/normal-saline-drug.htm
https://www.rxlist.com/consumer_gentamicin/drugs-condition.htm
https://go.drugbank.com/drugs/DB00316
https://www.drugs.com/pro/lactated-ringers.html
https://www.rxlist.com/consumer_ampicillin_penicillin/drugs-condition.html
Davis's drug guide for Nurses 14th Edition

Nursing Care Plan

Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales 15th Edition
https://nurseslabs.com/