Panpacific University

School of Nursing

In Partial Fulfillment of the Requirements in the subject NCM 107

Submitted by:
BSN II A

Submitted to:
Faculty of the Dr. Carl E. Balita
Institute of Health Sciences
School of Nursing

January 2022
INTRODUCTION
 A threatened abortion is vaginal bleeding during pregnancy that does not meet the diagnostic
criteria for spontaneous abortion. In a threatened abortion, the cervical os remains closed. The World
Health Organization (WHO, 2022) defines a threatened abortion as pregnancy-related bloody vaginal
discharge or frank bleeding during the first half of pregnancy without cervical dilatation. A threatened
abortion can present during early pregnancy with lower abdominal pain, and/or vaginal bleeding. Nearly
25 percent of pregnant women have some degree of vaginal bleeding during the first two trimesters and
about 50 percent of these progress to an actual abortion. The bleeding in a threatened abortion is mild to
moderate. The abdominal pain may present as intermittent cramps, suprapubic pain, pelvic pressure, or
lower back pain.
The exact etiology of threatened abortion is not always known. Threatened abortion can occur in
any pregnancy regardless of maternal age, race, comorbidities, lifestyle, or socioeconomic status. If a
woman has previously had bleeding in the first trimester of pregnancy, her risk of bleeding in the first
trimester of subsequent pregnancies does appear to be increased. Risk factors for any type of miscarriage
include advanced maternal age, advanced paternal age, prior history of pregnancy loss, TORCH
infections, uncontrolled hyperglycemia, obesity, uncontrolled thyroid disease, significant stressors, use
of teratogenic medications, and presence of a subchorionic hemorrhage.
About 20% of all pregnancies experience threatened abortion, making it a reasonably frequent
pregnancy problem. Out of 95 patients who were admitted with an abortion threat, 42 (44%) patients had
an abortion, while 53 (56%) patients' pregnancies were prolonged. 39 pregnancies persisted and 21
pregnancies were aborted out of a total of 60 individuals who were admitted with the complaint of
merely vaginal spotting.
Without undergoing any medical or surgical procedures, patients who are in danger of having an
abortion should be managed expectantly. Patients should be informed about the significance of follow-
up, and they should be given stringent return precautions for heavy vaginal bleeding, abdominal pain, or
fever. To help ease the pain of cramping, analgesia can be given. NSAIDs should be avoided in the
setting of threatened abortion because the pregnancy could continue to develop to viability. Serial
transvaginal ultrasounds are advised as a form of follow-up until the presence of a viable intrauterine
pregnancy is established or until the development of an unavoidable, total, or partial abortion. Some
medical professionals do prefer to suggest that their patients refrain from physically demanding
activities and maintain pelvic rest, at least until vaginal bleeding stops. Further, clinicians should
recommend that patients start or continue to take prenatal vitamins with folic acid supplementation.

OBJECTIVES

General
This case study aims to widen the knowledge and enhance the skills of nursing students in
managing threatened abortion utilizing the nursing process.

Specific
 To properly examine the circumstances or causes leading to the development of a threatened
abortion.
 To develop nursing diagnoses that can serve as a foundation in prioritizing a plan of care for the
patient with threatened abortion. 
 Formulate a specific, measurable, attainable, realistic, and time-bound nursing care plan and
determine the expected outcomes.
 To perform appropriate dependent and independent nursing interventions in promoting the
client’s comfort and wellness. 
  To determine whether the anticipated results are achieved and to assess the effectiveness of the
interventions provided to the client.

CASE SCENARIO

According to Client A, 8 weeks and 3 days AOG, on the evening of October 20, 2022, at 10 pm
she just finished washing her husband's clothes and preparing herself to sleep, she suddenly just felt
something coming out on her vaginal part and having pain in her abdomen. She just noticed that she has
bleeding which she thinks will just diminish for the following days. But in the days gone by the bleeding
still had not stopped and was accompanied by pain in her lower abdominal part. On October 21, she
continues to complete simple tasks like folding clothes and preparing breakfast while taking a short
break whenever she feels tired. As the bleeding is continuing as of October 22, she is greatly worried.
She spent the whole day resting her body and decided to visit the clinic when she have time. On October
23, 2022, she consulted Dr. Johdel Clinic at Urdaneta City and later was ordered to take a UTZ and was
seen via Ultrasound that she has a minimal subchorionic hemorrhage. She received instructions the next
several days to reduce her activities, such as heavy lifting and sex avoidance, and to spend the entire
time in bed. She is unable to continue doing light to minimal jobs because her husband is still working
despite advice to the contrary. On November 08, 2022, at 11:00 pm she submitted herself at Panpacific
Hospital upon assessing her upon admission she has minimal vaginal bleeding before admission and the
UTZ confirmed that it has the presence of a blood clot in her intrauterine segment but her cervical os is
closed. She was diagnosed with Threatened Abortion v/s Incomplete Abortion.

a. PATIENT’S PROFILE
● Name: Client A
● Address: 55-A, Provincial Road Bayaoas, Urdaneta, Pangasinan
● Age: 27
● Sex: Female
● Religion: Iglesia ni Cristo
● Nationality: Filipino
● Occupation: Housewife
● Marital Status: Married
● Number of Children: 1
● Admission data
A. Date of admission: November 08, 2022
B. Time of admission: 11:00 PM
C. Hospital: Panpacific Hospital
D. Chief Complaint: “A week PTA, pt. complaint of vaginal bleeding accompanied with
pain on her lower abdominal area.”
E. Admitting Diagnosis: Pregnancy uterine 8 weeks and 3 days AOG G2P1 Threatened
Abortion v/s Incomplete Abortion
Final Diagnosis: Threatened Abortion

b. HEALTH HISTORY

A. History of Present Illness

  The client claims that at 10 o'clock on October 20, 2022, she had just finished
washing her husband's clothes and was getting ready to go to bed when she felt
something coming out of her vagina and discomfort in her abdomen. She just
became aware of the bleeding and anticipates that it will stop in the next few days.
But as the days passed, the bleeding would not stop and she was experiencing
pain in her abdominal area. 
 On October 23, 2022, she consulted Dr. Johdel Clinic and was ordered to undergo
a UTZ and was seen via Ultrasound that she had a minimal subchorionic
hemorrhage.
 On November 08, 2022, at 11:00 pm, she submitted herself at Panpacific
Hospital. After being evaluated upon admission, it was determined that she had
minimal vaginal bleeding prior to admission and that a blood clot was present in
her intrauterine section. Threatened Abortion vs. Incomplete Abortion was her
diagnosis.

B. History of Past Illness

1. Heredo-Familial tendency (genogram with legend)

Client A has a family history of ovarian cysts. She is the very first member
of their family to be admitted to the hospital due to Threatened Abortion v/s
Incomplete Abortion. Her father was diagnosed with hypertension, and he is
taking metoprolol as his maintenance drug for this condition. Then, the rest of the
family is living a healthy life.

Genogram:

Father Mother
(Hypertension) (Ovarian Cyst)

1st brother 2nd sister 4th sister 5th brother

Client A
(Ovarian cyst)

Legend:

MALE OVARIAN CYST

FEMALE

HYPERTENSION
 2. OB history (for female patients)
- Menarche at 15 years old.
- Menstruation last for 6 days, and is irregular.
- G2P1
- Did not undergo Pap smear.

3. Travel History
- No travel history

4. Surgical procedures done

- Had a previous operation for C/S delivery during her first pregnancy.

5. Hospitalizations
- Gave birth at Urdaneta Sacred Heart Hospital, C/S delivery.

6. Accidents/Injuries
- No past accidents/injuries

7. Childhood Illnesses
- Had chickenpox, colds, fever, and cough at 12 years old.

8. Socio-economic history
Client A is a plain housewife residing in Urdaneta City, Pangasinan, and
her husband works as a tricycle driver and is not earning enough to provide for
the needs of the family. Client A blames her daily activity, such as washing the
dishes, doing the laundry, cleaning the house, and cooking causing her bleeding.
She believes that she needs rest during her pregnancy, but because of their current
status, they are having financial problems since her husband's salary is their only
source of income. For that reason, they find it challenging to buy prescribed
medicines and vitamins, like folic acid supplements during her pre-natal check-
up.

9. Allergies
- No presence of allergies.

c. PHYSICAL ASSESSMENT

A. General Survey
1. Appears well when not moving but shows face grimaces upon movement.
(Appearance and Behavior)
2. The patient’s speech was understandable but in a slow pace, possibly due to
anxiety. (Speech and Language)
3. The client keeps on holding her abdominal area. (Mood)
4. The patient has sense of reality. (Thought processes, content, and perceptions)
5. The patient appears alert and oriented but is anxious. (Cognitive function)

B. Measurement (Height, Weight, BMI, Vital signs)

 Height: 5’2 ft (62”)
 Weight: 58 kg (127.868)
 BMI: 23.4, Normal
 Vital Signs
Pulse rate: 85 bpm, normal
Respiratory rate: 20 cpm, normal
Temperature: 38.6, above normal
Blood pressure: 100/70 mmHg, normal
PHYSICAL ASSESSMENT (CEPHALOCAUDAL)
Body parts Technique Norms/Standard (with
reference and page
number)
Head & Inspection Proportional to the size
Skull of the body, round with
prominences in frontal,
parietal, and occipital
area (Normocephalic),
symmetrical in all planes.
Gently curved, no lumps,
smooth skull contour.
Palpation
Barbara Kozier,
Fundamentals of
Nursing, 7th Ed., p 554
Scalp/Hair Inspection Thick, silky, and resilient
hair; evenly distributed
and no presence of
infections or infestations.
Pearson, Health and
Physical Assessment, p
Actual findings Analysis Interpretation (with reference)
Her head and skull are Normal It is normal because the head & skull
proportional to the size of are proportional to the size of the body,
the body; it is round with round with prominences in frontal,
prominences in frontal, parietal, and occipital area
parietal, and occipital (Normocephalic), symmetrical in all
area (Normocephalic); planes.
and is symmetrical in all
planes.
It is gently curved,
without presence of
lumps, and skull is
smooth in contour.
Barbara Kozier, Fundamentals of
Nursing, 7th Ed., p 554
Hair is thick, silky and Normal It is normal because the hair is thick,
resilient; evenly silky and resilient; evenly distributed;
distributed; no presence no presence of infections or
of infections or infestations.
infestations.
Pearson, Health and Physical
 529 Assessment, p 529

Face Inspection Symmetric or slightly Face is slightly Normal It is normal because her face is slightly
asymmetric facial asymmetric; palpebral asymmetric; palpebral fissures equal in
features; palpebral fissures equal in size; and size; and nasolabial folds is symmetric.
fissures equal in size; nasolabial folds is
symmetric nasolabial symmetric.
folds

Pearson, Health and Physical

Pearson, Health and Assessment, p 532
Physical Assessment, p
532

Eyes Inspection and No edema No presence of edema. Normal It is normal because there is no
Palpation presence of edema upon inspection and
palpation.

Pearson, Health and Pearson, Health and Physical

Physical Assessment, p Assessment, p 532
532

Ears Inspection and Color same as facial skin; Ears color same as facial Normal It is normal because the color of the
palpation of the Symmetrical, and auricle skin, symmetrical and ears matches the color of the facial
external ear, aligned with the outer aligned with the outer skin, symmetrical and aligned with the
inspection of canthus of the eye. canthus of the eye. eye's outer canthus
the internal
parts of the ear
by an otoscope.
Pearson, Health and Physical Assessment,
Pearson, Health and p 541
Physical Assessment, p
541

Nose Inspection Symmetric and straight, Nose is symmetric and Normal It is normal because the shape of the
through the use and no discharge or straight; no discharge or nose is symmetric and straight; no
of flashlight and flaring; Uniform color flaring; and uniform in discharge or flaring; .and uniform in
 palpation of the and not tender; No color. No presence of color. No tenderness and lesions.
external nose. lesions. tenderness and lesions.

Pearson, Health and Physical

Assessment, p 544
Pearson, Health and
Physical Assessment, p
544

Mouth  Inspection Moist, smooth, soft, Mouth is moist, smooth, Normal It is normal because the mouth is moist,
glistening, and elastic glistening and elastic smooth, glistening and elastic in
texture (drier oral texture. texture.
mucosa in older clients
due to decreased
salivation)
Pearson, Health and Physical
Pearson, Health and Assessment, p 547
Physical Assessment, p
547

Heart Auscultation S1: usually heard at all S1 and S2 heard at all Normal It is normal because S1 and S2 is heard
sites. Usually louder at sites, but S1 is louder at at all sites, S1 is louder at apical while
apical area; S2: usually apical and S2 louder at S2 is louder at the base of heart.
heard at all sites. Usually base of heart.
louder at base of heart.
Systole: silent interval; Pearson, Health and Physical
slightly shorter duration Assessment, p 564
than diastole at normal
heart rate (60-90
beats/min); Diastole:
silent interval; slightly
longer duration than
systole at normal heart
rates.

Pearson, Health and

Physical Assessment, p
 564

Abdomen Inspection Unblemished skin; Abdomen’s skin is Normal

Uniform in color. unblemished and uniform
in color.

Auscultation Audible bowel sounds. Bowel sounds audible.

Normal
Tympany over the
Percussion stomach and gas-filled Tympany over the
bowels; dullness, stomach and gas-filled Normal
especially over the liver bowels; dullness,
and spleen, or a full especially over the liver
bladder. and spleen, or a full
bladder.
No tenderness; relaxed
abdomen with smooth,
Palpation consistent tension. Flabby, soft, and pain on Deviation from There is pain felt on the lower part of
the lower abdomen felt. normal. the abdomen.
Pearson, Health and
Physical Assessment, p
573-576
Pearson, Health and Physical
Assessment, p 576

Genitalia Inspection and No inflammation, Minimal vaginal Deviation from There is spotting and few drops of
Palpation of swelling or discharge. bleeding. normal. blood. She is also soaking less than 1
external pad in more than 3 hours.
genitalia. Pearson, Health and
Physical Assessment, p Pearson, Health and Physical
591 Assessment, p 591

Balance

Walking Ask the client to Has upright posture and Has upright posture and Normal It is normal since she is just 8 weeks
Gait walk across the steady gait with opposing steady gait with opposing and 3 days AOG and also has upright
room and back, arm swing; walks arm swing; walks posture and steady gait with opposing
and assess the unaided, maintaining unaided, maintaining arm swing; walks unaided, maintaining
client’s gait. balance. balance. balance.

Pearson, Health and Physical

Pearson, Health and Assessment, p 584
Physical Assessment, p
584
 d. LABORATORY FINDINGS (state only the abnormalities)

Date Laboratory exam Normal Result Clinical Nursing

Values Interpretation responsibilities
with analysis
(with reference)

11-08- URINALYSIS 1. Tell the patient that

22 Color Straw yellow Light yellow Normal the test is done to detect
to amber renal and urinary tract
disorders and used to
Transparency/ Clear Clear Normal assess body function.
Appearance
2. Notify the patient
pH 5-9 7.5 Normal that the procedure
requires a urine sample.
Specific gravity 1.003-1.030 1.005 Normal Urine must be acquired,
most likely on the first
Protein Negative Negative Normal void in the morning.

Glucose Negative Negative Normal 3. Notify the laboratory

and physician of any
Ketone Negative Negative Normal drugs the patient has
taken that may affect
Blood Negative 0.1 Deviation from the results.
normal, presence
of blood in the
urine may
sometimes
indicate urinary
tract problems.

Pus cells Negative 0.2 Deviation from

normal, pus cells
Epithelial cells Negative Rare and bacteria
should be absent
in urine.

https://
www.uncmedicalc
enter.org/
mclendon-
clinical-
laboratories/
available-tests/
urinalysis-
general-
microscopic/
11-08- HEMATOLOGY 1. Explain to the patient
22 the necessity of
WBC (White Blood 3.9-11.7 12.3 Bacterial infection undergoing the test that
Cells) it helps detect the
Low RBC is due occurrence of anemia
RBC (Red Blood 3.85-5.16 2.89 to enormous and polycythemia.
Cells) blood loss which
can result to 2. Notify the patient
anemia. that the test requires
blood samples, as well
Normal as the person who will
Hgb (Hemoglobin) 12.0-15.0 g/dL perform the
13.0 g/dL Normal venipuncture.
Hct (Hematocrit) 0.34-0.45
0.35 3. Inform the patient
that the procedure may
cause slight discomfort
and that she may feel a
little pain.

4. After the procedure,

apply direct pressure to
the injection site until
the bleeding stops.

5. Refer if it developed
a hematoma and
monitor the pulses
distal to sites.
https://
www.pubinfo.vcu.
edu/pathlabs/
print_menu/
appendix_hemato
logy_reference_r
anges.pdf

Ultrasound Report

Client A 27/F
October 23, 2022 Dr. Johdel

TRANSVAGINAL ULTRASOUND

Within an enlarged uterus is a single live embryo exhibiting good cardiac contractions during time scanning
of about 177 beats/ min. The crown-rump length measures about 0.53cm equivalent to 6 weeks and 2 days
age of gestation.

Minimal subchorionic hemorrhage is evident. The right ovary is normal in size with few small follicles. No
e. PATHOPHYSIOLOGY (client-based)
Predisposing factor:
Precipitating factor:
- Performing strenuous activities, - Age – common among women
such as washing the dishes, over 35 y/o.
doing laundry, cleaning the - 8 weeks AOG (occurs during
house, and cooking. first trimester of pregnancy)
-

During egg implantation, egg slightly separates or tears from the uterus.

Blood collects between the chorionic membrane (a membrane that

develops around a fertilized egg) and the wall of the uterus.

Blood will then leak in the cervix

Mild uterine cramping (lower abdomen) Minimal vaginal spotting/bleeding

Date: October 20, 2022 (3-4 days) Dates: October 20-23, 2022
Infection PAIN SUBCHORIONIC HEMORRHAGE
(Determined by UTZ) Date: October 23, 2022

*Severe bleeding can lead to the rupture of the

Increased
subchorionic membrane.
WBC

FEVER THREATENED ABORTION (Risk

for Miscarriage and Stillbirth)
 f. NURSING CARE PLAN no. 1

Date Assessment Diagnosis Analysis (with Planning Intervention Rationale Evalua

reference) tion

Nove SUBJECTI Hyperther Hyperthermia Within 5 INDEPENDEN After 5

mber VE DATA: mia R/T refers to an hours of T: hours
8, bacterial abnormally rendering of
2022 “Mataas na infection high body proper 1. Provide a 1. To maintain renderi
rin po ang as temperature. A nursing comfortable metabolic ng
lagnat ko” evidenced person's interventions, environment and demands or proper
as by normal body her body instruct the oxygen nursing
verbalized increased temperature temperature patient to consumption. interve
by the body averages about will subside maintain bed ntions,
patient. temperatur 98.6o F from 38.6 to rest. her
e, flushed (37oC). In 37 C. body
2. To help
skin; pregnancy, a tempera
reduce
warm to body ture
OBJECTI 2. Perform tepid increased body
touch and temperature of subside
VE DATA: sponge bath or temperature
increased at least 101o F d from
immersion. through heat
Flushed WBC. (38.3oC) or 38.6 to
loss by
skin higher can be 37 C.
evaporation
of concern,
and
Skin is especially if it
conduction.
warm to lasts for an
touch extended
3. To prevent
period of time.
dehydration.
Vital signs 3. Discuss the
taken are as importance of
follows: adequate fluid
intake.
PR: 85 bpm
DEPENDENT: 4. To prevent
RR: 20 cpm 4. Administer shivering and
antipyretics, seizures. But
BP: 100/70 orally or rectally be careful
mmHg as ordered. because some
https:// medications
Temperatur www.seslhd.he may cause
e: 38.6 alth.nsw.gov.a teratogenic
u/sites/ effects.
Laboratory default/files/ 5. To support
findings: migration/ circulating
RHW/ 5. Administer
WBC: 12.3 volume and
Patient_Leafle replacement
tissue
ts/Antenatal/ fluids and
perfusion.
Hyperthermia electrolytes as
%20during needed.
%20pregnancy
 .pdf

Reference:
Doenges, E.,
Moorhouse,
M., Murr, A.,
Nurse’s Pocket
Guide,
Diagnoses,
Prioritized
Interventions,
and
Rationales,
10th Ed.

https://
nursing.com/
lesson/
nursing-care-
plan-for-
abortion-
spontaneous-
abortion-
miscarriage

NURSING CARE PLAN no. 2

Date Assessm Diagnos Analysis Plannin Intervention Rationale Evaluatio

ent is (with g n
reference)
Nove SUBJE Acute Acute Pain Within 2 INDEPENDENT After 2
mber CTIVE Pain happens hours of : hours of
8, DATA: R/T suddenly, renderin 1. Vital signs are rendering
2022 vaginal starts out g proper 1. Monitor vital usually altered in proper
“Sumasa bleeding sharp or nursing signs. acute pain. nursing
kit ang as intense intervent interventio
aking evidenc and serves ions, her 2. Provide quiet 2. To provide ns, goals
tiyan” ed by a as a pain will environment, nonpharmacologi are met as
as pain warning alleviate calm activities, cal pain evidenced
verbalize scale of sign of from a and comfort management. by the
d by the 8/10, disease or scale of measures such as decrease in
patient.” facial threat to 8/10 to change of a pain
grimace the body. 0/10. position. scale of
Pain 3. To prevent
s upon It is fatigue and 8/10 to
scale: moveme 3. Encourage 0/10.
caused by relieve pain.
8/10 as 0 nt, adequate rest
injury,
is the abdomin periods.
surgery, 4. These actions
lowest al illness, 4. Instruct her not increase your risk
and 10 guardin trauma or to put anything on for infection and
as the g, painful her vagina. Do miscarriage.
highest. restlessn medical
With the not have sex,
ess, and procedures
pain douche or use
anxious and
character tampons.
ness. generally
istic of last from a
severe DEPENDENT: 5. To maintain
few
pain. minutes to acceptable level
5. Administer of pain. Notify
less than analgesics as
six physician if
indicated to regimen is
OBJEC months. maximal dosage
Acute pain inadequate to
TIVE as needed. meet pain control
DATA: usually
disappears goal.
Facial whenever
grimaces the
upon underlying Reference:
moveme cause is Doenges, E.,
nt treated or Moorhouse, M.,
healed. Murr, A., Nurse’s
Abdomi Pocket Guide,
nal Pathophys Diagnoses,
guarding iology of Prioritized
Acute & Interventions,
Alert, Chronic and Rationales,
Oriented, Pain 10th Ed.
Anxious PowerPoi
and nt https://
Restless Presentati www.drugs.com/
on - cg/threatened-
Minimal ID:74338 miscarriage.html
 2
vaginal (slideserve
bleeding .com)

Vital
signs
taken are
as
follows:

PR: 85
bpm

RR: 20
cpm

BP:
100/70
mmHg

Tempera
ture:
38.6