I. INTRODUCTION A.

Background of the Study Anemia is a medical condition in which the red blood cell count or hemoglobin is less than normal. The normal level of hemoglobin is generally different in males and females. For men, anemia is typically defined as hemoglobin level of less than 13.5 gram/100ml and in women as hemoglobin of less than 12.0 gram/100ml. These definitions may vary slightly depending on the source and the laboratory reference used. Acute blood loss from internal bleeding (as from a bleeding ulcer) or external bleeding (as from trauma) can produce anemia in an amazingly short span of time. This type of anemia could result in severe symptoms and consequences if not addressed promptly. (http://www.medicinenet.com/anemia/article.htm#1whatis, September 15, 2011)

B. Rationale for Choosing the Case

Our Group had chosen SEVERE ANEMIA on a Post Partum patient with a obstetric history of PU 19-20 weeks AOG,

because the group is interested to know more information about this illness and how the mother is suffering from this illness how it affects her body. Last September 5, 2011, during our first day of duty exposure in our rotation in Jose P. Rizal Hospital, there are more than twenty patients confined in the OB ward, and the group decided to make a case study about the patients condition because most of the patient doesnt have this condition and are mostly are about to be discharged from the hospital and doesnt require any critical medical attention

C. Significance of the Study as to the Individual Community and Profession

This study will help nursing students to have a greater understanding on SEVERE ANEMIA, its clinical manifestations and pathophysiology. Moreover, it will be a guide to be aware of the nursing responsibilities. It will also of great help for the communitys awareness on the possible risk factors of the disease and proper management during the occurrence of the disease. It will contribute to the nursing profession through continuous research on the disease and improvement of therapeutic regime for the patient.

D. Scope and Limitation of the Study

The study is focused on the nursing management to those patients who have SEVERE ANEMIA after having a greater understanding of the disease. The researchers have their emphasis on the medications, diagnosis, and plan of care of the said case.

II. CLINICAL SUMMARY/CLINICAL ABSTRACT Personal data/Profile of the Patient

Name: M.T.R. Age: 28 years old Birth date: October 7, 1982 Birth place: Leyte Address: Relocation 5, Pulong Sta. Cruz, Sta. Rosa Laguna

Religion: Roman Catholic Admission Date and time: September 6, 2011 (10:22 am)

Chief Complaint
Pallor

History of Present Illness

G5 P3 3013 PU 19-20 weeks AOG Anemia Severe

Past Medical History

DNC (2002)

Family History

Bernaldo, Paelden (Deceased)

Imelda, Paelden 52 years old

LEGEND:

Parents of the Patient

Children of the Patient

Patient M.T.R 28 years old Rolly Rivera 37 years old Patients Husband DIABETES LOW BLOOD ASTHMA

T.J. Rivera 9 years old

Kyc May 7 years old

Ace Jay 2 years old

III. PHYSICAL ASSESSMENT

AREA A. SKULL 1. Size, shape and symmetry of the skull Inspection Rounded (normocephalic and symmetric, with frontal, parietal, and occipital prominence); smooth skull Smooth, uniform consistency; absence of nodules or masses Symmetric or slightly asymmetric facial features; palpebral fissures equal in size No edema should be present Skull is rounded and smooth skull Normal TECHNIQUE NORMS FINDINGS ANALYSIS and INTERPRETATION

2. Presence of nodules, masses and depressions 3. Facial Features

Palpation

No nodules or masses

Normal

Inspection

Symmetric facial features

Normal

4. Presence of edema and hollowness in the eye. C. HAIR 1. Evenness of growth, thickness, or thinness of hair 2. Texture and oiliness over the scalp

Inspection

There is no edema present

Normal

Inspection

Evenly distributed hair. Thick hair.

Evenly distributed hair.

Normal

Inspection

Silky and resilient hair.

The texture and oiliness of hair is normal.

Normal

3. Presence of infection and infestation D. FACE Facial features, symmetry of facial movements IV. EYES A. EYEBROWS Hair distribution, alignment, skin quality and movement

Inspection

No infection or infestation

No presence of infections and infestations

Normal

Inspection

Symmetric facial movements

There is symmetric facial movements

Normal

Inspection

Hair evenly distributed skin intact. Eyebrows symmetrically aligned; equal movement

Hair is evenly distributed and symmetrically aligned with equal movement

Normal

B. EYELASHES Evenness of distribution and direction of curl C. EYELIDS Surface characteristics and position (in relation to the cornea, ability to blink, and frequency of blinking) Inspection Lids close symmetrically When lids open, no visible sclera above corneas, and upper and lower borders of cornea are slightly covered. Lids close symmetrically. No visible sclera above the corneas. Normal Inspection Equally distributed; curled slightly outward Equally distributed. Eyelashes slightly curved outward. Normal

D. CONJUNCTIVA 1. Color, texture, and the presence of lesions in the bulbar conjunctiva 2. Color, texture, and the presence of lesions in the palpebral conjunctiva E. SCLERA Color and clarity F. CORNEA Clarity and texture Inspection Transparent, shiny, and smooth; details of the iris are visible. Cornea is transparent, shiny and smooth. Iris are visible. Normal Inspection Sclera appears white Sclera is white. Normal Inspection Transparent; capillaries sometimes evident; sclera appears white Bulbar conjunctiva are transparent and no presence of lesions. Normal

Inspection

Shiny, smooth, and pink or red

Palpebral conjunctiva shiny and smooth pinkish in color.

Normal

G. IRIS Shape and color Inspection Rounded. Most color are black and brown. The iris is round and the color is dark brown. Normal. Color of the iris is still normal.

H. PUPILS 1. Color, shape, and symmetry of size Inspection Black in color; equal in size; normally 3 to 7mm diameter; round smooth border, iris flat Pupils color is black, equal in size, 3mm in diameter and iris is flat Normal

and round 2. Light reaction and accommodation Inspection Illuminated pupil constricts Nonilluminated pupil constricts Reactive to light Normal

I. VISUAL ACUITY 1. Near vision Inspection Able to read newsprint Can read without eyeglasses Normal

J. LACRIMAL GLAND Palpability and tenderness of the lacrimal gland. K. EXTRAOCULAR MUSCLES Eye alignment and coordination Inspection Eyes aligned in the midline of the head with normal coordination Parallel alignment Normal Palpation No edema, no tenderness over lacrimal gland Normal Normal

L. VISUAL FIELDS Peripheral visual fields Inspection When looking straight ahead, clients can see objects in the periphery Client can see object in the periphery Normal

V. EARS

A. AURICLES 1. color, symmetry of size and position Inspection Color same as facial skin, symmetrical, auricle aligned with outer canthus of the eye Color same as facial skin Normal

2. Texture, elasticity and areas of tenderness C. HEARING ACQUITY TESTS 1. clients response to normal voice tones

Inspection

Mobile, firm, not tender, pinna Mobile, firm; pinna recoils when folded recoils after it is folds

Normal

Inspection

Normal voice tones audible

Patient was able to recognize and response to normal voice

Normal

VI. NOSE 1. any deviations in shape, size, or color and flaring or discharge from the nares 2. nasal septum (between the nasal chambers) 3. patency of both nasal cavities Inspection Symmetric and straight, no discharge or flaring, uniform color Symmetric and straight No discharge or flaring Uniform in color Inspection Nasal septum intact and in the Nasal septum intact and midline of the nose in midline Normal Normal

Inspection

Air moves freely as the client breathes

Client breathes easily

Normal

4. tenderness, masses, and displacement of bone and cartilage VII. SINUSES Identification of the sinuses and for tenderness VIII. MOUTH A. LIPS Symmetry of contour, color and texture B. BUCCAL MUCOSA Color, moisture, texture, and the presence of lesions C. TEETH Color, number and condition and presence of dentures D. GUMS Color and condition

Palpation and inspection

Not tender, no lesions

Normal

Normal

Palpation & Percussion

no palpable nodules, not tender

No palpable nodules, normal

Normal

Inspection

Normal pink in color, soft, moist, smooth texture

Pale color of the lips

Abnormal

Inspection

Uniform pink in color, moist, smooth, soft, glistening and elastic texture

Uniform light pink color

Normal

Inspection

32 adult teeth Smooth, white, shiny tooth enamel

The teeth are complete; there is a tooth that is damaged.

Abnormal. Good teeth must be complete and strong.

Inspection

pink in color, moist firm

Gums are pinkish in

Normal.

texture to gums E. TONGUE/FLOOR OF THE MOUTH 1. color and texture of the mouth floor and frenulum 2. position, color and texture, movement and base of the tongue 3. any nodules, lumps, or excoriated areas F. PALATES AND UVULA 1. color, shape, texture and the presence of bony prominences 2. position of the uvula and mobility (while examining the palates) G. OROPHARYNX AND TONSILS 1. color and texture Inspection Pink and smooth posterior Inspection Light pink, smooth, soft palate; lighter pink hard palate, more irregular texture Uvula in the midline of soft palate Inspection Smooth tongue base w/ prominent veins

color

Normal

Normal

Inspection

Tongue moves freely; no tenderness

Normal

Normal

Palpation & Inspection

No palpable nodules and tenderness

Normal

Normal

Normal

Normal.

Inspection

Normal

Normal

Normal

Normal

wall 2. size, color and discharge of the tonsils 3. gag reflex IX. THORAX A. ANTERIOR THORAX 1. breathing patterns Auscultation Quiet, rhythmic, and effortless respirations Effortless respirations Effortless respirations show normal breathing. Normal Inspection No discharge, pink and smooth Gag reflex present Normal Normal

Inspection

Present gag reflex

Normal

2. temperature, tenderness, masses 3. anterior thorax auscultation B. POSTERIOR THORAX 1. shape, symmetry, and comparison of anteroposterior thorax to transverse diameter 2. spinal alignment

Palpation

Warm to touch, no masses and no signs of tenderness Normal breath sounds

Normal

Auscultation

Normal

Normal

Palpation

Anteroposterior : transverse diameter is in ratio 1:2; chest symmetric

Normal

Normal

Inspection

Spine vertically aligned

Spine, shoulders and hips are even

Normal

3. temperature, tenderness, and masses 4. posterior thorax auscultation X. CARDIOVASCULAR A. AORTIC AND PULMONIC AREAS B. TRICUSPID AREA

Palpation

Warm to touch, no masses and no signs of tenderness Normal breath sounds

Normal

Normal

Auscultation

Normal

Normal

Inspection and Palpation Inspection and Palpation Inspection and Palpation

No pulsations

Normal

Normal

No pulsations; no lift or heave

Normal

Normal

C. APICAL AREA

No lift or heave; diameter of 1 to 2 cm Aortic pulsations S1 usually heard at all sites; louder at apical area; S2 usually heard at all sites; louder at base of the heart

Normal

Normal

D. EPIGASTRIC AREA E. CARDIOVASCULAR AREAS AUSCULTATION XI. CAROTID ARTERIES 1. carotid artery palpation Palpation

Normal Normal

Normal Normal

Quality remains the same when the client breathes, turns head, and changes from sitting to supine position

Normal

Normal

XII. AXILLAE 1. axillary, subclavicular, and supraclavicular lymph nodes XIII. ABDOMEN 1. skin integrity Inspection Normal skin integrity Normal Symmetrical skin integrity. A huge abdominal contour is normal in pregnancy. Normal Palpation No tenderness, masses or nodules Normal Normal

2. abdominal contour

Inspection

Symmetrical

Big abdomen is visible due to pregnancy.

3. enlargement of liver or spleen 4. symmetry of contour 5. abdominal movements associated with respirations, peristalsis or aortic pulsations 6. vascular pattern XVI. MUSCULOSKELETAL SYSTEM

Palpation

May not be palpable; border feels smooth Symmetrical Audible bowel sounds; absence of arterial bruits; absence of friction rubs

Normal

Inspection Inspection

Normal Normal

Normal Normal

Inspection Technique

No visible vascular pattern Norms

Normal Findings

Normal. Analysis & interpretation

A. MUSCLES 1. Muscle size and other comparison on the other side 2. Fasciculation and tremors in the muscles 3. Muscle tonicity Inspection and Palpation Should have equal size in both sides Equal size on both sides of the body The patient has equal size on both sides of the body The patient does not have tremors and fasciculation The patients muscle tonicity is normally firm Normal

Inspection and Palpation

Should not have tremors and Fasciculation

The patient does not have tremors and fasciculation Normally firm

Palpation

Should Normally firm

4. Muscle strength

Deltoid: Able to hold arm up and resists while you try to push it down. Biceps: Able to fully extends arm and able to flex it while you attempt to hold arm in extension. Triceps: Able to flex each arm and then tries to extend it against your attempt to keep arm in flexion

Should Equal strength on each body side

Has equal strength on each body side

B. JOINTS 1. Joint swelling Inspection and Palpation No swelling No tenderness, swelling, crepitation or nodules Joints move smoothly EXTREMETIES Inspection Skin should be normal in color and must have a normal skin integrity Client has hematoma in her right forearm and left forearm near her wrist. No swelling, tenderness, crepitation or nodules and the joints move smoothly The patients has no swelling, tenderness, crepitation or nodules and the joints move smoothly Abnormal. Clients hematoma may be due to her severe anemia.

IV. GORDONS 11 FUNCTIONAL HEALTH PATTERN ASSESSMENT

The researchers utilized the Gordons Typology in assessing the pattern of functioning of our patient in her life. How does she manages and takes care of herself based on the Eleven Patterns. Functional Health Pattern Prior to Hospitalization Norms and Standards Health Perception-Health Management Being physically healthy is of prime importance in life. Being ill or not feeling well can drastically affect the daily activities. If one feels physically and mentally healthy, one can be more productive. It was the fourth time the patient has been admitted to the hospital. Regular medical check-ups will pick up any potential problems, allowing you to She didnt experience any allergies to take steps in either preventing them or beginning early treatment. foods and drugs. Personal hygiene pertains to hygiene practices performed by an individual to

 For her, being healthy is important because you can be able to do everything without thinking that you will become sick and will cause you to stop doing the things that you normally do. When she feels something wrong in her body or when she feel sick and in pain, her family and/or relatives bring her to the hospital immediately. She doesnt experience any kind of accidents. According to her, during her pregnancy she used to have regular check up at their Barangay health center. She takes a bath twice a day.

care for ones bodily health and well being through cleanliness. Motivations for personal hygiene practice include reduction of personal illness, healing from personal illness, optimal health and sense of well being, social acceptance and prevention of spread of illness to others.

Personal hygiene practices include: seeing a doctor, seeing a dentist, regular washing (bathing or showering) of the body, regular hand washing, brushing and flossing of the teeth, and healthy eating. Personal grooming extends personal hygiene as it pertains to the maintenance of a good personal and public appearance which need not necessarily be hygienic.

She doesnt smoke and avoids alcoholic drinks.

Personal hygiene is achieved by using personal hygiene products including: soap, hair shampoo, hair conditioner, toothbrushes, tooth paste, cotton swabs, deodorant, chapstick, cream, lotion, facial tissue, hair clippers, nail clippers, mouthwash, nail files, skin cleansers, razors, shaving cream, skin cream and toilet paper. Other personal hygiene and grooming products can be used to improve health and well being. http://www.webhealthcentre.com/HealthyLiving/personal_hygiene_index.asp

 Her finances for check-ups and other matters dealing with her condition were supported by her family.

Nutritional Metabolic Pattern According to her, she is not choosy in the foods she eats She eats more than three (3) times a day. She likes to eat fruits especially banana. The patient rarely eats junk foods. She drinks more than 8 glass of water in a day. For her, she eats enough amount of food a day. She is not taking any vitamins. She is taking all the prescribed medicines for her condition. A healthy diet is one that helps maintain or improve health. It is important for the prevention of many chronic diseases such as: obesity, heart disease, diabetes, and cancer. A healthy diet involves consuming appropriate amounts all of the food groups, including an adequate amount of water. Nutrients can be obtained from many different foods, so there are a wide variety of healthy diets. Fruits and vegetables provide a wide range of valuable nutrients like fiber, vitamins and potassium. One possible short-term effect might be constipation since fruits and vegetables are high in fiber, although this would depend on the other foods in your diet. Effects of not including fruits and vegetables in the long-term might include risk for a few vitamin deficiencies, such as Vitamin C, which is provided solely by certain fruits and vegetables If ingredients make junk foods appealing, it is the same reason that makes them health hazardous too. The fat contents, barring a few manufacturers, have high cholesterol levels. Secondly, the sugar and sodium salts have their effects on health. High calorie content with sugar can lead to obesity. Cholesterol and salt are known to setoff blood pressure, stroke and heart diseases in a chain.

 She has a good appetite.

Excessive salts can affect functioning of kidneys too. http://nutrition.about.com/ Human survival is dependent on water. The average adult body is 55 to 75 percent water. Because our bodies are mostly water, water figures heavily in how our bodies function. Aside from helping digestion and absorption of food, water regulates body temperature, carries nutrients and oxygen to cells, and removes toxins and other wastes. Water also cushions joints and protects tissues and organs, including the spinal cord, from shock and damage. Conversely, lack of water (dehydration) can be the cause of many ailments. http://nutrition.about.com/od/hydrationwater/Healthy_Beverages.htm Taking vitamins is important to prevent diseases, to get the Recommended Daily Allowance of nutrients, nutrient deficiencies in food, consistent nutrient intake, to maintain cellular efficiency and the activation of enzymes essential to cellular function. http://ezinearticles.com/?Importance-of-Vitamins-in-Your-Life&id=94540

 Elimination Normally, people have bowel movements at fairly regular intervals, and stool passes out of the body easily without much straining or discomfort. Although the normal frequency of bowel movements varies from person to person, about 95% of healthy adults have a pattern that ranges from three times a day to three times a week. http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/10175.html To eliminate soluble wastes, which are toxic, most animals have excretory systems. In humans soluble wastes are excreted by way of the urinary system, which consists of the kidneys, ureters, urinary bladder, and urethra. The kidneys extract the soluble wastes from the bloodstream, as well as excess water, sugars, and a variety of other compounds. The composition of urine is adjusted in the process of reabsorption whereby certain solutes, such as glucose, are reabsorbed back into the blood stream via carrier molecules. The remaining fluid contains high concentrations of urea and other substances, including toxins. Urine flows through these structures: the kidney, ureter, bladder, and finally the urethra. Urine is produced by a process of filtration, reabsorption, and tubular secretion.

The client usually defecates twice or thrice a day. She usually urinates more than 6 times a day. She feels no difficulty in defecation.

 She feels no difficulty in urination.

http://www.webmd.com/a-to-z-guides/urine-test

She feels no pain in her abdomen when urinating or defecating. Activity and Exercise The patient is a typical housewife and was doing all the household chores. The patient is not engaged in any exercise or any physical activities except from doing household chores.
Exercise is any bodily activity that enhances or maintains physical fitness and overall health. It is performed for many different reasons. These include strengthening muscles and the cardiovascular system, honing athletic skills, weight loss or maintenance and for enjoyment. Frequent and regular physical exercise boosts the immune system, and helps prevent the "diseases of affluence" such as heart disease, cardiovascular disease, Type 2 diabetes and obesity. It also improves mental health and helps prevent depression.

 Her hobby is just watching television during her leisure time.

http://www.nlm.nih.gov/medlineplus/exercisexerciseandphysical.html Regular physical activity reduces the risk of dying prematurely from CVD. It also helps prevent the development of diabetes, helps maintain weight loss, and reduces hypertension, which are all independent risk factors for CVD. Less active, less fit persons have a 30-50 percent greater risk of developing high blood pressure. Physical inactivity is a significant risk factor for CVD itself. It ranks similarly to cigarette smoking, high blood pressure, and elevated cholesterol. One reason it has such a large affect on mortality is because of its prevalence. Twice as many adults in the United States are physically inactive than smoke cigarettes. Regular physical activity has been shown to help protect against first cardiac episode, help patients' recovery from coronary surgeries, and will reduce the risk of recurrent cardiac events http://www.health.state.ny.us/diseases/chronch/cvd.htm

Education in its broadest sense is any act or experience that has a formative effect on the mind, character, or physical ability of an individual (e.g., the consciousness of an infant is educated by its environment through its interaction with its environment); and in its technical sense education is the process by which society deliberately transmits its accumulated knowledge, values, and skills from one generation to another through institutions. http://www.education.com/ Cognitive-Perceptual The patient has reached 2nd year higschool.

 She is aware of the people and the things that are happening around her. She doesnt experience mood swings. She has an open line of communication with her family in the house. A mood swing is an extreme or rapid change in mood. They are commonly associated with mood disorders, of which the classic example is bipolar disorder (also known as manic depression) and also a major factor in hyperactive or hyperactive/inattentive such as ADHD[1]. However, they should not be confused with these disorders, for they are not the same. http://www.womentowomen.com/understandyourbody/symptoms/moodswi ngs.aspx

Sleep and Rest The patient usually sleeps at 7:00pm and wakes up at 4:00am Sleep is a natural state of bodily rest observed in humans and other animals. It is distinguished from quiet wakefulness by a decreased ability to react to stimuli, and it is more easily reversible than hibernation or coma. It is common to all According to her, she just experience mammals and birds, and is also seen in many reptiles, amphibians, and fish. In difficulty and intermittent sleep when humans, other mammals, and a substantial majority of other animals that have she feels that there is something wrong been studied (such as some species of fish, birds, ants, and fruit flies), regular about her health. sleep is essential for survival. According to her it is normal for her to wakes up early. She always takes a nap for some minutes especially when she is all done with the household chores. http://www.sleepfoundation.org/ Rest times are essential because they give the heart a chance to pump more easily. Daytime rest can help keep a person from "overdoing it," which can make one feel much worse for a day or two. It helps ease feelings of tiredness caused by nighttime sleep interruptions. People with heart failure sometimes

find themselves awakened by symptoms such as shortness of breath and coughing. Their sleep may also be interrupted because they need to urinate more often. This is a result of the diuretics (water pills) that may have been prescribed to help rid your body of extra fluid. http://www.americanheart.org/presenter.jhtml?identifier=361 Self-Perception

For her, she thinks she is a very optimistic person, and she is fully aware of her condition. Her strength are her family and relatives.

An attitude is a hypothetical construct that represents an individual's degree of like or dislike for an item. Attitudes are generally positive or negative views of a person, place, thing, or event-- this is often referred to as the attitude object. People can also be conflicted or ambivalent toward an object, meaning that they simultaneously possess both positive and negative attitudes toward the item in question. http://www.nd.edu/~rwilliam/xsoc530/attitudes.html

Her religion is Buddhism, thats why she is always under the belief of their religion.

Role-Relationship The patient has already 3 children. Bali pang apat na anak ko na itong pinag bubuntis ko ngayon as verbalized by the patient. An interpersonal relationship is a relatively long-term association between two or more people. This association may be based on emotions like love and liking, regular business interactions, or some other type of social commitment. Interpersonal relationships take place in a great variety of contexts, such as family, friends, marriage, acquaintances, work, clubs, neighborhoods, and churches. They may be regulated by law, custom, or mutual agreement, and are the basis of social groups and society as a whole. Although humans are fundamentally social creatures, interpersonal relationships are not always

healthy.

http://www.questia.com/library/sociology-and-anthropology/relationshipsand-the-family/interpersonal-relationships.jsp?CRID=interpersonalrelationships&OFFID=se2q&KEY=interpersonal%20relationship She has a good relationship with her family and relatives that take care of her whenever she got hospitalized.

Sexuality Injections The patient used contraceptives after giving birth to her Eldest and second children. She is able to express feminine attitudes. (E.g The way she dresses)

Depo-Provera is an injection a woman can get as birth control; she must get the shot four times per year. It has an effectiveness rating of 97 percent to 99 percent. http://www.ehow.com/facts_4855115_artificial-methods-family-planning.html It has been written in books and addressed by psychologists that sexual desire and sexual act are biological needs. Sexual contentment is as much necessary as food and sleep for the body. The body gets weak and infected by various diseases if it does not get food when hungry. In the same manner, human beings become physically and mentally sick, when they suppress their sexual desire. Therefore, it is necessary to fulfill ones sexual desire with his/her sexual partner in the right time in an appropriate manner. http://www.asmita.org.np/Women_Subject_Category/sexuality.htm

Coping-Stress Whenever she has problem/s, she asks help sometimes to her relatives. Whenever she gets mad, she is not speaking because she is afraid that she can hurt someone on the words shes going to say. She does not get hysterical. Prolonged psychological stress may negatively impact health, such as by weakening the immune system and mind. Stress management is the application of methods to either reduce stress or increase tolerance to stress. Relaxation techniques are physical methods used to relieve stress. Psychological methods include cognitive therapy, meditation, and positive thinking which work by reducing response to stress. Improving relevant skills and abilities builds confidence, which also reduces the stress reaction to situations where those skills are applicable. http://stress.about.com/ If ones methods of coping with stress arent contributing to greater emotional and physical health, its time to find healthier ones. There are many healthy ways to manage and cope with stress, but they all require change. You can either change the situation or change your reaction. When deciding which option to choose, its helpful to think of the four As: avoid, alter, adapt, or accept. http://www.helpguide.org/mental/stress_management_relief_coping.htm

Value-Belief The patients religion is Buddhism. A religion is an organized approach to human spirituality which usually encompasses a set of narratives, symbols, beliefs and practices, often with a supernatural or transcendent quality, that give meaning to the practitioner's experiences of life through reference to a higher power, God or gods, or ultimate truth. It may be expressed through prayer, ritual, meditation, music and art, among other things. It may focus on specific supernatural, metaphysical, and moral claims about reality which may yield a set of religious laws, ethics, and a particular lifestyle. Religion also encompasses ancestral or cultural traditions, writings, history, and mythology, as well as personal faith and religious

experience. http://www.beliefnet.com/

V. ACTIVITIES OF DAILY LIVING

ASPECT 1.Nutrition PRIOR TO HOSPITALIZATION DURING HOSPITALIZATION INTERPRETATION and ANALYSIS

The patient is fond of eating The patient is helping The patient loves to eat vegetables and she is not choosy she loves herself to eat more fruits; this would help her to get strong

fruits she loves eating junk healthy foods and to especially during her confinement. foods she eats more than 3 minimize the fondness times a day. 2.Elimination on eating junk foods. still eliminates Since the patient drink lots of water, thats why she dont have any difficulty in elimination process

The patient voids normally She

and defecates twice or thrice normal. a day. She has no difficulty in urination. 3. Exercise The patients have daily The patient is

not The patient have her exercise because it is a

exercises she is a house wife engaged in exercises due daily routine for her. doing all house chores. 4. Hygiene to hospitalization.

The patient is taking a bath Tepid sponge bath is Tepid sponge bath is considered as one of twice a day. initiated. the best cooling treatments. It is helpful in alleviating discomfort and it promotes

relaxation. 6. Sleep and Rest The patient usually sleeps by She just stays on her bed The patient has good sleeping pattern. 7 p.m. and usually wakes up and relaxes. by 4 a.m. she only

experience intermittent sleep disturbances at night if she dont feel well. 7. Sexual and Religious She is a Buddhists and she She always needs rest She is taking care of her body and is always activity is sexually active because of thats why she only pray asking doctors before doing any activities her age. in bed, and sexual that physicians advice is needed.

activities were stopped.

VI. PATIENTS CONCEPT ABOUT HEALTH, ILLNESS AND HOSPITALIZATION

Health The patients perception about health is feeling okay. She stated that it is when one is able to eat healthy foods, be free from any sickness, and has a good hygiene.

Illness Feeling weak physically and having financial burden is how she sees illness. She believes that it is really hard to get sick so one must know how to take care of himself/herself.

Hospitalization The patient thought about hospitalization as something she cant afford because according to her she doesnt have money that is why she stated that she wont be hospitalized again because it is really hard for her husband to find source of money.

--A state of complete physical, mental, and social well being, and not merely the absence of disease or infirmity (World Health Organization- 1950s) (Fundamentals of Nursing 7th edition by Wolff, Weitzel, Zornow, Zsohar.)

--A condition characterized by a deviation from a normal healthy state. (Fundamentals of Nursing 7th edition by Wolff, Weitzel, Zornow, Zsohar.)

--the hospital milieu is a strange and anxiety provoking environment for most patients he may question whether the environment is designed to work for him or against him. (Fundamentals of Nursing 7th edition by Wolff, Weitzel, Zornow, Zsohar.)

VII. NURSING THEORIST

Dorothea E. Orem: The Self- Care Deficit Nursing Theory An underlying premise of Orems theory is the belief that humans engage in continuous communication and their environments to remain alive and to function as what our patient needs for instance, she undergoes blood transfusion to stay alive and to still perform activities of daily living. In the case of our patient, the power to act deliberately is exercised to identify needs and to make needed judgments. Furthermore, mature human beings experience privations in the form of action in care of self and others involving making life- sustaining and function- regulating actions. Human agency is exercised in discovering, developing, and transmitting

to others ways and means to identify needs for, and make inputs into, self and others. Concepts that is applicable to our patient: Nursing is seen as an art through which the practitioner of nursing gives specialized assistance to persons with disabilities which makes more than ordinary assistance necessary to meet needs for self- care. The nurse also intelligently participates in the medical care the individual receives from the physician. Humans are defined as men, women, and children cared for either singly or as social units and as the material object of nurses and others who provide direct care. Environment has physical, chemical and biological features. It includes the family, culture and community. Health is being structurally and functionally whole or sound. Also, health is a state that encompasses both the health of individuals and of groups, and human health is the ability to reflect on ones self, to symbolize experience, and to communicate with others.

VIII. DEVELOPMENTAL STAGE Age Freud Piaget Formal operational 28 The Genital Stage years old Genital stage: post puberty (Adolescence onwards) Physical focus: genitals Kohlberg Level 3. Postconventional Morality Erickson Young Adult Intimacy vs Isolation Learns to make personal commitment to another as spouse, parent or partner Occurring in Young adulthood, we begin to share ourselves more intimately with others. We

This stage brings cognition to its final form. This person Stage 5 - Social Contract and Psychological theme: no longer requires concrete Individual Rights maturity and creation and objects to make rational enhancement of life. So this judgements. At his point, he At this stage, people begin to account for the is not just about creating is capable of hypothetical

new life (reproduction) but also about intellectual and artistic creativity. The task is to learn how to add something constructive to life and society. Adult character: The genital character is not fixed at an earlier stage. This is the person who has worked it all out. This person is psychologically welladjusted and balanced. According to Freud to achieve this state you need to have a balance of both love and work.

and deductive reasoning. Teaching for the adolescent may be wide ranging because he'll be able to consider many possibilities from several perspectives.

differing values, opinions and beliefs of other people. Rules of law are important for maintaining a society, but members of the society should agree upon these standards. Stage 6 - Universal Principles Kolhbergs final level of moral reasoning is based upon universal ethical principles and abstract reasoning. At this stage, people follow these internalized principles of justice, even if they conflict with laws and rules.

explore relationships leading toward longer term commitments with someone other than a family member. Successful completion can lead to comfortable relationships and a sense of commitment, safety, and care within a relationship. Avoiding intimacy, fearing commitment and relationships can lead to isolation, loneliness, and sometimes depression.

References: http://www.learningplaceonline.com/stages/organize/Erikson.htm http://psychology.about.com/od/theoriesofpersonality/ss/psychosexualdev.htm http://faculty.plts.edu/gpence/html/kohlberg.htm http://psychology.about.com/od/developmentalpsychology/a/kohlberg.htm

IX. ANATOMY/PHYSIOLOGY
THE FEMALE REPRODUCTIVE SYSTEM The female reproductive system or genitalia has two main parts, namely: the uterus and the ovaries. The uterus houses the fetus during its development stage. It also produces secretions in the vagina and the uterus as well. It is also where the sperm cells during copulation pass in order to reach the fallopian tubes to fertilize the egg cell. The ovaries, upon the other hand, produce the egg cells. The aforementioned parts are internal in the female reproductive system. As regards the external parts, these are the vagina with the vulva in the external region with the labia minora and majora, the clitoris and the urethra. The cervix connects the vagina to the uterus, while the fallopian tubes attach the uterus to the ovaries. During periods or intervals, the ovaries release an ovum through the fallopian tube. If during such release, the sperm meets the ovum, fertilization occurs. Fertilization occurs when the sperm impregnates the ovum and unites with it in the process. In fertilization, the sperm and egg meet, most commonly, in the oviducts or the fallopian tube. This process may also occur within the uterus. Then the fertilized egg or zygote is implanted in the walls of the uterus to commence further changes or processes such as embryogenesis and morphogenesis. After a period of about nine months, and when the embryo is well developed in order to survive apart from the womb, the cervix dilates and contractions occur in the uterus, which pushes the fetus through the vagina. This is commonly known as childbirth. However, if fertilization does not occur, the ova, is released approximately every month, a process commonly known as menstruation, or a process of oogenesis wherein the mature ovum is passed through the fallopian tube in anticipation of fertilization. Parts of the Female Reproductive System Vagina: A muscular passageway that leads from the vulva (external genitalia) to the cervix.

 Cervix: A small hole at the end of the vagina through which sperm passes into the uterus. Also serves as a protective barrier for the uterus. During childbirth, the cervixdi lates (widens) to permit the baby to descend from the uterus into the vagina for birth. Uterus: A hollow organ that houses the baby during pregnancy. During childbirth, the uterine muscles contract to push out the baby. Each month, unless a fetus has been conceived, the uterine wall sheds its lining (see The Menstrual Cycle and Ovulation below). Ovaries: Two organs that produce hormones and store eggs. Each ovary releases one egg per month. Fallopian tubes: Muscular tubes that eggs released from the ovaries must traverse to reach the uterus. The Menstrual Cycle and Ovulation Each month a womans body goes through a menstrual cycle. A woman can become pregnant only during ovulation, a several-day phase in the middle of the menstrual cycle when one of the ovaries releases an egg. If the ovulated egg is fertilized by a mans sperm following sexual intercourse, it will implant in the endometrium, the lining of the uterus that becomes the placenta during pregnancy. The placenta nurtures the fertilized egg as it develops and grows into a baby.

Event 1st Trimester The woman's last period before fertilization occurs. Fertilization occurs. The fertilized egg (zygote) begins to develop into a hollow

Week of Pregnancy 0

2 2

ball of cells called the blastocyst. The blastocyst implants in the wall of uterus.The amniotic sac begins to form. The area that will become the brain and spinal cord (neural tube) begins to develop. The heart and major blood vessels are developing. The beating heart can be seen during ultrasonography. The beginnings of arms and legs appear. Bones and muscles form. The face and neck develop. Brain waves can be detected. The skeleton is formed. Fingers and toes are fully defined. The kidneys begin to function. Almost all organs are completely formed. The fetus can move and respond to touch (when prodded through the woman's abdomen). The woman has gained some weight, and her abdomen may be slightly enlarged. 2nd Trimester The fetus's sex can be identified. The fetus can hear.

7 9

10

14

The fetus's fingers can grasp. The fetus moves more vigorously, so that the mother can feel it. The fetus's body begins to fill out as fat is deposited beneath the skin. Hair appears on the head and skin. Eyebrows and eyelashes are present. The placenta is fully formed. The fetus has a chance of survival outside the uterus. The woman begins to gain weight more rapidly. 3rd Trimester The fetus is active, changing positions often. The lungs continue to mature. The fetus's head moves into position for delivery. On average, the fetus is about 20 inches long and weighs about 7 pounds. The woman's enlarged abdomen causes the navel to bulge. Delivery

16

20 24

25

25

37-42

X. PATHOPHYSIOLOGY The fetus uses the mother's red blood cells for growth and development, especially in the last three months of pregnancy. This causes the concentration of red blood cells in her body to become diluted.

Diagnosis: Ineffective tissue perfusion R/T decreased hemoglobin concentration in blood Acute pain R/T impaired blood flow due to obstruction of sickled cells

Blood loss at delivery and postpartum (after delivery) can also cause anemia. The average blood loss with a vaginal birth is about 500 milliliters, and about 1,000 milliliters with a cesarean delivery.

Nursing Management: Inadequate blood can develop anemia. Monitor vital signs. Assess for pain. Obtain blood and urine culture, chest x-ray and CBC results if infection is the cause of sickling. Diagnostic Procedures: Adequate Hydration

Signs and Symptoms: Pale skin, lips, nails, palms of hands, or underside of the eyelids Fatigue Vertigo or dizziness Labored breathing Rapid heartbeat (tachycardia)

Diagnostic procedures for anemia may include additional blood tests and other evaluation procedures. hemoglobin - the part of blood that distributes oxygen from the lungs to tissues in the body. hematocrit - the measurement of the percentage of red blood cells found in a specific volume of blood.

Oxygenation

Medical Management/ Treatment: We cant always prevent anemia during pregnancy, but eating foods rich in iron can help. Doctors recommend that pregnant women eat at least 27 mg of iron daily. (This is in addition to what youre taking in your prenatal vitamin.)

XI. LABORATORY RESULT AND DIAGNOSTIC PROCEDURE

HEMATOLOGY Result WBC 16.4 Normal Value/Range 5-10*10g/L Interpretation Abnormal Elevated WBC may mean presence of infection Neutrophils 0.74 0.51-0.67 Abnormal Elevated neutrophils means the body is fighting an infection

Lymphocytes Hgb

0.26 97

0.21-0.35 F: 120-160g/dL

Normal Abnormal Low Hgb means the patient is anemic

Platelet Hct Blood Type

339 28 O+

150-400*10g/L F: 36-48

Normal Abnormal

XII. COURSE IN THE WARD

Date September 6, 2011 Doctors Order Please admit D5LR 1L @ KVO For BT Infused in 2u FWB and 2u PUBC Nursing Assessment and Function based on Nursing Concept Vital Signs T: 36.5 P: 110 R: 24 BP: 80/60

September 7, 2011

Facilitate BT Consent BT of IU BT c serial # 2010 31727 Collection date: 8-25-11 Exp. Date: 9-29-11 For urinalysis Start Duvadilan 1 tab 3x a day

Vital Signs T: 35.9 P: 98 R: 32 BP: 110/60

11:00pm Consent for BT of 1u PUB type B+ SN: 2010-31728 CR: 8-25-11 ER: 9-29-11 September 8, 2011 For BT of 2u PRBC PTAC Vital Signs T: 36.0 P: 112 R: 34 BP: 100/60 Vital Signs T: 36.4 P: 120 R: 21 BP: 100/70 Vital Signs T: 36.1 P: 90 R: 30 BP: 100/60 Vital Signs T: 36.5

September 9, 2011

Start for BT

September 10, 2011

September 11, 2011

For pelvic ultrasound Consent for BT at 1u PRBC type BT SN: 290-266374 CD: 9-4-11 ED: 10-9-11 Facilitate BT Paracetamol TIV

September 12, 2011

For BT

P: 88 R: 32 BP: 90/50 Vital Signs T: 36.2 P: 92 R: 21 BP: 100/60

XIII. DRUG STUDY/ FLUIDS

GENERIC / BRAND NAME Generic Name: Isoxsuprin e Brand Name: Duvadilan ACTION Isoxsuprine, the active principle in Duvadilan, is a adrenoceptor agonist with selectivity of action for the smooth muscles of the blood vessels, particularly the cerebral vessels and the deeper vessels of the limbs. In CLASSIFICATION Vasodilator INDICATION Circulatory Disturbances: Cerebral vascular insufficiency with a spastic comp onent showing symptoms dizziness, forgetfulness, disorientation, confusion, visual, auditory and speech abnormalities and transient ischemic CONTRAINDICATION Recent arterial hemorrhage. Patients with known heart disease and severe anemia. SIDE EFFECTS transient palpitatio ns, fall in blood pressure or dizziness and slight increase in the rate of the fetal heart beat skin rashes NURSING INTERVENTION Patients should be watched for transient palpitations, sudden fall in blood pressure and dizziness.

higher doses, isoxsuprine has a relaxant action on the smooth muscles of the uterus. Isoxsuprine also has a beneficial effect on blood viscosity.

attacks. Peripheral vascular insufficiency with a spastic component showing symptoms eg, coldness and numbness of the limbs, intermittent cla udication, color changes and ischemic ulcers. Uterine Hypermotility: Uncomplicated premature labor. SIDE EFFECTS a rash blood disorders, such as thromboc ytopenia and leukopeni a NURSING INTERVENTION Discontinue drug if hypersensitivity reactions occur. Treatment of overdose: Monitor serum levels regularly, N-acetylcysteine

GENERIC / BRAND NAME Generic Name: Aceptami nophen Brand Name: Paracetam ol

ACTION Reduces fever by acting directly on the hypothalami c heat-

CLASSIFICATION Analgesic

INDICATION Mild to moderate pain Fever Migraine Tension headaches

CONTRAINDICATION Hypersensitivity to drug

regulating center to cause vasodilation and sweating, which helps dissipate heat. Site and mechanism of action unclear

hypotensi on

should be available as a specific antidote; basic life support measures may be necessary.

Treatment / Infusion 0.9 NaCl

Classification Isotonic Solution

Indication

Contraindication

Nursing Responsibilities *Do not connect flexible plastic containers of intravenous solutions in series, i.e., do not piggyback connections. Such use could result in air embolism due to residual air being drawn from one container before administration of the fluid from a secondary container is completed. *Pressurizing intravenous solutions contained in flexible plastic containers to increase flow rates can result in air embolism if the residual air in the container is not fully evacuated prior to administration. *Use of a vented intravenous administration set with the vent in the open position could result in air embolism. Vented intravenous administration

*Hypovolemia *CHF *Heat-related emergencies *Freshwater drowning *Diabetic ketoacidosis(DKA)

sets with the vent in the open position should not be used with flexible plastic contain.

XIV. NURSING PROCESS

Long Term Objective Educate the patient to be careful with her activities and avoid doing strenuous activities until she can feel that she is healthy again that she can breathe easily and normal vital signs to teach her the right ways of maintaining a healthy living that could help her to avoid the disease from coming back again, teach the patient to eat healthy foods and vitamins specially his medications for her fast recovery. Short Term Objective 1. Assess patients breathing patterns. 2. Monitor patients vital signs. 3. Assess patients fetal heart tone closely. 4. Maintains patients safety(airway, circulation, prevention of injury) 5. Administer medication, prescribed.

Problem List
Cues S- madali akong mapagod e. as verbalized by the patient. Nursing Problems Fatigue related to decreased hemoglobin and diminished oxygen carrying capacity of blood. O- pallor -delayed capillary refill time -weakness -v/s taken as follows: T-37.1 P-75 R-21 BP-100/70 S- Anemic ako, e baka nga makasama kay baby. As verbalized by the patient. Mild anxiety related to threat to or change in health status. 2 The patients anemia during pregnancy is caused by a decline in the concentration of hemoglobin in the blood. The O- pallor -delayed capillary refill time -weakness -anxious reason hemoglobin concentrations tend to decrease during pregnancy is due to an increase in blood volume Rank 1 Justification The patient is difficult to demonstrate within normal range strong haemoglobin s and ability to tolerate activity because of delayed capillary refill time.

-v/s taken as follows: T-37.1 P-75 R-21 BP-100/70 S- di ako makatulog ng ayos dito eh as verbalized by the patient Sleep disturbance related to stress as evidenced by irritability and weakness 3 The patient is complaining that she cant sleep well because she always thinks her condition can affect her baby. Objective: Irritable Restless Weakness Facial grimace And make demands of growing fetus during pregnancy create a need for increased stores of iron in her body.

XV. NURSING CARE PLAN

Nursing Priority # 1 Assessment S- madali akong mapagod e. as Diagnosis Fatigue related to decreased Planning The patient will show (1) decreased Interventions - Monitor v/s and fetal heart tone Rationale - This will serve as a baseline if there is Expected Outcome - Reports less fatigue.

verbalized by the patient.

hemoglobin and diminished oxygen carrying capacity

fatigue and (2) attain and maintain adequate nutrition.

closely.

an abnormality.

- Attains adequate nutrition.

- Advice patient to prioritize and minimize act and establish balance between activity and rests.

- This will make the patient less fatigued because of the balance in activity and rest.

O- pallor -delayed capillary refill time -weakness -v/s taken as follows: T-37.1 P-75 R-21 BP-100/70

of blood.

- Encourage a healthy diet.

- The diet will be good for the patient and the baby especially high in iron foods.

- Discuss nutritional supplements such as vitamins, iron, folate, etc. if there are prescribed.

- Supplements such as these will make the patient control anemia.

Nursing Priority # 2 Assessment S- Anemic ako, e baka nga makasama kay baby. As verbalized by the patient. Diagnosis Mild anxiety related to threat to or change in health status. Planning The patient will (1) appear relaxed and (2) reports anxiety is reduced to a manageable level. - Be available to patient for listening and talking. O- pallor -delayed capillary refill time -weakness -anxious -v/s taken as follows: T-37.1 P-75 R-21 BP-100/70 - Encourage a healthy diet. - The diet will be good for the patient and the baby especially high in iron foods. -Establish therapeutic relationship - This will establish rapport to patient so thus reducing - This will establish rapport to patient. Interventions - Monitor v/s and fetal heart tone closely. Rationale - This will serve as a baseline if there is an abnormality. Expected Outcome - Reports less anxious. -Maintains therapy supplemental therapy.

conveying empathy anxiety. and positive regard.

- Discuss nutritional supplements such as vitamins, iron, folate, etc. if there are prescribed.

- Supplements such as these will make the patient control anemia.

Nursing Priority # 3 Assessment S- di ako makatulog ng ayos dito eh as verbalized by the patient Diagnosis Sleep disturbance related to stress as evidenced by irritability and weakness Planning After 4 hours of nursing intervention the patient will be able to report improvement in Objective: Irritable Restless Weakness Facial Provide a quiet and calm Reduces stress and excess sleep/rest pattern Intervention Evaluate patients response to the activity Rationale Establishes patients capabilities and needs and facilitates choice of intervention Evaluation After 4 hours of nursing intervention the patient was reported improvement in sleep/rest pattern

grimace

environment

stimulation promoting rest

Encourage adequate rest and balanced with moderate activity

Facilitates healing process and enhances natural resistance

XVI. DISCHARGE PLANNING (METHOD APPROACH)

Medication Education Proper compliance with the medication prescribed to the patient will help limit the progression of her condition, so it is advise to continue her medications (iron and folic acid supplements) Emphasize the need to maintain simple regular exercise and activities; to maintain muscle strength and motility, to promote good circulation of the body system. Passive exercise like breathing can also help the patient to feel calm and comfortable and it is also good for her baby. Anemia can increase the risk for anemia later in infancy.. Early detection of it is very important. Blood transfusion can help replace the iron and hemoglobin in her body if anemia persists. Teach the patient/folks the importance of monitoring the progress and compliance with the treatment regimen. Patient needs ongoing education and reinforcement on the multiple dietary requirement she needs. Patient

Treatment Health Teaching

needs health promotion activities and health screening. Emphasize to the patient the importance of having regular check-up to know her present condition. Out Patient After discharged, patient may go to clinic for follow-up check-up after a week. As part of this follow-up care, she should undergo blood test to check for the level of her RBC and Hgb. Encourage foods that are rich in B12 because it is essential for the production of red blood cells, as well as the maintenance of the nervous system, and is found in food of animal origin such as meat, fish and dairy products. Encourage high calorie and high iron containing foods like liver, red meat, seafood, poultry, eggs, beans and peas, dark green leafy vegetables and raisins, nuts, and seeds. These foods are not only good for her but also for her growing fetus.

Diet