Introduction

Abnormal uterine bleeding is a condition in which a woman bleeds from

her uterus at an unexpected time or in a way that is unusual for her. For example,
bleeding between periods, a period that is heavier longer-lasting than normal,
bleeding after sexual intercourse, clots or spots in the menstrual blood and any
bleeding after menopause may all be considered abnormal uterine bleeding.
The most common reason for irregular uterine bleeding is pregnancy.
Spotting or very light bleeding may occur with no real significance, but you
should always check with your doctor if youre bleeding while pregnant. Another
common reason for abnormal menstrual bleeding is having too much or too little
of certain hormones. This often occurs during adolescence, when hormone levels
fluctuate. Intrauterine device (IUD) can cause abnormal bleeding by irritating the
uterine lining. The bleeding is usually accompanied by cramping. Also called
Stein-Leventhal syndrome, Polycystic Ovarian Syndrome occurs when you dont
ovulate regularly. If your period comes with pain or foul-smelling greenish
discharge you may have an infection of a pelvic organ, such as your uterus,
cervix or ovaries. Bleeding would commonly follow sex or douching. These
infections are often caused by sexually transmitted diseases. Fibroid tumors are
non-cancerous tumors that grow in the uterine muscle. They usually affect
women in their 30s or 40s. most common among black women, they are also
fairly common among white women, but extremely rare in Asian women. Other
possible reasons for abnormal menstrual bleeding include polyps, small growths
that develop in the cervix or uterus. Their causes are unclear, but are related to
an excess of estrogen, which may be result of an infection, hormone treatment or
some types of ovarian tumors.
The most probable etiology of abnormal uterine bleeding relates to the
patients reproductive age, as does the likelihood of serious endometrial
pathology. The specific diagnostic approach depends on whether the patient is
premenopausal, perimenopausal or postmenopausal. In premopausal women
with normal findings on physical examination, the most likely diagnosis is

dysfunctional uterine bleeding (DUB) secondary to anovulation, and the

diagnostic investigation is targeted at identifying the etiology of anovulation.
Abnormal uterine bleeding (AUB) in nonpregnant women is a common
problem. In fact, AUB accounted for almost 4 million outpatient visits (mostly to
physicians offices) in the United States in 1996. Indeed, this problem may
prompt more than 20% of all visits to OB/GYNs, and may account for more than
one fourth of all hysterectomies. AUB is rare in prepubertal females. Newborn
girls occasionally have a slight bloody vaginal discharge secondary to withdrawal
of placental estrogens. AUB is common in adolescents because of the 1- to 5year delay in development of regular ovulatory menstrual cycles after menarche.
AUB also tens to be more common during the fifth decade of life (the
perimenopausal years). In the worst case, AUB may be a sign of atypical
endometrial hyperplasia, which, if undiagnosed and untreated, can progress to
uterine cancer-the most common female genital cancer. In 1998, estimated
36,100 women were diagnosed with uterine cancer, which led to approximately
6,300 deaths.
One popular form of treatment for abnormal uterine bleeding is birth
control pills, which contain hormones that can prevent the uterus lining from
thickening. If birth control pills arent stopping the bleeding, a doctor may
prescribe an intrauterine (IUD) device. An IUD is a plastic device that is inserted
into a womans uterus to prevent pregnancy. In rare cases, surgery may be
needed to stop abnormal bleeding. Two surgical procedures are recommended:
hysterectomy and endometrial ablation.

OBJECTIVES
General Objectives
This study attempts to examine the case of the client with abnormal
uterine bleeding, specifically it attempts:
1. To obtain clients data
2. To perform thorough physical assessment to the client
3. To discuss the anatomy and physiology of the reproductive system
4. To trace the pathophysiology of abnormal uterine bleeding
5. To present laboratory results and its interpretation
6. To formulate appropriate nursing diagnosis who has abnormal uterine
bleeding
7. To develop nursing care plan for client based to identifies nursing
problems.
8. To present drug studies as medications given to client as a part of
treatment regimen.
9. To provide health teaching to patient and significant others about
prevention of recurrence of AUB.

PERSONAL DATA
Name: Cristy Joy Lactason
Address: Brgy. Naje, Arakan, Cotabato
Date of Birth: August 7, 1990
Birthplace: Brgy. Naje, Arakan, Cotabato
Age: 19 years old
Sex: Female
Civil Status: Single
Religion: Roman Catholic
Educational Status: Second year high school
Nationality: Filipino

MEDICAL DATA
Hospital: Kidapawan Medical Specialists Center Inc.
Ward: NS 2
Room & Bed No. Room 218-A
Chief Complaints: Profuse menstruation/Menometrorrhagia
Date & Time Admitted: July 25, 2010, 4:30 pm
Physicial: Dr. Phillen Drama Ureta
Admitting Diagnosis: T/C abnormal uterine bleeding
Final Diagnosis: Abnormal Uterine Bleeding

FAMILY BACKGROUND
I. History of Present Illness
The condition started about 1 month prior to admission as onset of
prolonged vaginal bleeding lasting for 15 days soaking 4-6 pads per day
associated with dysmenorrhea. No consultation done and no medications taken.
Two days prior to admission patients vaginal bleeding spontaneously
regressed.
One day prior to admission patients vaginal bleeding recurred and
completely soaked several pads associated with pallor and dizziness prompting
to consult an OB-Gynecologist (Dr. Phillen Drama Ureta) and subsequent
admission.
II. History of Past Illness
Patient was hospitalized last March 2010 at Antipas Hospital due to
profuse vaginal bleeding and was treated with Diane pills taken with poor
compliance. She is non-asthmatic, non-diabetic, non-hypertensive with no known
food and drug allergies.
III. Medical History of Family
No heredofamilial diseases such as hypertension, diabetes, asthma and
cancer were reported in the family.
X,
IV. Personal and Social History
Patient is a second year high school student at Arakan National High
School. She is the second child among 3 siblings. Her father is a farmer and her
mother is a plain housewife. She is a non-smoker, an occasional alcohol
beverage drinker and denies any use of prohibited drug. She has a boyfriend but
denies coitus at her age. She spends most of her time watching television.

V. Menstrual History
She started her menarche at the age of 13 years old, with an interval of
28-30 days and duration of 4-6 days. Amount of blood is heavy soaking 3-4 pads
per day accompanied with dysmenorrhea.

DEVELOPMENTAL DATA
Age/Stage

19 y/o

Havighurst
-Adolescence
Erikson
-Adolescence (12-20)
Kohlberg
-Adolescence and
Adulthood

Havighurst

Description according to Theories

Erikson

Adolescence
1. Achieving new and more
mature relations with age-mates
of both sexes
2. Achieving masculine or
feminine social role
3. Accepting ones physique and
using the body effectively
4. Achieving emotional
independence from parents and
other adults.
5. Achieving assurance of
economic independence.
6. Selecting and preparing for an
occupation
7. Preparing for marriage and
family life.
8. Developing intellectual skills
and concept necessary for civic
competence
9. Desiring and achieving socially
responsible behavior
10. Acquiring a set of values and
ethical system as a guide to
behavior.

Central task
-Identity vs. Role Confusion

Indicators of Positive
Resolution
-Coherent sense of self;
Plans to actualize ones
abilities

Indicator of Negative
Resolution
-feelings of confusion.
Indecisiveness and possible
anti-social behavior

Analysis
Kohlberg

Conventional Level
-Person is concerned in
maintaining expectations and
rules of the family group,
nation or society. A sense of
guilt has developed and
affects behavior. The person
values conformity, loyalty and
active maintenance of social
order and control. Conformity
means good behavior or what
pleases or helps another and
is approved.
Law and Order Orientation
-The person wants
established rules from
authorities, and the reason for
decision and behavior is that
social and sexual rules and
traditions demand the
response.

On Havighurst
theory, the patient
has met the
indicators of an
adolescent except
achieving
assurance of
economic
independence.
On Eriksons theory,
client indicates
positive resolution,
she has a sense of
self and plans to
actualize her
abilities.
On Kohlbergs
theory, the client is
concerned in
maintaining
expectations and
rules of the family
group.

PHYSICAL ASSESSMENT
Date of Assessment:
I.

General Apperance
Date: July 26, 2010

Time: 9:45AM

Received client conscious and coherent on bed with PNSS 1L @ 20

gtts/min at the level of 200 cc infusing well @ right metacarpal vein. Patient appeared
ungroomed with uncombed hair and wrinkled clothes with black nail polish. When nail
polish was removed, clients nail bed showed pallor. Client was generally pale.
II.

Vital Signs and Clinical Measurements

Weight: 43 kg

Height: 51

Vital Signs upon Assessment:

BP: 110/90 mmHg

PR: 70 bpm

RR: 18 cpm
III.

Temp: 36.2

Hair
Hair is black, straight and well distributed. No presence of lice and

dandruff noted.
IV.

Head
Normocephalic. No deformities noted.

V.

Eyes
Eyes are symmetrically aligned and equal in movement, eyelashes are

evenly distributed and curled. Pupils are equally reactive to light and accommodation on
examination (using a penlight). She has good visual acuity based on snellens test.
Conjunctivas are pale and eyeballs are in good position and alignment.

VI.

Ears
Hearing is normal upon assessment using Webers test, no gross

deformities noted. She is able to locate the direction of the sound of her ringing
celphone.
VII.

Nose
No asymmetry, no nasal discharges noted and can identify odors.

VIII.

Neck/Throat
No neck vein engorgement, no lymphadenopathy, tonsils are in normal

size, no difficulty on swallowing. The neck can move from left to right and can be flexed,
extended and hyper extended.
IX.

Chest and Lungs

Equal chest expansion, no retractions noted, clear breath sounds and with

bilateral chest movements. RR: 18 cpm

X.

Heart and Circulation

Distinct heart sounds, regular rhythm, BP: 110/90mmHg

PR: 70 bpm.
XI. Breasts
Breast size and symmetry are relatively equal with slight variation. Shape
is round and firm. Color is flesh and skin surface is smooth. Nipples are pink in color
with no discharges noted. She uses brassieres, no lumps or masses noted upon
palpation.
XII.

Abdomen
No scars noted, soft, normoactive bowel sounds noted. No tenderness.

XIII.

Genito-urinary
Normal external genitalia, abundant pubic hair with moderate bleeding.

No alteration in urinary and bowel habits. She experiences 15 days of menstruation

and soaks 4-6 sanitary napkins a day. She also urinates every 20 minutes during this
period.
XIV.

Extremities
A.

Upper Extremities
No skin lesion is noted. No growth deformities. She can move her upper

extremities freely and are both symmetrical in size and length. With PNSS 1L @ 20
gtts/min at the level of 200 cc infusing well @ right metacarpal vein.
B.

Lower Extremities
No skin lesion is noted. No growth deformities. Her lower extremities are

both symmetrical in size and length with limitation of movement because movement and
straining or any forceful activity can aggravate profuse vaginal bleeding.
XV.

Food Preference
Patient verbalizes fondness of eating meat, fish and vegetables.

XVI.

Identified Needs
The patient needs to maintain fluid and electrolyte balance, needs to keep
body clean and well groomed and protect the integument and needs
performance of activities of daily living.

XVII. Nursing Diagnoses

Risk for Fluid Volume Deficit R/T Uterine Bleeding

Risk for Activity Intolerance related to decreased hemoglobin

Self-care deficit: bathing/ hygiene related to decreased motivation

Easy fatigability related to decreased hemoglobin

10

TERMINOLOGIES
Abnormal Uterine Bleeding excessive and prolonged menstruation.
Endometriosis ectopic growth and function of endometrial tissue.
Fibroids a fibroma or myoma particularly of the uterus
Fibroma a benign neoplasm consisting largely of fibrous or fully developed
connective tissue.
Menometrorrhagia - excessive menstrual and uterine bleeding other than that caused
by the menstruation.
Menorrhagia - abnormally heavy or long menstrual periods. Menorrhagia occurs
occasionally during the reproductive years of most womens lives.
Metrorrhagia uterine bleeding other than that caused by menstruation. It may be
caused by uterine lesions and may be a sign of uro-genital malignancy.
Myoma a common benign fibroid tumor of uterine muscle.
Polyps small, tumor like growth that projects from a mucous membrane surface.
Proliferation the reproduction or multiplication of similar forms.
Retroverted uterus- titled or tipped backwards.

11

Snellens Chart - an eye chart used by eye care professionals and others to measure
visual acuity. It is printed with eleven lines of block letters. The first line consists of one
very large letter, which may be one of several letters, for example E,H or N. subsequent
rows have increasing numbers of letters that decrease in size.
Snellens Test a test wherein a person covers one eye and reads aloud the letters of
each row beginning at the top. The smallest row that can be read accurately indicates
the visual acuity in that eye.
Withdrawal bleeding the passage of blood from the uterus, associated with the
shedding of endometrium that has been stimulated and maintained by hormones.
Webers Test a test for differentiating conductive hearing impairment from
sensorineural hearing impairment. A vibrating tuning for is applied to one of several
points in the middling of the forehead; if the sound is heard better in the impaired ear,
the middle-ear apparatus is at fault; if the sound is heard better in the normal ear, the
hearing impairment is caused by diseased sensorineural apparatus.

12

ANATOMY AND PHYSIOLOGY

Vagina:
The vagina is a fibro muscular tubular tract leading from the uterus to the
exterior of the body in female mammals. The vagina is the place where semen from the
male is deposited into the female's body at the climax of sexual intercourse, commonly
known as ejaculation.
Cervix:
The cervix is the lower, narrow portion of the uterus where it joins with the
top end of the vagina. It is cylindrical or conical in shape and protrudes through the
upper anterior vaginal wall. Approximately half its length is visible, the remainder lies
above the vagina beyond view. The vagina has a thick layer outside and it is the
opening where baby comes out during delivery. The cervix is also called the neck of the
uterus.
13

Endometrium
Is the inner membrane of the mammalian uterus. The endometrium
functions as a lining for the uterus, preventing adhesions between the opposed walls of
the myometrium, thereby maintaining the patency of the uterine cavity. During the
menstrual cycle or estrous cycle, the endometrium grows to a thick, blood vessel-rich,
glandular tissue layer. This represents an optimal environment for the implantation of a
blastocyst upon its arrival in the uterus. The endometrium is central, echogenic
(detectable using ultrasound scanners), and has an average thickness of 6.7mm.During
pregnancy, the glands and blood vessels in the endometrium further increase in size
and number. Vascular spaces fuse and become interconnected, forming the placenta,
which supplies oxygen and nutrition to the embryo and fetus.
Ovary
Is an ovum-producing reproductive organ, often found in pairs as part of
the vertebrate female reproductive system. Ovaries in females are homologous to
testes in males, in that they are both gonads and endocrine glands. Ovaries are oval
shaped and, in the human, measure approximately 3 cm x 1.5 cm x 1.5 cm (about the
size of a Greek olive). The ovary (for a given side) is located in the lateral wall of the
pelvis in a region called the ovarian fossa. The fossa usually lies beneath the external
iliac artery and in front of the ureter and the internal iliac artery.
Uterus or Womb
Is a major female hormone-responsive reproductive sex organ of most mammals
including humans. It is a flattened, pear-shaped, hollow organ in the pelvis of the human
female. The uterus consists of a body, a base or fundus, a neck or cervix, and a mouth.
Suspended in the pelvis, it lies with the base directed upward and forward and the
cervix directed slightly backward. It is connected to the vagina by the cervix. On either

14

side of the uterus lies an ovary. Eggs produced by the ovaries reach the uterus through
the fallopian tubes.

ETIOLOGY
PREDISPOSING
FACTOR
1. Age

ACTUAL

RATIONALE
- Abnormal uterine bleeding is one of
the most common reasons women
see their doctors. It can occur at any
age and has many causes.

(http://www.acog.org/publications/patient_ed
ucation/bp095.cfm)

Age: 19 years old.

- The uterus or womb is a major
female
hormone-responsive
reproductive sex organ of most
mammals
including
humans.
(http://en.wikipedia.org/wiki/Uterus)

2. Gender

Female

PRECIPITATING
FACTOR

ACTUAL

RATIONALE

1. Poor
compliance to
treatment

Noncompliance and poor compliance

may lead to relapse, aggravation of
the disease state, hospitalization,
escalating health care costs, and
even death.
(http://www.pharmacytimes.com/issu
e/pharmacy/2003/2003-07/2003-077310)

Complying only for 1 month and

stopping thereafter.
15

SYMPTOMATOLOGY
SYMPTOMS
1. More than 4 to 6
days of menstruation.

ACTUAL

RATIONALE
Causes may be due to disruption of
normal hormonal regulation of periods or
disorders of the endometrial lining of the
uterus.
(http://en.wikipedia.org/wiki/Menorrhagia)

She
experiences
15
days
of
menstruation.
Without
subsequent
progesterone
secretion, estrogen secretion continues
and causes extreme proliferation in the
endometrium.
(Maternal and Child health Nursing,
Volume 2, 4th edition , Pillitteri)

2.Blood loss of
greater than 80 ml.

Easily soaks 4 to 6 sanitary napkins a

day. ( 1 sanitary napkin is equal to 25 ml)
Bleeding causes loss of blood. This
causes an abnormally low number of red
blood cells which causes anemia. Red
blood cells, also called erythrocytes,
contain hemoglobin, a red, iron-rich
protein that carries oxygen in the blood
to the bodys tissues.
These symptoms include pale skin,
shortness of breath, rapid heartbeat, low
vitality, dizziness, and, if left untreated,
stroke or heart failure. (Microsoft
Encarta 2008. 1993-2007 Microsoft
Corporation.)

3.Anemia
> Dizziness
> Pallor

Client has pale conjunctiva and nail

beds. She experiences dizziness

16

17

Pathophysiology
Predisposing Factors
Gender Female
Age - Adolescent

Precipitating Factors
Poor medical
Compliance

OVULATORY

No Corpus Luteum is
formed

Estrogen levels remain the

same

No production of
progesterone

Hyperplasia of
Endometrium

As follicles degenerate,
estrogen levels decreases

Irregular Sloughing of
Endometrial Basalis Layer

18

Abnormal Uterine Bleeding

Heavy Prolonged Bleeding

(Duration of 15 days Menstruation
and soaking 4-6 Pads per day).

Decreased Serum
Hemoglobin
(Hgb Lab. Result 102)
Decreased O2 Carrying
Capacity of Blood
(Dizziness)

If not treated

If treated:
Complications

Death

Back to normal
Homeostasis
Meds.
ALTHEA 1 Tab.
O.D X3 months

Prognosis
Good

FeSO4 Tab. 200

mg BID

NURSING CARE PLANS

19

Anemia

Dizziness
and Pallor

Date: July 26, 2010

Assessment
Subjective
Cues:
> Gagawas
pirmi akoang
dugo. Gamens
ko ug 15 days
as verbalized.
Objective
Cues:
> Pallor of
conjunctiva and
nail beds.
>Consumes 4-6
sanitary napkin
per day
> Menstruation
lasting for 15
days

Needs

Diagnosis

>Risk for Fluid

Volume Deficit
PHYSIOLOGIC R/T Uterine
NEEDS
Bleeding
To facilitate in
the
maintenance of
fluid and
electrolyte
imbalance.

According to:
Abraham
Maslows
Hierarchy of
Needs

Scientific Basis:
Blood is composed of
blood cells
suspended in a liquid
called blood plasma.
Plasma, which
constitutes 55% of
blood fluid, is mostly
water (90% by
volume)
(http://www.wikipedia.
org)

Goal
After 8 hours
of nursing
care, patient
will be able
to maintain
fluid volume
within
functional
level as
evidenced:
a. cessation
of bleeding

Intervention

1. Monitored Vital
Signs for changes

20

>Indirect
indicators of
fluid status.

2. Counted
number of pads
consumed to
monitor actual fluid
loss.

>Serves as
baseline data

3. Encouraged
increase oral fluid
intake

> To provide
volume to
volume
replacement

fruits.

Date: July 26, 2010

Expected/Outcome

Independent

b. V/S within 4. Promoted high

normal range water content
c. Good skin
turgor and
moist
mucous
membrane.

Rationale

> To
replacefluid
lost.

Dependent
1. IVF PNSS 1L @
80cc/hr

> Fluid
replacement.

2. Tranexamic Acid
500mg QID as
ordered by
physician

>It stops
bleeding.

>Goal met.
After 8 hours of nursing
care, patient was able
to: Show good fluid
volume status as
evidenced by
a) Minimal
bleeding
b) Vital Signs
within normal
range
c) Lips and
mucous
membranes are
moist with good
skin turgor.

Assessment
Subjective
Cues:
>No subjective
cues
Objective Cues:
> Pale
conjunctiva
> Pale nail beds
> Hgb = 102
(normal value:
120-140)
> Weakness
> Dizziness

Needs

Diagnosis

>Risk for
PHYSIOLOGIC Activity
NEEDS
Intolerance
related to
- need for
decreased
activity
hemoglobin
(Maslows
Hierarchy of
Scientific
Needs)
Basis:
Hemoglobin
in the blood
is what
transports
oxygen from
the lungs or
gills to the
rest of the
body (i.e. the
tissues)
where it
releases the
oxygen for
cell use.

Goal
>After 8 hours
of nursing
care, patient
will be able to
identify
alternative
ways to
maintain
desired activity
level and
endure
performance
of Activities of
Daily
Living(ADL)

Intervention

Rationale

Independent
1. Discussed with
client the
relationship of
illness to inability
to perform desired
activities.

>Understanding
these
relationships can
help with
acceptance of
limitations or
reveal
opportunity for
changes of
practical value.

2. Assisted client in
doing basic
activities

>to conserve
energy and
promote safety.

3. Encouraged
patient to take
foods rich in iron.

>to replace iron

lost

Dependent
1. FeSO4 1tab
BID as ordered by
physician.

Date: July 26, 2010

21

ExpectedOutcome

> Provides
elemental iron an
essential
component in the
formation of
hemoglobin.

>Goal met. Client

was able to endure
& sustain basic
activity such as
moving to and from
the bathroom
without assistance.

Assessment
Subjective Cues:
> Wala pa koy
ligo client
verbalized
Objective Cues:
> dirty nail noted
> unfixed hair
noted.

Needs

Diagnosis

PHYSIOLOGIC >Self-care
NEEDS
deficit:
bathing/
- need to keep hygiene
body clean and related to
well groomed decreased
and protect the motivation.
integument
(Maslows
Scientific
Hierarchy of
Basis:
Needs)
Motivation
is the
psychologic
al feature
that
arouses an
organism to
action
toward a
desired
goal.
(http://www.
thefreedicti
onary.com/
motivation)

Goal
.After 8 hours
of nursing
care, patient
will be able
to:
Perform
proper
hygiene

Date: July 27, 2010

22

Intervention

Rationale

Expected
Outcome

Independent
>Goal met.

1. Monitored
vital signs.

> Serves as
baseline data.

2. Performed
cleansing bed
bath to patient.

> To promote
comfort and
reduce risk for
infection.
3.Encouraged
> To denote
patient to take a importance of
bath explain the proper
possible risks for hygiene.
infection.
4. Encouraged
patient to do
oral care.

> To promote
taste and
decrease
bacteria.

5. Trimmed
patients nails.

> To prevent
microorganis
m from
staying under
nails.

After 8 hours of nursing

care, patient was able
to perform proper
hygiene and good
grooming.

Assessment
Subjective Cues:
> Ginakapoy
gud ko client
verbalized.
Objective Cues:
> Pale
conjunctiva
> Pale nail beds
> Always lying on
bed.
>Feeling of
weakness.
> Hgb = 102
> 15 days of
menstruation
> 4 to 6 sanitary
pads a day.

Needs

PHYSIOLOGIC
NEEDS
- need for
activity
(Maslows
Hierarchy of
Needs)

Diagnosis

>Easy
Fatigability
R/T
decreased
hemoglobi
n.
Scientific
Basis:
Hemoglobi
n in the
blood is
what
transports
oxygen
from the
lungs or
gills to the
rest of the
body (i.e.
the
tissues)
where it
releases
the oxygen
for cell use

Goal
In the 8 hours
of nursing
care, patient
will be able
to:
>Participate
willingly in
necessary
desired
activities such
as going to
the bathroom,
eating,
standing and
walking
without
ambulatory.

Intervention

Expected/Outcom
e

Independent
>Goal met.

1. Noted client
reports of
weakness
and/or fatigue.
2. Adjusted
activities
according to
clients
condition.

> Symptoms
may be result
of/or to
contribute to
Intolerance to
activity.
> To prevent
Overexertion

3. Assisted client > To prevent

with activities.
client from
injury.
Dependent
1. FeSO4 1tab
BID.

23

Rationale

>Provides
elemental iron
an essential
component in
the formation
of
hemoglobin.

After 8 hours of nursing

care, patient was able
to:
> Perform the desired
activities such as going
to the bathroom with
assistance.

LABORATORY RESULTS
Diagnostic
Test
Complete
Blood Count
Date: July 25,
2010

Purpose
Complete Blood Count:
General survey of bone
marrow functions and
evaluates all three cell lines
(WBCs, RBCs, platelets)
White Blood Cells (WBC):
total WBC count
Hemoglobin: (Hgb): delivers
O2 through circulation to
body tissues and returns CO2
from tissues to lungs
Hematocrit (Hct): indicates
relative proportions of plasma
and RBCs ( volume of
RBCs/L whole blood)
Platelet: total number of
platelets in circulation
Lymphocytes: integral
component of immune
system
Segmenters:
Monocytes:

Result
Test

Result

WBC
9.4 (10 e g/L)
Hgb
102
Hct
0.35
Plt.ct
302
Lympho
0.30
Segs
0.66
Mono
0.04

24

Interpretation
Normal Values
5 10
120-140
0.37-0.43
150-350 x10 g/L
0.25-0.35
0.55-0.65
0.03-0.06

The Hemoglobin
levels are below the
normal range.
The Hematocrit levels
are below than the
normal levels.

Nursing
Implication
Below than normal
levels of Hemoglobin
are found in irondeficiency anemia
(Fischbach, 1988).
Below than the normal
of hematocrit are
found in Acute,
massive blood loss.
(Fischbach, 1988).

Diagnostic
Test

Purpose

Bleeding Time
and Clotting
Time
Date: July 25,
2010

Bleeding time: measures the primary phase

of hemostasis: the interaction of the platelet
with the blood vessel wall and the formation
of the hemostatic plug. This is one of the four
primary screening test for coagulation
disorders. (Fischbach, 1988).
Clotting time: the time required for blood to
form a clot, tested by collecting 4 mL of blood
in a glass tube and examining it for clot
formation. The first appearance of a clot is
noted and timed. The normal coagulation time
in glass tubes is 5 to 15 minutes. This simple
test has been used to diagnose hemophilia,
but it does not detect mild coagulation
disorders. (http://medicaldictionary.thefreedictionary.com/clotting+time)

Result
Test

Result

Bleeding
time:
Clotting
time:

25

Interpretation
Normal
Values

4 mins

1-3 mins

7 mins

2-8 mins

The Bleeding time

higher is than
normal.

Nursing
Implication
A single prolonged
bleeding time does
not prove the
existence of
hemorrhagic
disease because a
larger vessel may
have been
punctured.
(Fischbach, 1988).

Diagnostic
Test
Urinalysis
Date: July
25, 2010

Purpose

Result

Interpretation

Nursing Implication

Urinalysis: The urinalysis is used as a

screening and/or diagnostic tool because it
can help detect substances or cellular
material in the urine associated with
different metabolic and kidney disorders. It
is used to detect urinary tract infections
(UTI) and other disorders of the urinary
tract.
(http://www.labtestsonline.org/understandin
g/analytes/urinalysis/test.html)

Physical Examination
Color: Yellow
Transparency: Cloudy

Yellow is the normal

color of urine. Glucose
is normally not present
in urine.
Normal Urine can be
clear or cloudy.

"Normal" urine can be

clear or cloudy. Albumin
is smaller than most
other proteins and is
typically the first protein
that is seen in the urine
when kidney dysfunction
begins to develop. A
vegetarian diet, a lowcarbohydrate diet, or the
ingestion of citrus fruits
will tend to make the
urine more alkaline.
(http://www.labtestsonline
.org/understanding/analyt
es/urinalysis/ui_exams.ht
ml)
Normal urine ranges from
1.010 to 1.025.(Kozier &
Erbs, 2007)
Normal value for pus
cells in urine is 05/hpf(http://www.medhelp
.org/posts/Urology/Urinal
ysisinterpretation/show/7313
97)
The girl is not pregnant.
The human chorionic
gonadotropin (hCG) test
is done to check for the
hormone hCG in blood or
urine. Some hCG tests
measure the exact
amount and some just
check to see if the
hormone is present. HCG
is made by the placenta
during pregnancy. The
hCG test can be used to
see if a woman is
pregnant or as part of a

Chemical Examination
Albumin: Trace
pH
reaction: 5.0
Sugar: Negative
Specific
Gravity: 1.020
Microscopic findings
Pus cells: 1-3/hpf
Red Blood
Cells: Packed

The protein test pad

measures the amount
of albumin in the urine.
Normally, there will not
be detectable
quantities.
The ph reaction of the
urine is alkaline.
Specific gravity is
normal.
Pus cells are within
normal range.

Urine HCG

Serology
-

26

Negative

HCG is not found in

urine.

screening test for birth

defects.
(http://www.nlm.nih.gov/
medlineplus/ency/article/
003619.htm)

A retroverted uterus is
usually diagnosed during
a routine pelvic
examination.

Pelvic
Ultrasound
Date: July
26, 2010

Ultrasonography is an ultrasound-based
diagnostic imaging technique used to
visualize subcutaneous body structures
including tendons, muscles, joints, vessels
and internal organs for possible pathology
or lesions. Obstetric sonography is
commonly used during pregnancy and is
widely recognized by the public.
(http://en.wikipedia.org/wiki/Medical_ultraso
nography)

Lower back pains

The uterus is retroverted. It measures
4.2x3.6x3.9 cm and is normal in size for
nullipara. No myoma or adenomyosis is
noted. Endometrial stripe hyperechoic
measuring 0.6 cm. adnexae are free.
Minimal pelvic fluid is seen.
Impression: Normal studies save for
minimal pelvic fluid.

27

Retroversion of the
uterus is not normal

It usually does not pose

any medical problems,
though it can be
associated with
dyspareunia (pain during
sexual intercourse) and
dysmenorrhea (pain
during menstruation).
(http://en.wikipedia.org/wi
ki/Retroverted_uterus)

DRUG STUDIES
Name

Dosage and
Indication

Mechanism of
Action

Adverse Effects

Contraindication

Nursing Responsibilities

Generic
Name:
Ferrous
Sulfate

Iron Deficiency
200 mg
P.O BID

Provides
elemental iron
an essential
component in
the formation of
hemoglobin.

GI: Nausea, epigastric

pain, vomiting,
constipation, black
stools, diarrhea,
anorexia.
Other: temporarily
stained teeth in liquid
forms

Contraindicated in
patients with
Hemosiderosis,
primary
hemochromatosis,
hemolytic anemia
(unless patient
also has iron
deficiency
anemia), Peptic
ulceration,
ulcerative colitis or
regional enteritis
and in those
receiving repeated
blood transfusions.
Use cautiously on
long term basis.

1. Identify the client

correctly using the
appropriate means of
identification, such as
checking the identification
bracelet or asking the
clients name.
2. If the client is unfamiliar
with the medication, the
nurse should explain the
intended action as well as
any side effects or adverse
effects that may occur.
3. Administer drug in the
prescribed dosage by the
route intended and the
correct time.
4. Record the medication
given, dosage, time, any
complaints or assessments
and your signature.
5. Explain to the client that
she may have black stool
as effect of the drug.
6. Administer the drug with
juice for faster absorption.

Brand Name:
Magniferron
Classification:
Hematologic
Drugs:
Hematinics

28

Name

Dosage and
Indication

Mechanism of
Action

Adverse Effects

Contraindication

Nursing Responsibilities

Generic
Name:
Tranexamic
Acid
Brand Name:
Hemostan

Indicated for
short term use
for hemorrhage
or risk of
hemorrhage in
those with
increased
fibrinolysis or
fibrinogenolysis
. Local
fibrinolysis as
occurs in
menorrhagia.

Tranexamic
acid
competitively
inhibits
activation of
plasminogen
(via binding to
the kringle
domain),
thereby
reducing
conversion of
plasminogen to
plasmin
(fibrinolysin),
an enzyme that
degrades fibrin
clots,
fibrinogen, and
other plasma
proteins,
including the
procoagulant
factors V and
VIII.

GI: nausea, vomiting,

diarrhea may occur
but disappear when
the dosage is
reduced.

In patients with
acquired defective
color vision, since
this prohibits
measuring one
endpoint that
should be followed
as a measure of
toxicity.
In patients with
active
intravascular
clotting.

1. Identify the client

correctly using the
appropriate means of
identification, such as
checking the identification
bracelet or asking the
clients name.
2. If the client is unfamiliar
with the medication, the
nurse should explain the
intended action as well as
any side effects or adverse
effects that may occur.
3. Administer drug in the
prescribed dosage by the
route intended and the
correct time.
4. Record the medication
given, dosage, time, any
complaints or assessments
and your signature.
5. Check for presence of
spontaneous bleeding.

Classification:
Hematologic
Drugs:
Hematinics
amino acid
antifibrinolytic
s.

1tab 500mg
QID

29

Tranexamic
acid also
directly inhibits
plasmin
activity, but
higher doses
are required
than are
needed to
reduce plasmin
formation.

30

Name

Dosage and
Indication

Mechanism of Action

Generic
Name:
Cyproterone
acetate
Brand Name:
Althea
Classification:
Natural and
semisyntheti
c estrogens.

OC, control of
acne &
hsirsutism,
regulation of
menstrual
cycle, reduction
of premenstrual
tension, relief
from pain &
excess
bleeding during
menstruation.

Oral contraceptive.

Take 1 tab
starting on the
1st day of
menses &
throughout the
cycle.

Oral Contraceptive:
Althea stops ovulation,
thins the lining of the
uterus and thickens the
cervical mucus. In
combination, these
actions prevent
pregnancy.

Althea is a combined lowdose oral contraceptive

pill with antiandrogenic
properties. Each tablet
contains cyproterone
acetate, a progesterone
with antiandrogenic and
progestogenic properties
and ethinyl estradiol, an
estrogen.

Antiandrogen: Althea
contains cyproterone
acetate that works as an
antiandrogen. It
competes at the receptor
sites with androgens and
reduces their effects.
Cyproterone acetate

Adverse
Effects

Contraindication

Nursing Responsibilities

GI: Nausea,
vomiting,
chloasma
(melasma)
& other skin
or hair
changes,
headache,
water
retention,
slight wt
change,
breast
tenderness,
changes in
libido.
Menstrual
irregularities
eg spotting,
breakthroug
h bleeding
&
amenorrhea
.

Impaired liver
function or
cholestasis, DubinJohnson or Rotor
syndromes,
hepatic adenoma,
estrogendependent
neoplasms eg
breast or
endometrial
cancer, CV
disease, disorders
of lipid
metabolism,
undiagnosed vag
bleeding,
pregnancy, history
of pruritus or
cholestatic
jaundice during
pregnancy,
chorea, herpes
gestationis,
pemphigoid
gestationis,
deteriorating
otosclerosis,
severe or focal
migraine, lactation.

1. Identify the client

correctly using the
appropriate means of
identification, such as
checking the identification
bracelet or asking the
clients name.
2. if the client is unfamiliar
with the medication, the
nurse should explain the
intended action as well as
any side effects or adverse
effects that may occur.
3. Administer drug in the
prescribed dosage by the
route intended and the
correct time.
4. Record the medication
given, dosage, time, any
complaints or assessments
and your signature.
5. Report any signs of
headache.

31

inhibits the influence of

the androgens produced
in women. Althea reduces
the development of acne
and seborrhea. It heals
existing acne
efflorescence after 3-4
months therapy. It also
reduces the greasiness of
the hair and skin.

32

Name

Dosage and
Indication

Mechanism of Action

Adverse
Effects

Contraindication

Nursing Responsibilities

Generic name: Short-term

Ketorolac
management
tromethamine of moderately
severe, acute
Brand name:
pain
Toradol
-30mg IV TT
Classification:
Central
nerovous
system
drugs;
Nonsteroidal
antiinflammatoy
drugs

Unknown. May inhibit

prostaglandin synthesis,
to produce antiinflammatory, analgesic,
and antipyretic effects.

GI: Nausea,
dyspepsia,
GI pain,
diarrhea,
peptic
ulceration,
vomiting,
constipation,
flatulence,
stomatitis.

Contraindicated in
patients
hypersensitivity to
drug and in those
with active peptic
ulcer disease,
recent GI bleeding
or perforation,
advanced renal
impairement,
cerebrovascular
bleeding,
hemorrhagic
diathesis, or
incomplete
hemostasis and
those at risk for
renal impairment
from volume
depletion or at risk
of bleeding.

1.identify the client

correctly using the
appropriate means of
identification, such as
checking the identification
bracelet or asking the
clients name
2.If the client is unfamiliar
with the medication, the
nurse should explain the
intended action as well as
any side effect or adverse
effects that may occur.
3.Check IV patency and
observe for complication of
Iv therapy such as
infiltration and
extravasation phlebitis,
thrombophlebitis,
hematoma, and clotting of
the needle.
4.Administer drug in the
prescribed dosage by the
route intended and the
correct time.

33

5.Administer the
medication slowly
6.Record the medication
given, dosage, time, any
complaints or assessment
and your signature.

34

COURSE IN THE WARD

Progress notes

Doctors order

July 25, 2010

- admit under the service of Dr. Ureta

- DAT
- V/S Q4 h
- Labs: CBC, PLT Count, HCT, Urinalysis, Pregnancy Test

Soaking 1 4 napkin/ day

for CT, BT
For pelvic ultrasound in AM
- IVF: PNSS at 100 cc/hr
- IVF TF: PNSS in at 80 cc/hr
- Meds: Tranexamic acid 500 mg IM now
Tranexamic acid 500 mg 1 cap, QID, to start in AM
FeSO4 1 cap BID
- AP aware
- Refer accordingly

July 25, 2010

8:30
Vaginal bleed
July 25, 2010
10:10PM
July 26, 2010
6:00AM
12:30PM
(+) for hypogastric pain
7:20PM
10:00PM

Continue Meds
Pelvic Ultrasound @ AM tomorrow (07/26/10)
IVF TF: PNSS 1L @ 80 cc/hr
IVF TF: PNSS 1L @ 80 cc/hr
May give Ketorolac 30mg IV TT now
Althea 1 tab once and P.O 8 AM
PNSS 1L @80 cc/hr
35

July 27, 2010

7:00 AM
12:00 PM
4:00 PM

IVF: PNSS 1L @ 80 cc/hr

IVF: PNSS 1L @ 80 cc/hr
MGH
Meds:
Tranexamic acid 50 g
3x a day (1 week) (8am 11am 7pm)
Althea 1 tab once a day at 8 AM
Follow up. Aug. 4, 2010 at 2 PM, clinic
Magniferron 1 cap, OD at 7 PM
Advised:
Bed Rest
No work load

PROGNOSIS
36

FACTORS

PROGNOSIS

JUSTIFICATION

Medication Regimen

Good

Activity

Good

The client is able to

follow the treatment
regimen that was given
by the attending
physician.
The client is able to
comply with the advise
of bed rest & no work
load.

GENERAL PROGNOSIS:
Patient general prognosis is good since the disease of the patient could be managed through different varied
treatments with the help of her family. She has knowledge of what is medication is she taking & what it is for. She follows
religiously the attending physicians prescribed treatments and takes willingly the doctors prescription medication. The
case of her abnormal uterine bleeding is easier to treat than any other cases of abnormal uterine bleeding.

37

HEALTH TEACHINGS
1) Advised to take medicines religiously as prescribed by the doctor
2) Instructed to avoid strenuous activities such as heavy lifting for it may aggravate
vaginal bleeding
3) Advised to increase foods rich in iron
4) Instruct client to comply with the physicians advice for follow-up check-up

NURSING IMPLICATIONS
A.

NURSING EDUCATION
It helps the nursing profession gain more information regarding different

symptoms, different causes, different etiologies and different treatments and nursing
actions related to this case and to impart this information to the younger batches of
nursing students of Notre Dame of Kidapawan College.
It also helps the nursing profession to be aware of the different terminologies
used so that it would be imparted to the future incoming nursing students. It also helps
the nursing students of Notre Dame of Kidapawan College to be more knowledgeable in
dealing with patients who have abnormal uterine bleeding.
B.

NURSING PRACTICE
It helps the nursing profession to be more aware in dealing with this kind of cases

in different fields and hospitals.

It also helps the nursing students of Notre Dame of Kidapawan College to be
more skillful in doing the different nursing actions to the patients in different hospitals, to
have safe and quality nursing care that the patient needs.
It also helps the nursing profession to prevent any clinical errors that can harm
the patient and may result to mal-practice or globally known as negligence.

38

C.

NURSING RESEARCH
It helps the nursing profession to gain more knowledge regarding this case and

to impart this data to the incoming researchers who may need the said information.
It also helps the researchers to gather more reference to strengthen the validity
of the different information of the said case. It also helps to make the gathered
information to be more truthful in terms and learning that may found in the papers.

39

BIBLIOGRAPHY
A. Books
Andreasen, Charlotte and Aris Jr. Andrews. Et al. 2006. Mosbyss Pocket dictionary
of Medicine, Nursing and Health Professions 5 th Edition. Elsevier Pte. Ltd.
Singapore.
Berman, Audrey and Shirlee Synder. 2008. Kozier and Erbs Fundamentals of
Nursing 8th Edition. Pearson Education Inc. Jurong, Singapore.
Bullock, Barbara and Henze, Reet. 2000. Focus on Pathophysiology. Lippincot
Williams and Wilkins. Philadelphia.
Doenges, Marilyn E. and Mary Frances Moorhouse, et al. 2008. Nurses Pocket
Guide Diagnosis, Prioritized interventions and Rationales. L.A. Davis Company,
Philadelphia. Thomson Learning Asia. Singapore.
Fischbach, Frances. 1988. A manual of Laboratory diagnostic Tests 3 rd Edition. J. B.
Lippincot Company. Philadelphia.
McCann, Judith A. and H. Nancy Holmes. et al. 2008. The Nursing 2008 Drug
Handbook. Lippincot Williams and Wilkins. Philadelphia.
McCann, Judith Schilling. 2007. Assessment. Lippincot Williams and Wilkins.
Philadelphia.
Pilliteri, Adele. 2003. Maternal and Child Health Nursing. 4 th Edition. Lippincot
Williams and Wilkins. Philadelphia.

B. Internet
http://findarticles.com/p/articles/mi_m0689/is_3_58/ai_n31438489/
http://emedicine.medscape.com/article/795587-overview
http://www.acog.org/publications/patient_education/bp095.cfm
http://www.uptodate.com/patients/content/topic.do?topicKey=~.p55Sh88wWX6eG
http://familydoctor.org/online/famdocen/home/women/reproductive/menstrual/470.html
http://www.gynalternatives.com/abnormal_uterine_bleeding.htm

40

http://www.medicines.org.uk/emc/medicine/21712/SPC/tranexamic%20acid%20500mg
%20tablets%20(sandoz%20limited)/
http://www.nativeremedies.com/ailment/symptoms-of-hormone-imbalance.html
http://www.medicine.uic.edu/UserFiles/Servers/Server_442934/File/OBGYN%20Med
%20Ed/STUDENTS/Lectures/ELAM%20-%20AUB%20talk.pdf
http://www.medicine.uic.edu/UserFiles/Servers/Server_442934/File/OBGYN%20Med
%20Ed/STUDENTS/Lectures/ELAM%20-%20AUB%20talk.pdf
http://members.aapa.org/aapaconf2006/syllabus/6253TaylorDUB.pdfc

41