A Journal on Dysfunctional Uterine Bleeding

A Journal on Dysfunctional Uterine Bleeding

Abnormal uterine bleeding is a common presenting symptom in the family practice setting affecting the women of child-bearing age. This journal reviews the clinical procedure done to a patient admitted in CUMC due to 2 weeks of heavy and persistent menstruation. Patient X is a 39 year old female and a mother of three. She has no known familial history of hypertension, diabetes, or cancer. It is important that in women of child-bearing age, a methodical history, physical examination, and laboratory evaluation may enable the physician to rule out causes such as pregnancy and pregnancy-related disorders, medications, iatrogenic causes, systemic conditions, and obvious genital tract pathology. The impression made by the physician for the case of the client was then labeled; Dysfunctional uterine bleeding. According to one national study that menstrual disorders were the reason for 19.1 percent of 20.1 million visits to physician offices for gynecologic conditions over a twoyear period. Furthermore, a reported 25 percent of gynecologic surgeries involve abnormal uterine bleeding. Moreover, it was not mentioned in the impression whether what kind of dysfunctional bleeding the patient was experiencing. Now we have to know that dysfunctional bleeding has comes in two classifications; the anovulatory and ovulatory. Dysfunctional bleeding can be anovulatory, which is characterized by

irregular unpredictable bleeding, or ovulatory, which is characterized by heavy but regular periods (ie, menorrhagia). If we look upon the pathophysioogy, patients with dysfunctional uterine bleeding (DUB) have lost cyclic endometrial stimulation that arises from the ovulatory cycle. As a result, these patients have constant, noncycling estrogen levels that stimulate endometrial growth. Proliferation without periodic shedding causes

A Journal on Dysfunctional Uterine Bleeding

the endometrium to outgrow its blood supply. The tissue breaks down and sloughs from the uterus. Subsequent healing of the endometrium is irregular and dyssynchronous.In connection to this; abnormal bleeding can have many causes. In some women, too much or not enough of a certain hormone can cause abnormal or heavy bleeding. This imbalance can be caused by many things, such as thyroid problems or some medications. With regards to the condition of Patient X, she said during her interview with the physician that she used pills for birth control. Now, we could clearly see the link or the relationship of the patients condition and the clinical impression considering we have identified one important factor. Clinical manifestations include bleeding lasts for more days than normal or for more than 7 days, heavier accompanied by passing of large clots, needing to change protection during the night. All of these were manifested by the Patient X. She also appeared very pale and her capillary refill was 4 seconds and she also complained of shortness of breathing. Her vital signs were as follows; temp: 37.5 degrees Celcius; pulse: 148 bpm; RR: 27cpm; and blood pressure of 100/60 mmHg. We could really anticipate with these values that the patient was compensating due to blood loss. The patient was then hooked to 0.9% NSS intravenous fluid as ordered by the physician. She was also supplemented with oxygen at 2 liters per minute. Patient X was extracted with blood for CBC and it was found out that she had a very low RBC count with only 9.8 2.3x106L (normal value: gm/dL). 3.8The

5.5x106/L) and hemoglobin count of

gm/dL

(normal:12.0-15.2

physician then ordered two units of packed RBC to be infused to the patient. A diagnostic procedure called transvaginal ultrasonography was requested to look for abnormalities in the uterus or pelvis. As presented above, we could now formulate an appropriate nursing diagnosis which is ineffective tissue perfusion related to low hemoglobin count. Nursing interventions are as follows: monitoring the blood pressure every 30 minutes, instructing the patient to move or get up slowly so as to prevent orthostatic hypotension. A health teaching can also be given such as increasing food intake of foods high in Iron.

A Journal on Dysfunctional Uterine Bleeding

Hence, it is a very good experience to be able to know about this condition through actual experience and further research. This journal would be useful especially concerning the patients health. This would likely to supplement knowledge and awareness to readers especially nursing students who also have experienced or will in the future handle patients with similar condition.

Reference: o http://emedicine.medscape.com/article/257007-overview#a0104 o http://www.medicardphils.com/index.php?option=com_content&view=article&id=1 14:aub o http://www.aafp.org/afp/2004/0415/p1915.html

o Nurses Pocket Guide by Marilynn Doenges, Moorhouse and Murr Edition number I, published by F.A. Davis Company, Philadelphia Pages 705-714 o Medical Surgical Nursing by Brunner 10th Edition, volume II, published by J.B. Lippincott Company Page 1392