CAPTER IV CASE SUMMARY, EVALUATION, AND RECOMMENDATION

CONCEPT MAP
Female,19 years old,G1PAO, 7 weeks of pregnancy, with threatened
abortion

Categories
of
threatened
abortion

Sign and symptoms of 7

weeks pregnancy:

Differential diagnosis
of bleeding in
pregnancy

Morning
sickness
A heightened
sense of smel
Food cravings
and aversions
Eat mini-meals
throughout the
day

Definition: is a
termination of
pregnancy before 20
weeks ,with a sign of
vaginal bleeding.

Etiology
Sign and
symptoms
Pathophysiology

Laboratories:

Urinalysis
Hematology

Principles of
management

Case prognosis

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CASE PROGNOSIS
With the treatment in the hospital. Some patients will improve within in a few
days. A patient who fail to respond to treatment may die from excessive bleeding.
In the case of Mrs. XYZ , her prognosis was good since there was no recurrence
of vaginal bleeding.
After her admission in the hospital, she was able to respond on the medication
prescribed to her, she is on strict diet, and she have avoided extreme works.

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CASE STUDY EVALUATION

At the end of the two days admission in the hospital that was on March 13-15,
2013, the group had successfully gathered personal data of the patient. And we
gathered other data after the patient discharge in the hospital such as family history,
past history with socio-economic status of the patient. We have also observed and
noted the condition of the patient during and after the course of problem encountered.
During her stay at the USM Hospital, the health care professional gave her
proper and therapeutic management with the guidance for an early recovery. Different
nursing interventions were given to her, and she was discharge after 2 days and was
given medication for the continuity of care. We have also studied and analyze the
pathophysiology of threatened abortion with each symptomalogy and etiology. We have
also formulated our nursing care plan regarding the condition of the patient
After she hospitalized, we have monitored our patient by a follow up visit upon
seeing her; she demonstrated improvement to her condition
prescribed medications.

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and maintained her

RECOMMENDATIONS
After the treatment in the hospital. The doctor recommend a follow up check up that is
necessarily needed for wound evaluation and to assess the progression of wound
healing. And start for prenatal visitation for the monitoring of the health of Patient Z and
the developing fetus inside her womb. Bed rest is very helpful for threatened abortion.
Patients can do whatever they feel more comfortable with, whether it be rest or
continuing their usual activities.

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BIBLIOGRAPHY
Books

Gaufberg, Slava M. "Threatened Abortion." eMedicine. Eds. Roy Alson, et al. 17

Dec. 2008. Medscape. 31 Aug. 2009

http://emedicine.medscape.com/article/795439-overview
[1] Confucius, quoted in Henry Fairlie. "The Language of Politics." The Atlantic,

January 1975, pages 25 and 28.

Thompson JD, Rock JA. Leiomyomata Uteri and Myomectomy. Telindes
Operative Gynecology. 8th ed Lippincott-Raven. 1997. pp554-564.ment; Clinical
Management for Positive Outcomes,SixthEdition;WB Saunders

Company;Philadelphia,2007.
Doenges,JM.,Hawks, JH., Keene, AM.; Medical Surgical Manage
Timby,B.K., Smith, NE., Introductory Medical-Surgical Nursing, Ninth edition,

Lippincott, Williams and Wilkins,Philadelphia, 2007

Garcia,KJ,,Gonzaga,K,,Ulangkaya,M.,GeneralPsychology.Chart of
Psychosexual Stages,PsychosialDevelopment,Piagets Stages of Cognitive
Development,pages 56 to 66.

Internet

http://www.emedicinehealth.com/threatened miscarriage/article

em.htmwww.mdguidelines.com/threatened-abortion
http://miscarriage.about.com/od/diagnosingpregnancyloss/a/threatenedmisc.htm
http://babyandbump.momtastic.com/pregnancy-first-trimester/873947-er-visit-

due-bleeding.html
http://www.rapidlearningcenter.com/biology/anatomy-physiology/23-The-

Reproductive-System.html
http://www.slideshare.net/Mikeypendon/anatomy-and-physiology-of-urinarysystem-7897017
DEFINITION OF TERMS
TERMS AND DEFINITIONS

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ABORTION is defined by Williams Obstetrics as "The interruption of pregnancy before

viability at the request of the woman, but not for reasons of impaired maternal health or
fetal disease. The great majority of abortions now being done belong in this category."
This definition by an authoritative source confirms that most abortions are performed for
reasons that are considerably less than compelling;i.e.,basically convenience.
AMNIOTIC FLUID - the fluid surrounding a fetus within the amnion
AMENORRHEA - is an absence or extreme modification of the usual menstrual cycle.
Amenorrhea is a generally temporary condition that may be caused by disease,
excessive exercise, or breastfeeding. Not related to menopause.
AMNIOTIC FLUID is the serous (thin and watery) fluid in which the preborn baby
swims and rests.
AMNIOTOMY is the rupture of the bag of waters by a physician for the purpose of
facilitating childbirth or late abortion.
ANTEPARTUM is a term used to describe any event that occurs approximately at the
time of birth. It is often used to describe the labor and delivery strategy used by doctors,
nurses, or midwives.

BAG OF WATERS - is the double-walled fluid-filled sac that encloses and protects the
preborn baby in the uterus. The bag of waters is frequently mechanically ruptured at the
end of pregnancy to induce hard labor..
BLASTOCYST - a mammalian blastula in which some differentiation of cells has
occurred

CLITORIS is a small sensitive and erectile part of the female genitals at the anterior
end of the vulva.
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COMPLETE MISCARRIAGE - is an abortion in which all of the unborn child's parts

have been expelled or removed from the uterus and have been identified.
CONCEPTION is the creation of a new human life through the union of egg and
sperm. Sometimes referred to as fertilization. This is not to be confused with
implantation or nidation.

DILATION is sometimes called 'dilatation,' this is the process of opening the cervix by
use of laminaria or cannula of progressively larger diameter in order to facilitate
abortion.
DILATION AND CURETTAGE (D&C) it is most common abortion procedure. Also
used for completing or checking miscarriage, it consists of scraping the walls of the
uterus with a knife-edged, spoon-shaped instrument. For more information on this
procedure, see Chapter 61 of Volume II, "Methodology and Aspects of Abortion."
DNA( Deoxyribonucleic acid) a nucleic acids located in cell nuclei and are the basis
of heredity in most mammals. DNA is constructed of a double helix held together by
hydrogen bonds between purine and pyrimidine bases which project inward from two
chains containing alternate links of deoxyribose and phosphate.

EMBRYO - an unborn or unhatched offspring in the process of development

ENDOMETRIUM - the inner uterine lining that is built up during the menstrual cycle and
is subsequently discharged if implantation has not taken place..

FALLOPIAN TUBE: The small vessels that conduct the egg from the ovary to the
uterus. Blockages in these tubes account for most cases of female infertility. Surgical
sterilization is usually performed by cutting, burning, or tying off these tubes.
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FERTILIZATION- the penetration of an oocyte by a sperm cell and the subsequent

process of the combining of maternal and paternal DNA. The beginning of a new human
being.
FETUS - the term (literally meaning "little one" in Latin) referring to the preborn baby
after eight weeks's gestation.
FOLLICLE - a small baglike structure in the ovary which contains an immature ovum
(oocyte).

GAMETE - A mature germ cell possessing a haploid chromosome set, which is capable
of initiating the formation of a human being by combining with a gamete produced by a
person of the opposite sex.
GENE: The portion of a DNA molecule that consists of an ordered sequence of
nucleotide bases and constitutes the basic unit of heredity.
GENETICS: The science of examining the basis of heredity.
GESTATIONAL AGE - the age of an embryo counting from the time of fertilization.
GESTATION: The time period between conception and birth.
GLOMERULAR FILTRATION - the renal process whereby fluid in the blood is filtered
across the capillaries of the glomerulus and into the urinary space of Bowman's
capsule.
GONADS- sexual reproduction couldnt happen without the sexual organs

Hematology - is the branch of internal medicine, physiology, pathology, clinical

laboratory work, and paediatrics that is concerned with the study of blood, the bloodforming organs, and blood diseases.

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Hymen -a membrane that partially closes the opening of the vagina and whose
presence is traditionally taken to be a mark of virginity.
IMMINENT ABORTION: A threatened miscarriage, in which there may be profuse
vaginal bleeding, cramps, and a softened and dilated cervix.
IMPLANTATION - the exact point in time when the developing blastocyst anchors itself
in the uterine wall or, in the case of ectopic pregnancies, in the Fallopian tube or
somewhere else in the woman's abdomen.
INCOMPLETE ABORTION: An abortion in which portions of the unborn child or the
placenta, remain in the uterus for an appreciable period of time after miscarriage or
abortion.
INEVITABLE ABORTION: An unintentional abortion brought about by the rupturing of
membranes (breaking of the bag of waters), in the presence of cervical dilation.

LABOR - physical or mental exertion, especially when difficult or exhausting

MEIOSIS: Cell division occurring during the development of gametes, lessening the
number of chromosomes in each cell.
MENARCHE - first menstruation.
MENOPAUSE - the permanent cessation of the menstrual cycle.
MENSTRUATION the beginning of the menstrual cycle, where the oxygen-rich lining of
the uterus is sloughed off and discharged.
MENTRUAL CYCLE - the monthly cycle of changes in the ovaries and the lining of the
uterus (endometrium), starting with the preparation of an egg for fertilization. When the
follicle of the prepared egg in the ovary breaks, it is released for fertilization and
ovulation occurs. Unless pregnancy occurs, the cycle ends with the shedding of part of

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the endometrium, which is menstruation. Although it is actually the end of the physical
cycle, the first day of menstrual bleeding is designated as "day 1" of the menstrual cycle
in medical parlance.
MISCARRIAGE - the natural and unintentional loss of a preborn child. Miscarriage is
also referred to as "natural" or "spontaneous" abortion. If repeated three or more times
within an interval of five years, usually referred to as "habitual" abortion.
MISSED ABORTION - an abortion by which the fetus dies but is retained in the uterus
for a significant period of time (usually two or more weeks).
MOLAR PREGNANCY usually benign formations of placental cells( trophoblasts) in
the uterus that can spread to nearby tissues and become malignant.
Mons Pubis the fleshy area located just above the top of the vaginal opening
Myomectomy - a procedure to remove the fibroid tumors from a uterus. It is usually
done through an abdominal incision. May potentially be done through a laparoscope.

NEONATE - anewborn baby or a baby less than about a month old.

OXYTOCIN -a hypothalamic hormone stored in the posterior pituitary, which has

uterine-contracting and milk-releasing actions; it may also be prepared synthetically or
obtained from the posterior pituitary of domestic animals; used to induce active labor,
increase the force of contractions in labor, contract uterine muscle after delivery of the
placenta, control postpartum hemorrhage, and stimulate milk ejection.
OVA - the woman's egg or gamete. Plural: ovum.
OVARY - the female reproductive organs that store the ovum, or eggs..
OVULATION - the release of an egg from an ovary after the rupture of an ovarian
follicle.

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PELVIC INFLAMMATORY DISEASE (PID): The inflammation of the female

reproductive organs, often resulting in inhibited fertility or sterility through scarring of the
Fallopian tubes.
PERINATAL: The period from the 28th week of pregnancy to one week after birth.
PITUITARY GLAND - a gland located at the base of the brain that discharges hormones
that control various body functions.
PLACENTA: The temporary organ that acts as a metabolic exchanger between the
mother and her preborn baby. The placenta also produces hormones that protect and
maintain pregnancy.
PRE-EMBRYO: This is an entirely unscientific and misleading term created by proabortionists specifically for the purposes of dehumanizing the preborn and obscuring the
facts in the debate over abortifacients.
PREMENSTRUAL SYNDROME (PMS) - refers to symptoms that occur between
ovulation and the onset of menstruation
PROSTAGLANDIN: An artificial hormone injected into the uterine muscle to induce
premature labor in later abortions. Also emitted by some intra-uterine devices (IUDs) as
part of their mode of action.
PROSTATE GLAND: Male sexual organ that produces the fluid in which sperm are
suspended.

REABSORPTION is the definition, is the movement of substances out of the renal

tubules back into the blood capillaries located around the tubules.
REPRODUCTION the process by which organisms make more organisms like
themselves.

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RNA: Ribonucleic acid. Nucleic acids that contain ribose and uracil as structural
components and are associated with the control of cellular chemical reactions.

SECRETION is the process by which substances move into the distal and collecting
tubules from blood in the capillaries aroundthese tubules.
SEX-LINKED - any genetic characteristic or disease controlled by the genes in sex
chromosomes.
SEX CELLS - a spermatozoon or an ovum; a cell responsible for transmitting DNA to
the next generation.
SPERM - the male germ cell that combines with the ova to produce a new human
being.
SPERMATOGENESIS- the production of sperm.
SPONTANEOUS ABORTION - a natural abortion, or miscarriage.
SUBCHORIONIC HEMORRHAGE - bleeding between the amniotic sac (membranes)
and the pregnancy, usually found near the placenta. This is something that may or may
not be associated with an increased risk of miscarriage, depending on the size, location,
symptoms and when it is found in the pregnancy.

Threatened abortion- is a condition in pregnancy before the twentieth week of

gestation characterized by uterine bleeding and cramping while the opening of the
uterus (cervix) is closed. Threatened abortion may progress to spontaneous incomplete
or complete abortion. Spontaneous abortion, or miscarriage, is defined as the naturally
occurring delivery or loss of the products of conception before the twentieth week of
pregnancy without induction or instrumentation.
TRIMESTER - the division of pregnancy into three roughly equal time periods. The first
trimester usually means up to 12 weeks, the second trimester usually means from 13 to
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24 weeks, and the third trimester is usually from 25 weeks to the end of the pregnancy
at birth.

UMBILICAL CORD -a flexible cordlike structure containing blood vessels and attaching
a human or other mammalian fetus to the placenta during gestation .
ULTRASOUND ahigh-frequency sound waves. Ultra-sound waves can be bounced off
tissues by using special devices. The echoes are then converted into a picture called a
sonogram. Ultrasound imaging allows an inside view of soft tissues and body
cavities without the use of invasive techniques. Ultrasound is often used to examine a
fetus during pregnancy. There is no evidence that any danger occurs from ultrasound
during pregnancy.
UREA the glomerular filtrate consists primarily of water, excess salts(primarily Na and
K), glocuse, and a waste product of the body.
URETHRA is the duct by which urine is conveyed out of the body from the bladder,
and which in male vertebrates also conveys semen.
URINALYSIS - is a test that evaluates a sample of your urine. It is used to detect a wide
range of disorders including urinary tract infection, kidney disease and diabetes.
UTERUS: Muscular female organ within which the preborn child grows. Often referred
to as the womb.

VIABILITY - refers to the point in time when a fetus is capable of surviving outside the
womb with or without heroic measures. The definition of viability varies from place to
place and depends strongly on the mother's health, but is now 90 percent certain at 24
weeks in the United States. See Chapters 69 to 75 of Volume II for more information on
fetal development and the status of the unborn.
Vulva - is the external opening of the vagina or reproductive tract in a female mammal
or nematode
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WOMBa place of origination and development

ZYGOTE - the fertilized ovum, or individual, created by the fusion of the father's sperm
cell and the mother's egg cell. This is the earliest stage of human individual
development. The zygote is also defined as the diploid cell resulting from the fusion of a
sperm cell and an ovum.

APPENDICES
The House of Ms. Z

75

Inside the house of Ms. Z

76

KITCHEN

77

the father & mother of Ms. Z

Road and Transportation

78

During Interview

79

Sleeplessnight
80

81