LYCEUM NORTHWESTERN UNIVERSITY

COLLEGE OF NURSING

A CASE STUDY
On
INDUCED ABORTION

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS IN NCM 102

SUBMITTED BY:
MINA, RYAZAN GRAVIN SHIHAN E.
PIMENTEL, ABEGAIL S.
ROLLODA, EUNICE A.
TADINA, CAMILLE V.
VELASQUEZ, TRISHA LOUISE L.

DELIVERY ROOM (REGION 1 MEDICAL CENTER)

CLINICAL INSTRUCTOR: Ms. Sharon C. Orcajo, RN, MAN

I.

INTRODUCTION

A self-induced abortion (or self-induced miscarriage) is

an abortion performed by the pregnant woman herself outside of the
recognized medical system. Although the term includes abortions induced
with legal over-the-counter medication, it also refers to efforts to terminate a
pregnancy through alternative, sometimes more dangerous means. Such
practices may present a threat to the health of the woman, and an
unsuccessful attempt to induce such an abortion may cause lasting damage
to the fetus.
Self-induced abortion is easier to accomplish in the earliest stages of
pregnancy (the first eight weeks from the last menstrual period). In recent
years, significant reductions in maternal death and injury resulting from selfinduced abortions have been attributed to the growing use
of misoprostol (known commercially at "Cytotec"), an inexpensive, widely
available drug with multiple uses, including the treatment of post-partum
hemorrhage, stomach ulcers, and induction of labor. The World Health
Organization has endorsed a standardized regimen of misoprostol to induce
abortion up to 9 weeks of pregnancy. This regimen has been shown to be up
to 83% effective in terminating a pregnancy.
There are a number of anecdotally recorded and disseminated methods of
performing a self-induced abortion. Many of the following methods present
significant danger to the life or health of the woman:

physical exertion designed to bring about a miscarriage

abdominal massage

receiving punches, kicks, or other blows to the abdominal area

belly flopping onto a hard surface, or throwing herself down a flight of

stairs

attempted removal of the fetus with a steel wire coat-hanger or similar

device inserted into the uterus through the cervix[6] (the historical use of
this method has led to instances of its use as a symbol against the pro-life
movement, illustrating dangers of barring state-condoned abortion)[7]

attempted piercing of the fetus with a knitting needle, crochet hook,

hat pin, bobby pin or similar device inserted into the uterus through the
cervix[6]

insertion of a rubber tube or catheter into the uterus and attempting to

suck the fetus out, or, alternatively, blowing air into the uterus to cause a
miscarriage (if the tube or catheter pierced a blood vessel, this would
sometimes lead to air embolism, which could be fatal)

ingesting abortifacients, Vitamin C mega dosage, Pennyroyal or other

substances believed to induce miscarriage[8]

douching with substances believed to induce miscarriage, such as

turpentine, clorox bleach, or lye, all of which could cause intense chemical
burns (beginning in the 1960s, many women used Coca Cola for this
purpose, although its utility is at best dubious)

vaginal pessaries

yoga

acupuncture at points linked to miscarriage

hypothermia (many women would lie for periods of time in snowbanks,

which could be fatal to them) or hyperthermia (women would lie in tubs
filled with hot or even scalding water for periods of time, often while
simultaneously drinking gin)

II.

OBJECTIVES

GENERAL OBJECTIVE:
The main goal is to be able to present the case study of our chosen
client that would provide a comprehensive discussion of the pathological
mechanism of the disease to yield significant information for the case study.

SPECIFIC OBJECTIVES:
In order to meet the general objective, our aims are to:

To trace the family genogram

State the past and present health history of the client
Establish rapport to the patient and the patients significant others
Interpret the pertinent data gathered from the patient and her

significant others
Define the complete diagnosis of the patient
Present the cephalocaudal assessment obtained from the patient
Discuss the anatomy and physiology of the organ involved in the

patients disease
Trace the pathophysiology of the patients disease
Obtain and rationalize the doctors order
Present the etiology and symptomatology of the patients disease

Interpret the laboratory results of the patient

Discuss the nature of the drugs given to the patient
Present a SMART nursing care plans for the client
Justify the clients prognosis according to the different criteria
Provide the patient and family with proper planning (M.E.T.H.O.D.)
Outline recommendations based on the case studys findings

IIIa. PATIENTS PROFILE

Name: P.B
Address: 7, Cabatuan, Umingan, Pangasinan
Age: 17
Birthdate: September 28, 1998
Birthplace: Nueva Ecija
Sex: Female
Civil Status: Single
Nationality: Filipino
Religion: Roman Catholic
Admission Date: January 27, 2016
Admission Time: 10:00 AM
Room/Ward: OB-DR
Admitting Diagnosis: G1P0 Incomplete Abortion 12 4/7 weeks AOG, Septic,
Induced
Admitting Physician: Dr. Aprilyn Cordero Cortez, M.D, OB-GYN
Chief Complaint: Vaginal bleeding

IIIb. PATIENTS HISTORY

Present Illness
Patient P.B is a 17 years old, single, Roman Catholic, 2nd year student from
Urdaneta, Pangasinan. She was admitted for the 1st time in Region 1 Medical
Center on January 27, 2016 around 10:00 am with chief complaint of vaginal
bleeding.
January 05, patient had abuses abortion (catheter), (+) passage of meaty
tissue 2nd week, (+) vaginal bleeding (3 pads/day), (+) fever.
Past Medical History
M- 14 years old
R- regular
D- 5-7 days
A- 4 pads/days
S- (+) Dysmenorrhea
Family History
There are non-hereditary diseases but Hypertension.

IV.

Laboratory Results

IMMUNO-SEROLOGIC TESTS RESULT

Test/ Determination
ANTISTREPTOLYSIN O
TITLER
CRP
DETERMINATION
DENGUE FEVER
TEST

Name of Kit
RHELAX-ASO

Method
AGGLUTINATION REACTION

RHELAX-CRP

AGGLUTINATION REACTION

SD DENGUE
DUO

IMMUNOCHROMATOGRAPHY

H. PYLORI
DETERMINATION
LEPTOSPIRA
DETERMINATION
TROPONIN I
DETERMINATION
TYPHOID FEVER
TEST

SD BIO LINE

IMMUNOCHROMATOGRAPHY

ANTI-HEPATITIS
C VIRUS
HEPTITIS A
VIRUS
HEPATITIS B
SURFACE
ANTIGEN
SYPHILIS

Result
normal value
NS1IgMIgG-

SD BIO LINE

IMMUNOCHROMATOGRAPHY

SD ONE STEP

IMMUNOCHROMATOGRAPHY

IgMIgG-

SD
IMMUNOCHROMATOGRAPHY
SALMONELLA
TYPHI IgG/IgM
SD BIO LINE
IMMUNOCHROMATOGRAPHY
SD BIO LINE

IMMUNOCHROMATOGRAPHY

SD BIO LINE

IMMUNOCHROMATOGRAPHY

SD BIO LINE

IMMUNOCHROMATOGRAPHY

IgM-

IgG-

IgM- IgG- NONREACTIV

E
NONREACTIV
E

HEMATOLOGY RESULT
Hemoglobin
Hematocrit
Total WBC
Segmenters
Lymphocytes
Eosinophiles
Monocytes
STAB
Basophile

76 g/L
0.23/L
13.1/L
0.78/L
0.16/L
0.06/L
12

Juvenile

V.

PHYSICAL ASSESSMENT

SKIN:
(-) Jaundice, (-) Osum, Good skin turgor
HEAD EENT:
Pale Palpebral Conjunctivae
LYMPH NODES:
(-) enlargement
CHEST:
(-) deformines
LUNGS:
Symmetric chest expansion, clean breath
CARDIOVASCULAR:
Adynamic preconnium, normal rate, regular rhythm (+) tachycardia
of 136bpm
BREAST:
(-) discharges
ABDOMEN:
Flabby Abdomen, Bowel sounds, Tenderness or Hypogastric area

RECTUM:
(-) external hemorrhoids
GENITALIA:
IE: cervix 3cm dilated, uterus 1-3 size, CH profused vaginal bleeding
R1MC-MED-HIM-FRM-046
GENERAL:
(+) body weakness, (-) anorexia
SKIN:
(-) Prurity
EENT:
(-) Blurring of vision

MUSCULOSKELETAL:
(+) Limitation of movement
RESPIRATORY:
(-) Difficulty of breathing
CARDIOVASCULAR:
(-) Palpitation, (-) Chest Pain (+) pale nail beds (+) delayed capillary
refill of 3-4 seconds (+) low Hgb count of 76 g/L
GASTROINTESTINAL:
(-) Nausea and Vomiting
GENITOURINARY:
(-) Dysuria
FEMALE-REPRODUCTIVE:
(+) Bleeding
NERVOUS:
(+) Dizziness, (-) Headache
PAST DISEASES; (Including treatment and its duration, hospitalizations):
(-)

HISTORY OF CANCER; (Type, Site and Treatment):

(-)
PTB: (-)
ASTHMA: (-)
CANCER: (-)
Others: (-)

Vital Signs:
Temperature: 36.5C
Blood Pressure: 110/70mmHg
R.R: 20cpm
P.R: 120bpm
VI.

ANATOMY AND PHYSIOLOGY

FEMALE REPRODUCTIVE SYSTEM

The main internal female genital organs and their functions are
explained briefly below:

The vagina is the passageway through which fluid passes out of the
body during menstrual periods . It is also called the birth canal .
The vagina connects the cervix (the opening of the womb, or uterus )
and the vulva (the external genitalia).

The uterus , also called the womb , is a hollow, pear-shaped organ

located in a woman's lower abdomen, between the bladder and the
rectum. The main parts of the uterus are:
o Cervix . The narrow, lower portion of the uterus.

o Corpus . The broader, upper part of the uterus.

o Myometrium . The outer layer of the corpus; the muscle that
expands during pregnancy to hold the growing fetus.
o Endometrium . The inner lining of the uterus.

The ovaries are female reproductive organs located in the pelvis.

There are two of them, one on each side of the uterus. The ovaries
produce eggs and the female hormones estrogen and progesterone.
Estrogen and progesterone control the development of female body
characteristics in puberty (i.e., breasts, body shape and body hair),
and regulate the menstrual cycle until menopause as well
as pregnancy .

The fallopian tubes are 2 extensions from the upper left and right

hand sides of the uterus to each of the 2 ovaries. Each ovum released
by the ovaries in its 28 day cycle drops into the enlarged end of the
fallopian tube nearest it, and is propelled along by cilia on the fallopian
tube wall in the hope of meeting sperm and thus become fertilized .

VII. PATHOPHYSIOLOGY

Unwanted
Pregnancy
Patient decided
to go to
Abortionist
Abortifacient
drug

Cortal

Hypogastric

Induce

pain

Abortion

Opening of
cervix

the

Expelling of some
product of
conception
Retained product
causes heavy
bleeding

VIII. MEDICAL MANAGEMENT

Medical Management:
This is a case of a 17 years old patient who had demonstrated blood loss due to vaginal
bleeding secondary to Induced Abortion on the 27th week of January. The patient was admitted to
have a D&C to remove the retained debris or body parts of the fetus. The patient was noted with
bleeding process so the physician ordered her to have a blood transfusion immediately and given
O2 via nasal cannula.
Blood Typing is usually one of the most important laboratory test for effective blood transfusion
and prevent uncertainty to the patient.
Cross-Matching is typically used to monitor blood compatibility by the donor.
The medication treatment for bleeding and drugs used to prevent entry of bacteria; infection that
was administered to patient:

Ampicillin
Gentamicin
Tranexamic Acid
Metronidazole

Also administration of IVF like: PNSS iL, DSLR

XI. DISCHARGE PLANNING

Medication

Instruct the client to continue take her prescribed medications.

Orient the client about the name of drugs, their actions, the exact dosage, the frequency
and the route of administration.
Instruct the client to follow the instruction when administering medication.
Advice the significant others not to leave the client during medication.
Explain to the client the side effects and adverse effects of the drugs she takes by
prescribing its manifestations.
Advise client not to stop intake of prescribed medications, unless approved by the
physician.

Exercise
Instruct client to balance activities with adequate rest periods.
Educate client on proper body mechanics to prevent muscle strain and enable client to
relax.
Encourage client to ambulate and assume normal.
Encourage deep breathing exercise.

Treatment
Educate client the importance of drug compliance.
Discuss to the client the complication of the condition because knowledge about the
condition supports learning that will decrease deficit and anxiety.
To promote healing, eat a balanced diet rich in fresh fruits and vegetables.

Hygiene
Do not douche or put anything on your vagina, such as a tampon, until your doctor tells
you otherwise.
Encourage client to do daily hygiene.
Encourage client to ask assistance if needed.

Outpatient Orders
Call the doctor if any of the following occurs:
Develop a fever
Become dizzy and faint
Experienced nausea and vomiting
Become short of breath
Have heavy bleeding
Have pain when you urinate
Have swelling, redness, or pain in your leg
Have questions about the procedure or its result

Diet
To promote healing, eat a balanced diet rich in fresh fruits and vegetables.
Depending on how much blood loss occurred during surgery, you may require a daily
iron supplement.
Eat high-fiber food, drink plenty of water, and necessary, use stool softeners.
Instruct client to eat foods that are high in protein and vitamins and minerals.