CHAPTER 1 INTRODUCTION

As a girl reaches her adolescence stage, she would be encountering many changes inside her body. One of these changes includes menstruation. Menstruation is the shedding of the lining of the uterus which is accompanied by blood loss. This event identifies the reproductive years of a womans life. It is a normal part of a cycle wherein there is a production of some hormones needed for the culmination of the release of a mature egg. This cycle is called menstrual cycle. Menstrual cycle starts with the one that controls it, the hypothalamus. The function of hypothalamus is to communicate with the pituitary gland for the release of hormones needed for the cycle. The anterior pituitary gland secretes follicle-stimulating hormone for the follicles to begin to mature. The maturing follicles then secrete another hormone which is the estrogen. The thickening of the lining of the uterus is caused by estrogen. When the estrogen reaches its highest level, another hormone will be released, the luteinizing hormone. The function of this hormone is to trigger the mature follicle to release an egg. Once the egg has been fertilized, the estrogen and its precursor progesterone prepare the uterus to receive the fertilized egg. If there is no fertilized egg, then the levels of these hormones will drop and the uterus lining will become thin. It will then generate bleeding which is what we know as menstruation. There are several menstrual disorders that cause discomfort among women. The most common menstrual disorder experienced by women is Dysmenorrhea. Dysmenorrhea is defined as painful menstruation and has two types primary and secondary. Primary or

normal cramps, is often caused by the secretion of prostaglandin F in the uterus, causing uterus contraction. It is usually felt in the back and may radiate on the tops of the legs. Symptoms usually begin with menstruation, although some women have discomfort several hours before onset flow. The range and severity of symptoms are different from woman to woman and from cycle to cycle in the same woman. (Lowdermilk, D. and Shannon, P., 2006) About 10 % of women who have this type of dysmenorrhea can't work, attend school, or participate in their normal activities

(http://www.lifesteps.com/gm/Atoz/ency/menstrual_disorders.jsp, Gordon and Frey, 2004). Many times menstrual cramps are described as a dull ache or a feeling of pressure in the lower abdomen. While the pain and intensity varies from woman to woman, dysmenorrhea is sometimes severe enough to cause nausea, vomiting, diarrhea, and or a general aches and pains

(http://womenshealth.about.com/cs/crampsmenstrual/a/dysmenorrhea.htm, Cornforth, T., 2003). Young adult women ages 17 to 24 years are most likely to report painful menses. Between 30% and 40% of women report some level of discomfort associated with menses, and 7% to 15% report severe dysmenorrhea (Parent-Stevens and Burns, 2000); however the amount of disruption in womens lives is difficult to determine. It has been estimated that up to 10% of women with dysmenorrhea have severe enough pain to interfere with their functioning for one to three days a month. (Lowdermilk, D. and Shannon, P., 2006)

On the other hand, secondary dysmenorrhea is less common than primary dysmenorrhea. Secondary dysmenorrhea is due to some physical cause or by another

medical condition present in the body that makes menstrual periods painful like the presence of pelvic inflammatory disease. Dysmenorrhea is one of the most common gynecologic complaints in young women who present to clinicians. The optimal management of this symptom depends on an understanding of the underlying cause (http://emedicine.medscape.com/article/253812overview, Calisa, K., PharmD, MPH, FASHP, FCCP, 2009) Treatment for dysmenorrhea differs from the type of dysmenorrhea that is being experienced. The usual treatment would be pain relievers or prescribed drugs for both types though secondary dysmenorrhea depends mostly on treating the pathologic condition. There are other options in preventing dysmenorrhea like maintaining a good nutrition or daily exercise. The best way of handling dysmenorrhea is providing health education and support to elicit positive attitude. In doing so, the client will be less dependent on drugs and will be able to maintain a healthy lifestyle.

PURPOSE AND OBJECTIVES This case study aims to analyze the factors contributing to the development of problems through the utilization of the nursing process on the care of a client experiencing hypogastric pain. Specifically, this study seeks to achieve the following objectives: 1. Identify factors that led to the development of the problem 2. Analyze the relationship of the factors leading to the development of the problem 3. Discuss the relevant interventions that were utilized to resolve problems 4. Explain the patients response toward the intervention

SIGNIFICANCE AND JUSTIFICATION

The study was conducted for the benefits of the following: To the client, this study will sustain information, and details regarding her illness. She'll be able to know the management of her condition. To the family and significant others, this study will let them know about the present status of the client. Thus, helping them cope with the situation, as well as encouraging them to cooperate towards the intervention provided. To the nursing students, this study will help them formulate the needed nursing diagnosis, and interventions applicable for their individual patients. To the clinical instructors, this will give additional knowledge and background on the diagnosis, thus updating and giving them new information regarding the diagnosis. To the future researchers, this study will serve as an allusion or an update for their future work.

SCOPE AND LIMITATION This is the study on the care of an adolescent female client who suffers hypogastric pain during menstrual days. The purpose of this study is to identify and analyze the variable that contributed to the development of the problem. The study was conducted at the Nursing Arts room or Skills lab at the Remedios Trinidad Romualdez Memorial School College of Nursing. The institution has two buildings, one next to a tertiary hospital and another one nearby to it. The main building of the school is located besides the hospital, where the study was conducted. The Nursing Arts classroom functions as and is intended for teaching learning experiences for nursing lectures, discussions and return demonstrations. The interview was conducted from 1300H to 1600H. This is the case of Ms. A.V., an 18 year-old female. She was interviewed last November 21, 2008 with a chief complaint of hypogastric pain. Data was gathered through history-taking, physical examination, and observation of the researchers. The patient was not given any medication and no medical consultation was done. Data was gathered through history taking. The primary source of the information is the client herself.

BACKGROUND OF THE STUDY This study was conducted in the Nursing Arts Room of the second floor of Remedios Trinidad Romualdez Memorial School - College of Nursing. RTRMS-MMC aims to be a center of excellence and a global trendsetter in nursing education. And to be as such, the school aims to reach it, through innovative teaching - learning experience, to have highly qualified faculty and staff, integrated information system, resources and new infrastructure with up to date technology, well develop research program, continuous improvement of administrative capabilities, dynamic student services, active linkages locally and internationally and to have an active alumni and parents involvement. The Nursing Arts Room is designed for teaching learning experiences for nursing; lectures and discussions are also conducted here. It is the foundation for the knowledge on nursing activities and for molding the skills needed for the hospital duties of the students. The room is used as a function room for the hands-on practice for the hospital setting, it has two rooms, one is used as a lecture room and the room beside it is used as a Nursing Arts Laboratory, it is being separated by a divider. The Nursing Arts Room, is a well lighted and air conditioned room, it has visual and audio-visual equipment appropriate for teaching. The room can be occupied approximately by 50 people. The study was conducted last February 28, 2009 (Saturday), from 1400 H - 1600 H. The researchers have chosen this case because dysmenorrhea is common to women. Whenever experiencing severe pain in the lower abdomen, it limits the capabilities of women to certain activities. And since the researchers are under the adolescent group, the researchers found this study useful because outcomes of the study help give them knowledge and to see the variables affecting it.

CHAPTER II PRESENTATION OF THE CLIENT

This is the case of Ms. A.V., an 18-year old female, a client at Nursing Arts room and Skills lab last February 28, 2009 at 1420 hours. The client arrived with a chief complaint of severe, cramp pain in the lower abdomen. History of present illness revealed that the client experiences hypogastric pain every time she will have her menstruation. She would put hot compress on the affected region of her abdomen to temporarily lessen the pain. One day prior, she also experienced nausea. The onset of her menstruation was when she was 12 years of age. Her menstrual cycle is regular with up to five days in duration, with a moderate amount of blood and always accompanied by dysmenorrhea. Based on history, the client had been hospitalized thrice for the treatment of extreme cough, dengue and asthma in which the year for hospitalization is unrecalled. She had chicken pox and urinary problem in the past, in which the treatment for those was unrecalled by the client. She does not smoke and only consumes alcoholic beverages occasionally. She is allergic to animal fur and dust. Her preferred foods are red meat and pork; she doesnt eat much of leafy vegetables. The most exercise she gets everyday is through walking. The clients family history shows that her grandmother, aunt and uncle, which are most from her fathers side, had Diabetes Mellitus, asthma, cancer, hypertension and anemia to which they have deceased.

Whenever having dysmenorrhea, the client is experiencing a localized, squeezing pain in her abdomen. The severity of pain can be scaled from 6-7. It is considered severe, thus the problem Acute Pain Related to uterine contraction as Evidenced by verbalization of the patient was identified. Other symptoms which are experienced like nausea, diarrhea and fatigue are sudden in character. The symptoms started when she was resting. When the client was exposed to strenuous activities, the pain was aggravated and it had also become worse. Aside from hypogastric pain, the client also experiences nausea and vomiting while having dysmenorrhea. She puts on hot compress and takes up Midol, or mefenamic acid to relieve the pain. Oral intake of Vitamin E also relieves hypogastric pain and reduces blood loss. Although the client is a regular coffee drinker, she avoids taking coffee when having dysmenorrhea as to not worsen the pain. She also takes up vitamin C and E daily to prevent her from having illness and from being susceptible to communicable diseases. Aside from what is stated, there are no other problems noted by the client. During the interaction with the patient, she was advised to continue present management and have an adequate rest.

APPENDICES

Clustering List A.V. patient 1. Age = 18, female, single 2. masakit ang puson ko as verbalized by the patient. 3. Pain in the hypogastric region. 4. Pain is localized and squeezing in nature. 5. Pain scale rates to 8/10 = severe 6. Onset is sudden which last up to 2 days 7. Pain is felt every menstrual period 8. Pain is felt every menstrual period 9. The patient was just resting when the symptom occurred. 10. Pain is relieved by hot compress. 11. Associated symptoms are nausea and vomiting. 12. Medication: Midol (mefenamic acid) 13. Menarche: Age 12 14. Premenstrual cycle lasts up to 5 days. 15. Moderate flow of menstruation 16. Irregular meal pattern 17. General perception of health masakitin at mahina

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Table 1. List of Diagnostic Labels of Ms. A.V. LIST OF DIAGNOSTIC LABELS OF MS. A.V. Health Perception and Health Management Disturbed energy force

Nutritional and Metabolic Nausea Risk for deficient fluid volume Imbalalced nutrition: less than body requirement

Activity and Exercise Activity Intolerance Deficient Diversional Activity

Cognitive-Perceptual Acute Pain

Role Relationship Ineffective Role Performance

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1. Acute pain related to uterine contraction as evidenced by verbalization of the patient.

2.

Risk for activity intolerance related to severe pain as evidenced by inability to perform strenuous activity.

3. Deficient Diversional activity related to physical limitations as evidenced by hypogastric pain.

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NURSING CARE PLAN

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Nursing Diagnosis #1

: ACUTE PAIN R/T UTERINE CONTRACTION AEB

VERBALIZATION OF THE PATIENT Goal: To reduce pain Expected Outcome: At the end of 3 hours nursing intervention, the client will be able to: Report pain is relieved or controlled Verbalize non-pharmacologic methods the provides relief

Demonstrate use of relaxation skills and diversional activities Interventions Evaluation 1. Note clients attitude toward pain and use of pain any 1. Client was relieved of pain by having hot compress and taking up Midol, 200mg if in case the pain starts to be intolerable.

medications

including

history of substance abuse.

2. Use

pain

rating for age

scale or

2. Client was able to assess as to how far the

appropriate cognition.

pain can go and was able to know when to take medications.

3. Observe non-verbal cue or pain 3. Client behaviors, walks, holds body, management of pain. and sits. was able to identify her

4. Provide

the client comfort 4. Clients pain was alleviated without medications yet.

measures.

5. Instruct in or encourage use of relaxation techniques.

5. The client was able to find a healthy way 14

of managing pain without being dependent

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NURSING CARE PLAN

Nursing Diagnosis # 2

: RISK FOR ACTIVITY INTOLERANCE R/T SEVERE

PAIN AEB BY INABILITY TO PERFORM STRENUOUS ACTIVITY Goal: To improve activity intolerance Expected Outcome: At the end of 3 hours nursing intervention, the client will be able to:

Identify techniques to enhance activity tolerance, participate willingly in

the necessary or desired activities Interventions Evaluation 1. Assess factors affecting

1. The client was able to identify the factors

current situation.

that may cause added fatigue.

2. To develop alternative ways to remain active such as promoting conditioning program.

2. Besides walking, client was able to develop ways to remain active.

3. Assist client to increase activity levels gradually.

3. The client was able to increase her exercise

routine, thus making her feel better and during menstrual period, it lessens the pain.

4. The client was able to conserve energy and 4. Instruct client in unfamiliar activities and alternately, promote safety.

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doing familiar activities.

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NURSING CARE PLAN

Nursing Diagnosis # 3: DEFICIENT DIVERSIONAL ACTIVITY R/T PHYSICAL LIMITATIONS AEB HYPOGASTRIC PAIN. Goal: To engage in diversional activities Expected Outcome: At the end of 3 hours nursing intervention, the client will be able to: Identify what diversional activities that she finds interesting Express her feelings in regards to doing diversional activities.

Perform activities within personal limitations Interventions Evaluation 1. Note factors that affect the clients participation from 1. Client identified reasons for passiveness.

diversional activities.

2. Stimulate the client to accept reality of situation and feelings of ones self.

2. Client was able to establish therapeutic relationship and support hopeful emotions.

3. Discuss

with

the

client

3. Client was able to establish trust between the nurse and the patient.

regarding activities that she enjoyed doing before but find it difficult to accomplish now.

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4. Encourage mix of desired activities or stimuli.

4. Client was able to demonstrate interest in engaging in the desired activities.

5. Institute/continue appropriate actions to deal with

5. Client was able to resolve and dissolve the negative effects of illness by letting her continue her daily actions.

concomitant conditions

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