Introduction

Vaginal bleeding is any blood coming from your vagina (the canal leading from the uterus to the external genitals). This usually refers to abnormal bleeding not associated with a regular menstrual period. > First trimester bleeding is any vaginal bleeding during the first 3 months of pregnancy. Vaginal bleeding problem in early pregnancy, complicating 20-30% of all pregnancies. > Any vaginal bleeding during the second and third trimesters of pregnancy (the last 6 months of a 9-month pregnancy) involves concerns different from bleeding in the first 3 months of your pregnancy. Any bleeding during the second and third trimesters is abnormal. > Bleeding from the vagina after the 28th week of pregnancy is a true emergency. The bleeding can range from very mild to extremely brisk and may or may not be accompanied by abdominal pain. Hemorrhage (another word for bleeding) is the most common cause of death of the mother in the United States. It complicates about 4% of all pregnancies.

GENERAL OBJECTIVE: This case study will serve as a guide on Nursing students to provide information about patient having Bleeding on their pregnancy stage.

SPECIFIC OBJECTIVE:    Plan.  Identify the risk factor contributing to the occurrence of disease. Explain the ANATOMY AND PHYSIOLOGY of Pregnancy bleeding. Formulate significant Nursing Diagnosis, with the significantly related Nursing Care Provide appropriate health teaching for the patient.

Theoretical Framework
Lydia Halls Model History Lydia Hall completed her basic nursing education in 1927 and her baccalaureate degree in public health nursing in 1937. She later achieved a masters degree in natural science and went on to become the first director of the Loeb Center for Nursing, a rehabilitation hospital in Bronx, New York, that is still in operation today. She had been a practicing nurse for more than 30 years when she developed the theory of Care, Core, Cure in the late 1960s. CARE Focuses on hands-on bodily care and the belief that a caring touch and thorough assessment in therapeutic.This nurturing component, also referred to as mothering the patient, was done with the goal comforting the patient and helping them meet their needs. Hall believed this was an aspect of care that was exclusive to nurse.

CORE In Halls theory, core refers to using therapeutic communication to help the patient understand not only his condition, but also his life. In this aspect, patient care was based on social sciences and shared with other parts of the community, such as psychologists and clergy. The goal is to help patients learn their roles in the healing process, maintain who they are, and learn to use the nurse as a sounding board.

CURE Refers to nurses applying their medical knowledge of the disease to assist with a plan of care . Patient care in this section is based on pathological science. In this aspect, the function of the nurse is to assist the patient and her family in coping with treatment ordered by a physician. It is also that s nurses role as a patient advocate comes into play; she must advocate her plan of care for the best interest of the patient.

Nursing History

Biographical Data Patient Name: A.A. Address: San Buena Compound, Gruar Cainta, Rizal Date of Birth: May 13, 1975 Age: 36 yrs. Old Occupation: None Civil Status: Married Religion: Catholic Educational Attainment: Under graduate

Chief Complaint: Sumasakit ang puson ko at bigla akong dinudugo as verbalized.

History of Present Illness: The client is having abdominal pain and sudden bleeding. No other symptoms noted and no medications were taken. Past Medical History According to client she has no any illnesses that shes been experienced aside from simple cough and colds.

Social History: According to patient she loves to spend her time reading news papers. She is not engaged in smoking and never try to drink alcohol during her pregnancy.

Family History DISEASE HPN Diabetes Mellitus Asthma Heart attack Athritis + + FATHER + + MOTHER

Anatomy and Physiology Oviduct: Passageway of the ovaries from the outside of the body. Ovary: Located in the pelvis, one on each side of the uterus; they produced eggs; connected to each other by the fallopian tube. Uterus: or womb is a major female hormone responsive productive sex organ. Cervix: the function of this is to allow flow of menstrual blood from the uterus into the vagina and direct the sperms into the uterus during intercourse. Clitoris: female sexual organ, providing its owner with sexual pleasure. Vaginal Opening: is a fibro-muscular tubular tract leading from the uterus to the exterior of body in female.

Gordons Functional Health Pattern.

Functional Health Pattern Previous Condition Present Condition Analysis

Health Perception- Patient A.A Health Described herself Management as a healthy Pattern person. he maintains a healthy body by eating nutritious food and doing household chores.

Patient A.A Considered himself unhealthy due to present condition. he is expecting to regain a better health from his present condition with the help of the health care provider.

Nutritional Metabolic Management

According to her she can eat whatever she wants during her past practice.

Attitude about health and personal vulnerability influences the development of beliefs about health care. An individual perform health maintenance activities and behaviour to maintain or improve a current health level. (Nursing Fundamentals by Rick Daniels, pp. 854,855) Patient A.A eats An individuals 3 times a day and health status her food and fluid greatly affects intake is adequate. eating habits and She likes to eat nutritional status. all kinds of food (Fundamental of she has no aller- Nursing by Kozier gies with regards pp. 1178) to food. Bowel: According to her, Elimination her stool usually Pattern vary in soft, minimal in at different amount and brown.stages of life. in color. Circumstances Bladder: Of diet , fluid The clients void Intake and output

Elimination Pattern

The client doesnt feel any pain and discomfort during voiding and defecation.

frequently 4-5 times a day. Her urine is often yellowish to whitish in color.

activity, psychologic factors, lifestyle, medication and medical procedures, and disease also affect elimination. (Fundamentals of Nursing, 8th edition, by Kozier p and Erbs p. 1326)

Activity, Leisure and Recreation Pattern

The client is able to do activities of sleeping, watching t.v. and doing household chores

Sleep and Rest Pattern

There is a growing evidence that exercise and activity are the most important behaviour in w/c we engage for developing and maintaining health. (Fundamentals of Nursing, 8th Edition, by Kozier And Erbs p.1105) The client is She complained Illness that satisfied with the difficulty in causes pain or amount of sleep sleeping and sleep physical distress because it lessen for short period of can result in the feeling of time (5-6 hours) problems. People stress and her who are ill require body is ready to more sleep do daily activities. problems. People who are ill require more sleep than normal and normal rhythm and wakefulness is often disturbed

According to her, because of her present condition, the client is doing limited household chores.

CognitivePerceptual Pattern

Self- Perception Self-Concept Pattern

RoleRelationship Pattern

(Fundamentals of Nursing 7th edition by Barbara Kozier p.1117) She can Her mind is An individual communicate focussed into pain usually well. Patient can rather than experiences speak and thinking. She saiddiscomfort and/or understand she is irritable anxiety when English and sometimes. She subjected to a Tagalog. She can always want a change in the clearly express happy life. type or in amount herself. of incoming stimuli. (Nursing Fundamentals by Rick Daniels p. 1329) According to her, She describe Self- concept is she wants to live herself as a happy the unique her life w/ the fu person and perspective of She is also a sometimes a personal loving wife to her moody one. The characteristics husband and has client is also and abilities, and genuine concern friendly and relationship w/ the for people who sometimes she supporting are close to her. sometimes world. ( Stuart socialized with her and Lauria 2001) friends and (Nursing neighbour. Fundamentals by Rick Daniels, p.1378) Her husband is The client has a According to the one who Good relationship Friedman (1938) supports her. with her husband. the family has In terms of She has no specific benefits decision making communication and function. both parties with her family, Specifically decide for the because they are families provide betterment of far from each for majority of their lifestyle. other. health promotion

Sexuality Reproductive Pattern

The client has experienced her first menstruation when she was 15 years old. She has a regular menstrual cycle and an interval of 28 days. Her menstruation usually last for 3-5 days. The client does not experiencing dysmenorrhea during menstruation. Client was able to cope up with stress that she faced and learned to manage it by resting and sleeping and sometimes to things to alleviate stress problems she feels.

The client is engaged w/ sexual activity. According to her, they had follow some natural planning method like calendar method and withdrawal for her husband.

activities and the management of minor health problems. (Spector 2001) ( Fundamentals By Rich Daniels p. 1397) WHO defined sexual health as a ability to form developmentally appropriate sexual relationships that are safe and respectful of ones self and to others. (Nursing Fundamentals By Rick Daniels p. 1444)

Coping and Stress Tolerance Pattern

The client stated that whenever there is a problem you should immediately think of a solution to that.

According to Folkman and Lazarus, Coping is the cognitive and behavioural effort to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person.

Values- Belief Pattern

She belongs to a Roman Catholic she does not attend mass every Sunday. The clients believes religion is important to ones life, because she believes, it can help individual in certain aspect of life.

According to the client even though she doesnt attend mass every Sunday, she said that she still have strong faith in God.

(Fundamentals Of Nursing by Kozier p. 1020) After what happened the client is now seeking for medical assistance. Religious effort is still part of clients life.

Physical Assessment

Vital Signs: Temperature: 36.7o C Pulse Rate: 81bpm Respiratory Rate: 18cpm Blood Pressure: 120/70 mmHg

Body Parts Skin (Inspection)

Normal Findings Light to deep brown; no edema when pinched, skin brings back previous stage. (Fundamentals of Nursing 8th edition; Unit 7, Chapter 30 p. 579-580)

Hair (Inspection and Palpation)

Head (Inspection and Palpation)

Actual Findings Has a brown skin color, w/c Is in normal racial tone. Her skin turgor is poor it takes 5 seconds to bring back after pinched. Temp. is warm and dry. There is a presence of some lesions, hair distribution is evenly distributed and thin. The skin is experiencing Edema. Hair must be evenly Her hair is evenly distributed. distributed, thick, silky, and It is thick, black and resilent. resilent. No infection or There is no infection or infestation variable body Infestations and her amount hair. ( Fundamentals of of hair is variable. th Nursing-Kozier 8 edition. Unit 7 chapter 30, p. 584) Round ( norm, cephalic and Upon assessment the symmetric w/ frontal, clients head is normoparietal and occipital cepahalic in shape, smooth prominence) Smoot skull contour and doesnt have contour, uniform consistency any lesions or masses. and absence of masses.

Face (Inspection and Palpation)

Ears (Inspection)

(Fundamentals of Nursing Kozier 8th Ed.; Chapter 30 p.584-585) Symmetric and slightly facial features, palpebral features, equal in size symmetric nasolabial folds, symmetric facial movement (Fundamentals oif Nursing By Kozier 8th edition; Unit 7 Chapter 30 p. 584) Normal ears should have the same colour as the facial skin. Auricle should be aligning with the outer cantus of the eye.

The clients facial features are symmetrical to each other and there are no palpable masses or lesion.

Nose ( Inspection)

Clients ear doesnt have any discharges. The color his ears is the same with his facial color. There is no hearing problem that client experienced. Normal nose should be The colour of the nose is symmetric and straight, no Similar to the colour of his discharge or flaring, no face. There is no swelling lesions, air moves freely as or deformities present. The the client breathes through client doesnt have any the nares. Mucosa should nasal stuffiness, nasal be pink and there should discharges and epistaxis. be no lesion uniform in colour.( Fundamentals of Nursing By Kozier 8th edition; Unit 7 Chapter 30 p. 599600) Normal mouth/lips should be The mouth of the patient uniform , pink in colour, soft Is pinkish in colour, moist and smooth in textures symmetrical w/o any symmetric of contour and presence of lesions. ability to purse lips. Tongue should be in central position pink in colour, moist move freely and no tenderness. Gums should

Mouth/Lips (Inspection)

Neck (Inspection)

Chest/ Thorax (Inspection/Palpation)

be pink in colour and moist. (Fundamentals of Nursing By Kozier 8th edition; Unit 7 Chapter 30 p. 601604) Normal neck should have muscles, equal in size, head is centered. Coordinated smooth movements w/o discomfort. (Fundamentals of Nursing By Kozier 8th edition; Unit 7 Chapter 30 p. 607609) Normal chest/thorax should have no discoloration, no sternum retraction, no chest exertion, no masses and normal muscles tone. No chest retraction. Chest symmetric and Spine vertically aligned. Skin is intact uniform in temperature, chest wall intact to tenderness. ((Fundamentals of Nursing By Kozier 8th edition; Unit 7 Chapter 30 p. 610618)

There is no distended neck Veins and palpable lymph nodes.

The chest of the patient is symmetrical. There is no sign of barrel chest or transverse diameter. There is no sign of lordosis or kyphosis. There is no auscaltated adventitious breath sounds.

Abdomen (IAPP)

Unblemished skin, uniform Her abdomen is in normal In colour, flat rounded. No racial tone and unblemished. evidenced of enlargement There is a presence of of liver or spleen. Audible stretch mark because of her bowel sound, absence of previous pregnancy. Bowel bruit sounds. No tenderness. sounds is normoactive. (Fundamentals of Nursing By Kozier 8th edition;

Upper Extremities and Lower Extremities (Inspection and Palpation)

Unit 7 Chapter 30 p. 631638.) Normal upper and lower extremities should have muscle not tender, firm and equal in size, bilaterally w/o fasciculation, equal in number and no abnormalities. (Fundamentals of Nursing By Kozier 8th edition; Unit 7 Chapter 30 ,p. 640641)

It has equal muscle strength There is a presence of some lesion. No deformities peripheral pulses are complete. Lymph nodes are not palpable.

Health Teachings  Teach the client to eat nutritious food.  Teach to eat green leafy vegetables.