STUDY LOG 4: OBJECTIVE CHECK

1. The patient is a 26-year-old G3P1A1 who has arrived at the emergency department
complaining of sharp abdominal cramping and vaginal bleeding. She is 10 weeks
pregnant. She is visibly upset, crying, and making statements such as, “Not again,” “I did
everything I was told to,” and “Why is this happening again?”

A. What should the nurse do?

 The nurse should listen empathetically and provide a caring atmosphere to
the patient to help her cope with the fear of possibly losing her unborn
child.
 The nurse has to help the patient calm down. Then, assess her for feelings
of helplessness, powerlessness, and guilt feelings.
 Explain the need for examinations/tests to rule out her condition.
 The nurse needs to assess the patient’s vital signs and do further
assessments.
 Check for the amount of the vaginal bleeding. Inquire of the number of
pads used since this may be helpful to determine the amount of blood loss.
 She should assess the patient for tenderness in the abdomen to rule out any
associated intra-abdominal bleed or complication.
 She should assess if there is any precipitating or aggravating factor for the
abdominal cramping and vaginal bleeding.
 The nurse should immediately notify the physician, send the laboratory
investigations of the patient [identify for Rh incompatibility], arrange for
an ultrasound, and inform the patient’s family.

B. What is possibly happening and why?

The patient is possibly experiencing a spontaneous abortion and is
exhibiting signs of severe emotional distress related to the current episode of the
suspected miscarriage and previous episode of abortion.
The occurrence of an abdominal pain and vaginal bleeding implies that the
gestational sac is separating from the uterine wall. The vaginal bleeding indicates
that the cervix is opened and the products of conception may be expelled.
The onset of abdominal cramping and vaginal bleeding at 10 weeks of
pregnancy with the patient's verbalization that it was happening to her again and
previous history of abortion as evident in the patient’s G3P1A1 status indicates
that this is a spontaneous miscarriage or spontaneous abortion occurring in the
first trimester of pregnancy for the second time.

C. What is the expected outcomes?

Expected Outcomes:
 The patient’s blood volume will be restored and the source of bleeding
will be stopped.
 The patient will exhibit a blood pressure level of above 100/60 mmHg.
 The patient will maintain a pulse rate of less than 100 beats per minute and
the fetal heart rate of between 120-160 beats per minute.
  The patient’s urine output should be more than 30 mL/hr, and only
minimal bleeding should be apparent for not more than 24 hours.

2. The patient is an 18-year-old G1P0 female with a past medical history of pelvic
inflammatory disease. She is brought to the emergency department by a friend because of
severe low abdominal pain and vaginal spotting. The nurse recognizes this could
potentially be an ectopic pregnancy.

A. What care should the nurse provide this patient?

 Care should be focused on providing the patient with adequate bed rest,
oxygen support, IV fluids, and the assessment of the patient’s vital signs.
 The nurse should assess for signs of pallor, tachycardia, hypotension and
other symptoms of shock like diminished peripheral pulses, cold clammy
extremities, guarding, and rigidity.
 The nurse must start the patient on intravenous fluids as required and
monitor for hemodynamic stability.
 The nurse should also administer supportive therapy intravenous fluids as
per the patient's blood pressure and the administration of medication like
antimetabolite methotrexate as prescribed by the physician.
 Inform the physician for the definitive treatment if ultrasound
confirmative of ectopic pregnancy.
 Provide patient teaching regarding ectopic pregnancy, its treatment
procedures, and the associated complications of this condition.

B. What teaching should the nurse provide this patient?

The nurse should:
 Explain the possible diagnosis of ectopic pregnancy and the need for an
urgent blood test and ultrasound in order to rule ectopic pregnancy.
 Explain that ectopic pregnancy implies implantation of the pregnancy
outside the uterus on the ovarian surface or in cervix, peritoneal surface or
in the abdomen or most commonly in the ovarian fallopian tube.
 Educate and explain the relationship of the ectopic pregnancy to pelvic
inflammatory disease.
 Educate patient about the need for medical or surgical interventions in
order to treat the patient.
 Inform about the complications associated with her condition at present
and teach about future possible health complications.

C. What nursing diagnoses would be appropriate for this situation?

 Acute pain related to ectopic pregnancy as evidenced by the patient's
complaints of lower abdominal pain and vaginal spotting.
 Deficient fluid volume related to blood loss.
 Risk for maternal injury related to ectopic pregnancy and bleeding.
 Powerlessness related to early loss of pregnancy secondary to ectopic
pregnancy.
  Risk for Deficient Fluid Volume related to bleeding from a ruptured
ectopic pregnancy.

3. The patient is a 17-year-old female who arrives to the emergency department in active
labor with a questionable past obstetrical history. She indicates that she has had no
prenatal care, does not remember her last menstruation period, and is evasive if this is her
first pregnancy. Blood work indicates she is Rh negative.

A. What are some concerns the nurse should be prepared for?

 In relation to the baby’s health and wellbeing, it is the nurse’s concern that
the baby is at risk of conditions such as:
 Intra uterine growth restriction
 Haemolytic disease of newborn(due to Rh incompatibility)
 Infant mortality
 Low birth weight
 Prematurity
 While, the mother is at risk of:
 Combination during child birth due to cephalo pelvic
disproportion.
 Isolation and depression
 Chance for cesarean section.
 Mental and financial difficulty.
 Preeclampsia and it's complication
 Anemia

B. What teaching does this patient need?

The patient needs to be educated on:
 The implications of an RH negative blood result and its effects on the
baby.
 The changes that may occur in her body related to pregnancy.
 Chronic conditions that she may develop like hypertension.
 The significance of a healthy diet and nutrient-filled meals.
 The importance of eating and sleeping adequately.
 The importance of breastfeeding and the positions related to this.

C. What are the expected outcomes for this patient?

 The patient will be administered an Anti rh antibody before giving birth to
avoid the development of hemolytic disease.
 The patient will take adequate amounts of nutrients for the well-being of
the baby and herself.
 The newborn will not show any complications.
 The newborn will begin an exclusive breastfeeding within 3 days.