L.F.GONZALES COLLEGE OF SCIENCE AND TECHNOLOGY INC.

, SAN LEONARDO NUEVA ECIJA

SEPTIC ABORTION

PRESENTOR BSN-IV (NEW CURRICULUM): Carl Aluning Dona Cantara Melanie Fernando Robert Ordonez Mary ann Ramos Michelle Suba Romarie Bulawit Rosenina Del Rosario

INTRODUCTION: Abortion-the spontaneous or induced termination of pregnancy before the fetus has developed to the stage of viability, that is before 20 weeks gestation from LMP or before the fetus weigh 500 grams. Occur in 15-20% of recognized pregnancy. TYPES: a. Threatened abortion-possible loss of product of conception. b. Inevitable abortion- the loss of the product of conception cannot be prevented. c. Complete abortion- spontaneous expulsion of the products of conception after the fetus has died in utero. d. Incomplete abortion- expulsion of some parts and retention of other parts of conceptus in utero. e. Missed abortion- retention of all products of conception after the death of fetus in the uterus. f. Habitual abortion- abortion occurring in 3 or more successive pregnancies. g. Septic abortion- abortion complicated by infection. DEFINITION: SEPTIC ABORTION-spontaneous or induced termination of a pregnancy in w/c the mother s life may be threatened because the invasion of germs into the endometrium, myometrium and beyond. OBJECTIVES: PATIENT PROFILE: Name: Mrs., ABC Age: 19 y/o Gender: Female Address: Brgy., Rizal San Leonardo N.E Civil status: Married Religion: Roman Catholic Chief complain: Fever Date of admission: July 12, 2011 Tentative diagnosis: Abortion Final diagnosis: Incomplete septic abortion Date of discharge: July 14, 2011

History of past illness: History of present illness: Fever and chill with foul smelling vaginal discharge Gynecological data: G-0 T-0 P-0 A-1 L-0 DEVELOPMENTAL TASK: ACTIVITY OF DAILY LIVING: PHYSICAL ASSESSMENT: COURSE IN THE WARD: Physician order: July 12, 2011 3:15pm y y y y y y y y y y y Please notify me once admitted DAT D5LRS iL with 10 u oxytocin and regulated at 20gtts/min Misoprostol itab Cefuroxime 750 mg IV every 8 hours ANST For D and C Referred 5:20 pm Give buscopan iamp + IV push now For D and C Please inform Dra. Jimenez now Please give paracetamol iamp TIV push now

Nurses remarks: July 12, 2011 3:15pm Admitted a 19y/o female client with chief complain of vaginal bleeding Occumpanied by relative  Conscious and coherent  v/s taken and recored BP-100/66 T-36.7c RR- 19 PR-75  with written order from dra. Marciano transcribed and carried out  consent for admission and operation signed  with IVF D5LRS 1L inserted aseptically +10 units of oxytocin result given  misoprostol inserted per deep vagina  Dra. Mariano notify with positive respond  To ward per wheel chair

 Needs attended  Endorsed WARD >in from er per stretcher >with an IVF D5LRS 1L +10 unit oxytocin and regulated at 20drops per minute >on dat >for DnC >Vital sign taken and recorded >febrile: 37.8 >TSB done >temp check 38.7 and referred to Dra. Mariona with orders made and carried out >buscopan 1 amp given >npo instructed >paracetamol 1 amp given >Dra, Himenez informed with positvew respond >gown on >to or per stretcher OR >in from ward per stretcher >with an IVF D5LRS 1L +10 unit oxytocin and regulated at 20drops per minute >place to dr table >BP-80/60 >IV sedation by Dr. Himenez >Perineal prep done >DnC done by dra mariano >Metronidazol 500mg IV given as first dose >procedure end >post of care rendered >latest bp 80/60 >legs elevated >for strict I and o and vital sign monitoring >to ward per stretcher with ivf of d5lrs 1L +10units oxytocin at 300cc and reg at 30 drops per min >endorsed

Physician order:

y y y y y y

y y

To ward Monitor v/s DAT Level on bed TF IVF D5LRS iL x 8hours Meds: cefuroxime 750mg IV q8 x 2doses Metronidazole 500mg IV q8 x 2doses Paracetamol 300g IV q4 PRN for fever I and O q4 Watch out for profuse vaginal bleeding

WARD