ASSESSMENT SUBJECTIVE: Chief complaint: Vaginal bleeding that varies from dark brown spotting for 1 day duration.

3 days PTA, Mrs. Smith experienced excessive vomiting that occurs in the morning. OBJECTIVE: >Urinalysis test for hCG revealed positive, >UTZ revealed multiple small cystic structures, negative for fetal parts and fetal heart beat.

DIAGNOSIS Fluid volume deficit r/t elevated levels of human Chorionic Gonadotropin (hCG) from the proliferating trophoblasts

PLANNING Client will display adequate fluid balance as evidenced by stable vital signs, moist mucous membranes, skin turgor less than 1 sec, and capillary refill of less than 2 secs. and adequate urine output

INTERVENTION Independent: -Monitor Vital signs. Evaluate peripheral pulses, capillary refill

RATIONALE -to have a baseline data, reflects adequacy of circulating volume -Decreasing renal output and concentration of urine suggest developing dehydration and need for fluid replacement. -Sensitive measurement of fluctuations in fluid balance -Early identification of problems (which may occur as a result of cancer), allows for prompt intervention.

EVALUATION Goal partially met.

-Monitor I&O; include all output sources (e.g., emesis, diarrhea

- Weigh daily

-Observe for bleeding tendencies; Note the amount, lochia/color of the vaginal discharge

-Encourage increase fluid intake as tolerated -Encourage ice chips on mouth

-To compensate with the fluid volume deficit problem -For the vomiting episodes

- Assess skin turgor and moisture of mucous membranes

-Prevent unnecessary energy expenditure related to vomiting (as may trigger) and bleeding (loss of blood/RBC) -Indicators of hydration status/ degree of deficit -Monitor VS -Monitor signs of allergy -Check blood package -Monitor IV line and regulate drops -For the vomiting episodes -Monitor VS -Give meds as ordered -Health teaching: diet and exercise -Promote exercise -Assist

-Encourage rest

Dependent: -Blood Transfusion for Anemia

-Antiemetic

-Hypertension Treatment

-Dilation and Curettage for Evacuation of the Uterus -Intravenous

-To be started with

Oxytocin

the dilation of the cervix and continued postoperatively to reduce likelihood of hemorrhage. Consideration of using other uterotonic formulations such as Methergine or Hemabate is also accepted. -Monitor IV line and regulate drops -During surgery, this can happen due to trophoblastic embolization, highoutput congestive heart failure caused by anemia, or iatrogenic fluid overload. Ventilation and monitoring should be done during such situation. -Increased HCG results to Choriocarcinoma (malignant)

-Assisted Ventilation and Monitoring for Respiratory Distress

-Monitor HCG for 1year

Drug of Choice: Methotrexate