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Wesleyan University- Philippines
Mabini Extension, Cabanatuan City
Case Study
In NCM 10! Care o" Clients #ith proble$s in
%xy&enation-Cardiovas'ular syste$ (isorder
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Sub$itted by!
)enilyn *aye M+ %rpilla
sn-./
Sub$itted o!
Pro"+ euben 2+ I&na'io, N M3N
Con'ept Instru'tor
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Abnormal Uterine Bleeding,
Iron deficiency Anemia Secondary Case Study
Table of Contents
I+ INTRODUCTIONError Boo!mar! not defined"
3+ rie" history o" the 'ase Error Boo!mar! not defined"
+ (e"inition o" related ter$s Error Boo!mar! not defined"
II" #ATIENT$S %ISTOR& 4
3+ io&raphi' data 4
+ Chie" 'o$plaints
C+ 5istory o" present illness
(+ Past $edi'al 6 health history
E+ *a$ily $edi'al 6 illness history
*+ evie# o" syste$
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7+ 8i"estyle and health pra'ti'es .
h+ (evelop$ental level 9
III" CO''ECTIN( OB)ECTI*E DATA 9
a+ Course o" 'on"ine$ent 9
i+ Medi'ation ad$inistered sin'e date o" ad$ission 9
ii+ I:* , and other parenteral $edi'ation in"used6 ad$inistered sin'e date o" ad$ission ;
iii+ 3ll dia&nosti' test $ade to pt sin'e date o" ad$ission ;
b+ Physi'al assess$ent ;
I*" 'IST O+ NANDA BASED OR (ORDON BASED NURSIN( D- 1<
*" #AT%O#%&SIO'O(& Error Boo!mar! not defined"=
*I" NURSIN( CARE #'AN Error Boo!mar! not defined";
e"eren'es 4=
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INTRODUCTION a" O.er.ie/
Patient 3 has been ad$itted in 3u&ust 44, 4014 9!0s pre&nant and
has been reported #ith a heavy va&inal bleedin&+ 5er "inal dia&nosis is 3bnor$al Uterine
leedin&, Iron (e"i'ien'y 3ne$ia Se'ondary+
Iron de"i'ien'y is the $ost 'o$$on de"i'ien'y disorder in the #orld, a""e'tin& $ore than t#o
billion people #orld#ide, #ith pre&nant #o$en at parti'ular ris>+ World 5ealth %r&ani?ation
W5%/ data sho# that iron de"i'ien'y anae$ia I(3/ in pre&nan'y is a si&ni"i'ant proble$
throu&hout the #orld #ith a prevalen'e ran&in& "ro$ an avera&e o" 1.@ o" pre&nant #o$en in
industriali?ed 'ountries to an avera&e o" 9no#n and 'onsiderable ris> "a'tor "or both $other and
"etus+ *etal 'onseuen'es are an in'reased ris> o" &ro#th retardation, pre$aturity, intrauterine
death, a$nion rupture and in"e'tion+ Pre$aturity is a 'onseuen'e o" early anae$ia durin&
Maternal 'onseuen'es o" anae$ia are also #ell >no#n and in'lude 'ardiovas'ular sy$pto$s,
redu'ed physi'al and $ental per"or$an'e, redu'ed i$$une "un'tion, tiredness, redu'ed
peripartal blood reserves and "inally in'reased ris> "or blood trans"usion in the postpartu$
period+
Definition of Related terms
Anemia/ Anaemia- is a de'rease in nu$ber o" red blood 'ells Cs/ or less than the nor$al uantity o" he$o&lobin
in the blood+
Iron deficiency anemia-(IDA) is an ail$ent #hen there is not enou&h he$o&lobin produ'ed by the body to $eet its
reuire$ent+
Iron- he total body iron in a B0->& $an is about .
Abnormal Uterine Bleeding (AUB) or Dysfunctional uterine bleeding (DUB) is abnor$al bleedin& "ro$ the va&ina
that is due to 'han&es in hor$one levels+
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Anemia - a de'rease in red blood 'ell C/ $ass+
Red blood cell (RBC)/ Erytrocyte- deliver oxy&en "ro$ the lun&s to the tissues and 'arbon dioxide "ro$ the tissues
to the lun&s
Cesarean !ection- is a sur&i'al pro'edure in #hi'h one or $ore in'isionsare $ade throu&h a
$otherDs abdo$en laparoto$y/ and uterus hysteroto$y/ to deliver one or $ore babies, or,
rarely, to re$ove a dead "etus+ 3 Caesarean se'tion is usually per"or$ed #hen a va&inal delivery
#ould put the babyDs or $otherDs li"e or health at ris>, althou&h in re'ent ti$es it has also been
per"or$ed upon
reuest "or 'hildbirths that 'ould other#ise have been natural+
"ocia rubra (or cruenta/ is the "irst dis'har&e, red in 'olor be'ause o" the lar&e a$ount o" blood it 'ontains+ It
typi'ally lasts no lon&er than to 9 days a"ter birth+
#ematocrit - 5t or 5C/ or pa'>ed 'ell volu$e PC:/ or erythro'yte volu$e
"ra'tion E:*/ is the volu$e per'enta&e @/ o" red blood 'ells inblood+ It is nor$ally about .9@"or $en and .0@ "or #o$en+
1F It is 'onsidered an inte&ral part o" a personDs 'o$plete blood
'ount results, alon& #ith
he$o&lobin 'on'entration, #hite blood 'ell 'ount, and platelet 'ount+
#emoglobin- tetra$er protein 'o$posed o" he$e and &lobin+ Is the iron-'ontainin& oxy&en-transport$etalloprotein
in the red blood 'ells
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$C#- %mean cell emoglobinG is the avera&e $ass o" he$o&lobin per red blood 'ell in a sa$ple o"
blood+ It is reported as part o" a standard 'o$plete blood 'ount+ MC5 value is di$inished in
hypo'hro$i' ane$ias+
$C#C- mean cor&uscular emoglobin concentration, a $easure o" the 'on'entration o"he$o&lobin in a &iven volu$e o" pa'>ed red blood 'ells+ It is reported as part o" a standard
'o$plete blood 'ount+ It is 'al'ulated by dividin& the he$o&lobin by the he$ato'rit+
$C'- mean cor&uscular olume, or G$ean 'ell volu$eG MC:/, is a $easure o" the avera&e red
blood 'ell si?e that is reported as part o" a standard 'o$plete blood 'ount+ he MC: is
'al'ulated by dividin& the total volu$e o" pa'>ed red blood 'ells also >no#n as he$ato'rit/ by
the total nu$ber o" red blood 'ells+
!erum ferritin- *erritin is a protein "ound inside 'ells that stores iron so your body 'an use it later+ 3
"erritin test indire'tly $easures the a$ount o" iron in your blood+
Total Iron Binding Ca&acity in te Blood (TIBC)-/ is a $edi'al laboratory test
that $easures the bloodDs 'apa'ity to bind iron #ith trans"errin+ It is per"or$ed by dra#in& blood
and $easurin& the $axi$u$ a$ount o" iron that it 'an 'arry, #hi'h indire'tly $easures
trans"errin sin'e trans"errin is the $ost dyna$i' 'arrier+
Transferrin- are iron-bindin& blood plas$a &ly'oproteins that 'ontrol the level o" "ree iron in
biolo&i'al "luids+ rans"errin saturation! 19 A90@ $ales/, 14A.9@ "e$ales/
Erytro&oiesis- is the pro'ess by #hi'h red blood 'ells erythro'ytes/ are produ'ed+ It is sti$ulated by
de'reased %4 in 'ir'ulation, #hi'h is dete'ted by the >idneys, #hi'h then se'rete the hor$one erythropoietin+
#ATIENT$S %ISTOR&
A" Biogra01ical Information
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Na$e! Patient 3
3&e! . years old
7ender! *e$ale
irthday! Mar'h 4, 1; 1, 8aur, Nueva E'iHa
Phone Nu$ber! 0;4B-.B44-99;
Edu'ational 8evel! 5i&h s'hool 7raduate
%''upation! None
a'e6 Ethni' 7roup! a&alo&
eli&ion! o$an Catholi'
Nationality! *ilipino
xiv+ Citi?enship! *ilipino 'iti?en
8an&ua&e spo>en! a&alo&
Sour'e o" in"or$ation! Patient 3
eliability! ;;@
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b" C1ief Com0laints2 :a&inal leedin&
i+ Initial dia&nosis! 3bnor$al Uterine leedin& /
*inal (ia&nosis! 3bnor$al Uterine leedin&, Iron (e"i'ien'y 3ne$ia Se'ondary c" %istory
of #resent Illness2
1 $onth prior to ad$ission- Junusual bleedin&K des'ribed as $essy lastin& only "or B days,
'onsu$in& 4 pads+
19 days prior to ad$ission- va&inal bleedin& noted to be pro"use, 'onsu$in& = pads "ully
soa>ed
days prior to ad$ission- va&inal bleedin& noted to be pro"use, 'onsu$in& ; pads "ully and
#ith pain in lu$bosa'ral re&ion
4 days prior to ad$ission- still #ith bleedin&, #ith lu$bosa'ral pain and heada'he
#ast 3edical4 %ealt1 %istory
Proble$s at birth- none
Childhood illnesses-
1;B=! Measles
1;=1! Mu$ps
I$$uni?ation to date A
Patient 3 'annot re$e$ber iv+ 3dult illnesses
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4000-4014! 5ypotension v+ 3''idents! None
vi+ 3ller&ies! None
vii+ Previous 5ospitali?ation, Medi'al and Sur&i'al
(ia&nosis
Lear
Cause
3bdo$inal
1;;=
Pre&nan'y o her *irst Child
Caesarean Se'tion
e" +amily 3edical4 Illness %istory i+ 5eredo"a$ilial
In her "ather side, her "ather is re'ently been dia&nosed #ith diabetes and an al'oholi' drin>er+
5er 7rand$other had uber'ulosis o" the bone and also asth$ati'+ In her $other side her
$other has a history o" hypotension, and ane$ia+ 5er &rand$other had a history o" hepatitis
and diabetes+
Re.ie/ of System
S>in, 5air Nails-
S>in A Pallor
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5air- la'>
Nails- Pin>ish
5ead and Ne'>
5ead- No heada'he reported
Ne'>- No sti""ness o" ne'> "elt, #ith $elas$a at ba'> o" ne'>
EEN Sinuses
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Ears- No draina&e or rin&in& ears reported
Eyes- lurred :ision #hen readin& *arsi&hted/
Nose- No dis'har&es
hroat- No pain or hoarseness o" voi'e "elt
Chest and 8un&s
Chest- No pain reported
8un&s- No shortness o" breath or pain reported
reast e&ional 8y$phati's
reast- #ith Mil> dis'har&es
*eelin& o" tenderness, and dar> areola
e&ional 8y$phati's- 8y$ph nodes are not enlar&ed nor tender
5eart, Ne'> :essels Central C:S
5eart- No pain, distress or palpitations "elt
Ne'> vessels- are not distended+
Cardiovas'ular Syste$- No ti&htness, ede$a, or orthopnea reported
P:S
With :ari'osities in i&ht 8e&
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3bdo$en
No abdo$inal pain, bo#el $ove$ents are &ood, #ith linea ni&ra
7enitalia and eprodu'tive Syste$
With :a&inal dis'har&e 8o'hia rubra/
No pain durin& sexual inter'ourse reported
3nus, e'tu$ Prostate
3nus- No it'hiness or lesion reported
e'tu$- No it'hiness or lesion reported
Mus'ulos>eletal Syste$ and Extre$ities
No $us'le pain, sti""ness or s#ellin& "elt
Neurolo&i'
With di??iness and #ea>ness as reported
'ifestyle and %ealt1 #ractices5 67% day Descri0tion
Nutrition, diet and Wei&ht $ana&e$ent
She pre"ers ve&etables, ri'e and a &lass o" #ater in her $eal+
3'tivity Exer'ise
She does household 'hores as her exer'ise+ She usually at ho$e #ith her dau&hter+
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est and Sleep
he 'lient ta>es a 9-
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Spiritual, Cultural, :alues and elie" Syste$
he patient 7oes to Chur'h every Sunday and prays at ni&ht and be"ore $eals+ She believes that everythin& happens"or a reason+
Edu'ation and #or>
3 hi&h s'hool &raduate and #ith no #or>+ Patients 3 stays at ho$e and do household 'hores+
Stress 8evel and Mana&e$ent6 Copin& Stress
Patient 3 is havin& a heada'he and "eels di??y #hen she is stress or an&ry at her 'hild+ SheOs #at'hin&
television at ni&ht be"ore sleep, and tal>in& #ith her peer &roup at $ornin& as a #ay o" relievin&
stress+
Environ$ent Nei&hborhood
Patient 3 lives in a rural area in a bedroo$-house, #ith a ba'>yard and a &arden+ he houses in their
to#n are 9 $eters apart+ With a uiet nei&hborhood and "ar "ro$ hi&h#ay+
De.elo0mental Stage
heory! Eri> Eri'>sonOs Psy'hoso'ial (evelop$ent
ii+ 7enerativity vs+ Sta&nation Middle adulthood .0-
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'on"ident o" raisin& her pre$ature 'hild and her "irst 'hild so that so$eday, her 'hildren #ill do
the sa$e to her+ She believes that all o" their sa'ri"i'es he 'lient and her husband/ are #orth it
"or their "a$ily+
iii" Co$parison o" Nor$al and 3bnor$al develop$ental para$eter!
People extend their 'on'ern "ro$ the$selves and their "a$ilies to the 'o$$unity and to the
#orld+ hey $ay be'o$e politi'ally a'tive, #or> to solve proble$s, or to parti'ipate in "ar-
rea'hin&-'o$$unity or #orld based de'isions+ People #ith sense o" &enerativity are sel"-
'on"ident and better able to Hu&&le their various lives as a $other and 'hur'h $e$ber+ People
#ithout this sense be'o$e sta&nated or sel"-absorbed+ hose #ho have devoted the$selves to only
one role are $ore li>ely to "ind the$selves at the end o" $iddle a&e #ith a narro# perspe'tive and
la'> o" ability to 'ope #ith 'han&e+ Wo$en #ithout a sense o" &enerativity $ay have $oredi""i'ulty than others a''eptin& a late-in-li"e pre&nan'y and a ne# role o" 'hildbearin&+
CO''ECTIN( OB)ECTI*E DATA a" Course of Confinement
3edications Administered since date of admission
ysician*s +rder
3s'orbi' a'id 1'ap I( P+%+
,eneric ame
3s'orbi' 3'id
Brand ame
3po-C, 3s'orbi'ap, Cebid, Ce'on,
Cenolate, Ce$ill, C-Span, Cetane,
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Cevalin, Cevi-id, Ce-:i-Sol, Cevita,
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*lavor'ee, edoxon, S'hi"" E""erves'ent
:ita$in C, :ita-C+
Classification
:ita$in
$ecanism of Action
:ita$in C or 8-as'orbi' a'id, or
si$ply as'orbate the anion o" as'orbi'
a'id/, is an essential
nutrient "or hu$ans and 'ertain other
ani$al spe'ies+ :ita$in C re"ers to a
nu$ber o" vita$ers that have vita$in C
a'tivity in ani$als, in'ludin& as'orbi'
a'id and its salts, and so$e oxidi?ed
"or$s o" the $ole'ule
li>e dehydroas'orbi' a'id+ 3s'orbate and
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as'orbi' a'id are both naturally present in
the body #hen either o" these is
introdu'ed into 'ells, sin'e the "or$s
inter'onvert a''ordin& to p5+
:ita$in C is a 'o"a'tor in at least
ei&ht en?y$ati' rea'tions in'ludin&
several 'olla&en synthesis rea'tions that,
#hen dys"un'tional, 'ause the $ost
severe sy$pto$s o" s'urvy+
!ide Effects
ursing $anagement
7I disturban'es in hi&h doses nausea,
Instru't Client to ta>e the $edi'ation
vo$itin&, and diarrhea/+
a"ter $eals to avoid 7I upset+
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Instru't 'lient to $easure and "ollo#
the pres'ribed dosa&e o" the
$edi'ation to avoid overdosin&+
ri&ht yello# dis'oloration o" urine
3dvise the 'lient that yello#
dis'oloration o" urine is nor$al
Aderse Effects
ursing $anagement
arely, hypersensitivity rea'tion
Instru't the 'lient to dis'ontinue the
$edi'ation, and re"er to the do'tor+
*latulen'e, 'onstipation
Instru't the 'lient to dis'ontinue the
$edi'ation, and re"er to the do'tor+
5eartburn,
Instru't the 'lient to ta>e the
$edi'ation a"ter $eals to avoid
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adverse rea'tions+
ysician*s +rder
ranexa$i' a'id 900$&, 1'ap I( P+%+
,eneric ame
ranexa$i' a'id
Brand ame
5e$ostan, *ibrinon, Cy>lo>apron,
8ysteda, ransa$in
Classification
3nti-"ibrinolyti', antihe$orrha&i'+
5ae$ostati's
$ecanism of Action
ranexa$i' a'id is a syntheti' derivative
o" the a$ino a'id lysine+ It exerts its
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anti"ibrinolyti' e""e't throu&h the
reversible blo'>ade o" lysine-bindin&
sites on plas$ino&en $ole'ules+ 3nti-
"ibrinolyti' dru& inhibits endo$etrial
plas$ino&en a'tivator and thus prevents
"ibrinolysis and the brea>do#n o" blood
'lots+ he plas$ino&en-plas$in en?y$e
syste$ is >no#n to 'ause 'oa&ulation
de"e'ts throu&h lyti' a'tivity on
"ibrino&en, "ibrin and other 'lottin&
"a'tors+ y inhibitin& the a'tion o"
plas$in "inronolysin/ the anti-
"ibrinolyti' a&ents redu'e ex'essive
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brea>do#n o" "ibrin and e""e't
physiolo&i'al he$ostasis+
!ide Effects
ursing $anagement
7I disturban'es Nausea, vo$itin&,
Instru't Client to ta>e the $edi'ation
diarrhea/
a"ter $eals to avoid 7I upset+
Aderse Effects
ursing $anagement
5ypotension
a>e the 'lient lood pressure
be"ore and a"ter ta>in& the
$edi'ation to identi"y i" hypotension
o''urs as adverse e""e'ts, i" so,
dis'ontinue the $edi'ation and re"er
to the do'tor+
5eada'he
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Monitor the 'lient a"ter ta>in& the
$edi'ation and Instru't to ta>e bed
rest to avoid inHury
5ypersensitivity s>in rea'tions6
Instru't the 'lient to dis'ontinue the
aller&i' rea'tions
$edi'ation, and re"er to the do'tor
(isturban'es in 'olor vision
Instru't the 'lient to dis'ontinue the
$edi'ation, and re"er to the do'tor
ysician*s +rder
*errous *u$erate 1'ap, I( P+%+
,eneric ame
*errous *u$erate
Brand ame
*e$iron, *erretts, *erro-Seuels,
*erro'ite, 5e$o'yte, Ir'on
Classification
3ntiane$i'6 Supple$ent
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$ecanism of Action
Iron is an essential 'o$ponent in the
physiolo&i'al "or$ation o" he$o&lobin,
adeuate a$ounts o" #hi'h are ne'essary
"or e""e'tive erythropoiesis and the
resultant oxy&en transport 'apa'ity o" the
blood+ 3 si$ilar "un'tion is provided by
iron in $yo&lobin produ'tion+ Iron also
serves as a 'o"a'tor o" several essential
en?y$es, in'ludin& 'yto'hro$es that are
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involved in ele'tron transport+ Iron is
ne'essary "or 'ate'hola$ine
$etabolis$ and the proper "un'tionin& o"
neutrophils+
!ide Effects
ursing $anagement
•
sto$a'h upset,
Instru't Client to ta>e the $edi'ation
a"ter $eals to avoid 7I upset+
•
diarrhea,
Instru't 'lient not to ta>e #ith $il>
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or anta'ids
• bla'> or dar>er than nor$al
In"or$ patient the 'olor stool bla'>
appearin& stools, or
$ay be bla'>
• te$porary stainin& o" the teeth+
In"or$ patient that te$porary
stainin& o" the teeth is nor$al
3dverse E""e'ts
Nursin& Mana&e$ent
nausea or vo$itin&,
Instru't 'lient to ta>e the $edi'ation
a"ter sna'> or $eal
epi-&astri' pain+
Instru't 'lient to ta>e the $edi'ation
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4 hours prior to or . hours a"ter
anta'ids
Physi'ianOs %rder
Me"ena$i' a'id 900$& 1'apsule, I(
P+%+
7eneri' Na$e
Me"ena$i' a'id
rand Na$e
Pharex, Me"ene$ax, *ena$ax, *e$a'id
Classi"i'ation
Nonsteroidal 3nti-In"la$$atory (ru&s
NS3I(s/
Me'hanis$ o" 3'tion
Me"ena$i' a'id binds the prosta&landin
synthetase re'eptors C%-1 and C%-4,
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inhibitin& the a'tion o" prosta&landin
synthetase+ 3s these re'eptors have a role
as a $aHor $ediator o" in"la$$ation
and6or a role "or prostanoid si&nalin& in
a'tivity-dependent plasti'ity, the
sy$pto$s o" pain are te$porarily
redu'ed+
Side e""e'ts!
sto$a'h pain or 'ra$ps
Instru't patient to avoid al'ohol inta>e
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vo$itin& or upset sto$a'h
#hen ta>in& this $edi'ine sin'e it 'an
'ause in'reases in sto$a'h irritation+
in'reased shortness o" breath
Use 'aution i" the patient has a
#ea>ened heart+ It $ay 'ause in'reased
shortness o" breath or #ei&ht &ain+
di??iness and dro#siness
(o not drive or en&a&e in potentially
ha?ardous a'tivities until response to
dru& is >no#n+ It $ay 'ause di??iness
and dro#siness+
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3dverse E""e'ts
Nursin& Mana&e$ent
sto$a'h ul'er or bleedin&
Instru't 'lient to i$$ediately tell the
health provider about bleedin& or
sto$a'h ul'er
dar> stools, he$ate$esis,
Instru't 'lient to (is'ontinue the dru&
e''hy$oses
pro$ptly, do not use a&ain and
Conta't the physi'ian+
diarrhea, epistaxis, or rash
Instru't 'lient to (is'ontinue the dru&
pro$ptly, do not use a&ain and
Conta't the physi'ian+
ii" I*+, BT and ot1er #arenteral 3edication infused4administered since date of
admission
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INTRA*ENOUS +'UID OREDERED
reious I'.
Rationale his pulls the "luid into the
8S 18iter Q RCl .0 $e68
vas'ular by os$osis resultin& in an
in'rease vas'ular volu$e+ It raises
intravas'ular os$oti' pressure and
provides "luid, ele'trolytes and 'alories
"or ener&y+ Potassiu$ 'hloride is used to
prevent or to treat lo# blood levels o"
potassiu$ hypo>ale$ia/+
Current I'.
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Rationale only I: "luid #hi'h is
Plain NSS 18iter "or 4.hours
'o$patible to lood rans"usion
To follo0 I'.
Rationale o "a'ilitate another lood
Plain NSS 18iter "or 4.hours
rans"usion
OT%ERS
lood rans"usion
Rationale o restore blood volu$e a"ter
severe he$orrha&e and to restore the
oxy&en-'arryin& 'apa'ity o" the blood
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%xytoxin
Rationale Sti$ulatin& labor #hen the
'ontra'tions are 'onsidered too #ea>+
Preventin& or 'ontrollin& heavy bleedin&
"ollo#in& delivery o" the 'hild post-
partu$ he$orrha&e/+
iii" Diagnostic Test since Date of Admission
Na$e o"
esult
Nor$al
Unit o"
I$pli'ation
(ia&nosti'
:alues
Measure$ent
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est
Co$plete CC
5e$o&lobi
100
*e$ale! 110 A
&6dl
Indi'ates a de'rease in
n $ass
19=
ed blood 'ell
Male! 1= to 1=4
5e$ato'rit
0+4
0+B A 0+9.
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8eu>o'yte
;
.+9 A 10
Count
Platelet
.
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Seru$ Iron
.0
*e$ale! 90
'on'entration
to 1B0
Male!
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underlyin& 'ondition
that is 'ausin& the
disorder+
p&
(e'rease in redness is
due to a
disproportionate
redu'tion o" red 'ell
he$o&lobin+
"8
(e'rease in red blood
'ell si?e
(e'rease in he$o&lobin 'on'entration+
U68
Indi'ate a nu$ber o"
$edi'al 'onditions su'h
as tissue da$a&e due to
trau$a or disease/,
he$olyti' ane$ia an
abnor$al brea>do#n o"
red blood 'ells/
T&6d8
Indi'ates poor
absorption o" Iron,
Chroni' heavy
$enstrual bleedin&,
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Poor absorption o" iron,
Not enou&h dietary iron
or Pre&nan'y
T&68
here is a ris> "or la'>
o" iron
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Male! 0A
00
otal Iron
B9
490AB0
T&68
In pre&nant, the liver
indin&
in'reases the produ'tion
Capa'ity in the
o" trans"errin& thus
lood IC/
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raisin& IC+ When
IC is hi&h, it
indi'ates iron de"i'ien'y
ane$ia+
iv+ %ther relevant events durin& hospitali?ation - none+
b" #1ysical Assessment
7eneral I$pression
5y&iene- Clean and 7roo$ed appropriately
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Intera'tion6behavior- Cooperative attitude as her 'ondition per$its
Posture- edridden and #ea>
"a'ial Expression- Sy$$etri' #ith $ove$ent
5ei&ht, #ei&ht and :ital Si&ns
5ei&ht! 9 "eet and in'hes
Wei&ht! 14< lbs
:ital si&ns!
e$perature! B+O C
Pulse rate! == 'p$
lood Pressure! 1106B0 $$65&
espiratory ate! 4 bp$
S>in
Color o" s>in- Pallor
Color o" hair- la'> Nor$al/
%dor- No odor
8esion- No lesion
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Moisture- Moist
e$perature- War$
exture- S$ooth So"t
ur&or- Pin'hed up s>in returns i$$ediately to ori&inal position
Ede$a- No s#ellin&, pittin& or ede$a
Nails- 5as a 'onvex 'urvature o" "in&ernail plate, 1
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Mental Status! 3#a>e 3lert oriented to person, pla'e ti$e
Cranial Nerves!
:isual 3'uity- 40640 #ith po'>et s'reener, both eyes
:isual *ields- inta't in all "ields
II and III! Pupillary ea'tion to 8i&ht- dire't 'onsensual nor$al 3''o$$odation-
nor$al
PE83, pupils, eual, round, rea'tive to li&ht, and a''o$$odation "or both/
III, I:, :I! E%M- inta't
:! 8i&ht ou'h *a'e- nor$al in all divisions
:II! Wrin>le *orehead, Close Eyes, Sho# eeth- nor$al :III! 5earin&- nor$al by rou&h
testin&
! Cou&h- nor$al able to 'ou&h/
I! Shru& Shoulders and 'he'> sterno'leido$astoid $us'les - nor$al II! Protrude
on&ue- $idline protrusion
Motor Syste$! Nor$al tone
Sensory! 3ble to "eel !
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8i&ht ou'h- nor$al
Position Sense- nor$al :ibration- nor$al
Sharp- nor$al
e"lexes! (eep tendon
O i'eps C9-le S1/- esponsive
Patholo&i'al - Plantar e"lex- none bilateral do#n &oin& toes/
Coordination! 7ait and alan'e- nor$al
*in&er to Nose- nor$al
apid "in&er $ove$ents- nor$al
5EEN, Sinuses and Ne'>
5ead2
Si?e6Shape- Sy$$etri', round, ere't in $idline
%M6 5ead 'ontrol- Ne'> $ove$ent is s$ooth 'ontrolled #ith .9 de&ree "lexion, 99
de&ree extension, .0 de&ree lateral abdu'tion, B0 de&ree rotation
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S'lera6ConHu'tiva- No s#ellin&, dis'har&es, lesions or la'eration are noted
Iris6Pupils A Color la'>, round, "lat and 'onstri'ted #hen dire't to li&ht
:isual 3'uity est- 40640 vision Can di""erentiate 'olors
Ears!
External!
Pla'e$ent- 3li&n$ent o" pinna #ith 'orner o" eye #ithin 10 de&ree an&le o" verti'al position
No s#ellin&, dis'har&es and lesions+
Internal!
No dis'har&es, lesion, ex'oriation or presen'e o" "orei&n body+
Mouth!
8ips- S$ooth $oist, #ithout lesions or s#ellin&
Palates- 5ard palate is pale or #hitish #ith "ir$, transverse ru&ae #rin>le li>e "olds/
on&ue- Pin>, $oist, a $oderate si?e #ith papillae
u''al Mu'osa- S$ooth $oist #ithout lesion
7u$s- Pin>, $oist and "ir$
eeth- 1 adult teeth, #hite to yello#ish in 'olor, shiny tooth ena$el, no inta't dentures
Uvula- Positioned in $idline o" so"t palate
hroat6tonsils- Pin> and sy$$etri'
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Nose6sinuses!
Stru'ture and paten'y o" nares- 3ble to sni"" throu&h ea'h nostril #hile other is o''luded
Color and proble$ o" turbinates - Color is the sa$e as the rest o" the "a'e
No dis'har&es or tenderness
Ne'>!
Mobility- Sy$$etri'
Cervi'al 8y$ph Nodes- No enlar&e$ent or tenderness
e$perature- War$
No s#ellin& or tenderness
C6 8 and 5eart
reasts and Nipples- sy$$etri'al--nipples sy$$etri'al and everted
No $asses, #ith $il>y dis'har&es
3reola- Eual, round, sy$$etri', dar> bro#n, s$ooth,has no lesions
horax-
Posterior thorax-
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o Sy$$etri', ribs are sloped do#n#ard at .9 relative to the spine, $us'le
develop$ent is eual, anteroposterior to transverse dia$eter in ratio o" 1!4
o Spinal ali&n$ent- Sli&htly
o Uni"or$ in te$perature, no tenderness and $asses
o espiratory ex'ursion- *ull and sy$$etri' 'hest expansion
o :o'al "re$itus- ilaterally eual, heard $ostly at the apex o" the lun&s
Sounds- Per'ussion notes resonant ex'ept over the s'apula, bron'hovesi'ular and
vesi'ular
3nterior thorax
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o reathin& patterns- 2uiet, rhyth$i' e""ortless
e$perature, tenderness, $asses- War$, no tenderness or $asses
espiratory ex'ursion- *ull and sy$$etri' 'hest expansion
:o'al "re$itus- ilaterally eual, $ostly heard at the apex o" the lun&s
Sounds- *lat sound on the part #ith heavy $us'les and bony pro$inen'es, ty$pani on
the sto$a'h, dullness on the liver and spleen, bron'hovesi'ular, vesi'ular
ra'hea- ron'hial sound
3xillary, sub'lavi'ular and supra'vi'alar ly$ph nodes- 3bsen'e o" $asses or lu$ps
Cardiovas'ular
Pre'ordiu$-
3orti', pul$oni', tri'uspid area- No pulsation
3pi'al area- With palpable pulsation point o" $axi$al i$pulse/
Sounds o" tri'uspid and api'al- S4 is louder than S1
Sounds o" ri'uspid and api'al area- S1 is lauder than S4
Carotid arteries- Sy$$etri' pulse volu$es, "ull pulsation, no sound
:isibility- Not visible
8un&s-
respiratory e""ort! Even, 4bp$, unlabored
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Per'ussion and Palpation o" 8un& *ields- nor$al resonant per'ussion
3us'ultation- 'lear, nor$al vesi'ular breath sounds
3bdo$inal
Unble$ished s>in, uni"or$ in 'olor, no si&ns o" enlar&e$ent o" the liver and spleen, sy$$etri'al 'ontour
Peristalsis $ove$ent not visible
vas'ular patterns not visible
3udible bo#el sounds, not audible vas'ular and peritoneal "ri'tion rubs
With suture in
Urinary Syste$
No Pain or dis'o$"ort in response to pressure on the lo#er ba'>, abdo$en, or the area above the pelvi'
bone,
No&ro#ths, or abnor$alities dete'ted
No dis'har&e "ro$ the urethra
7enitalia and eprodu'tive
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External 7enitalia- labia, 'litoris, urethral ori"i'e introitus A all nor$al no s#eelin, pus, #arts or
in"la$$ation/
i$anual Exa$- uterus is anterior, $idline, s$ooth, enlar&ed and tender
*undus in $idline, about hal" #ay to 46 #ay bet#een u$bili'us and sy$physis pubis
Inspe'tion o" Cervix and :a&ina- bul&in& #ith strainin&, nor$al va&ina $u'osa, 'ervix- pin>,
#ith lo'hia rubra, 'ervix! Spongy and flabby
3nus
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Nor$al re'tal sphin'ter tone no re'tal $asses or tenderness+ 0 stool "or days+
no "issures, no he$orrhoids
Mus'ulos>eletal, upper and lo#er extre$ities and P:S
Mus'ulos>eletal syste$
Mus'les-
Si?e, 'ontra'tures, tre$ors- ilaterally sy$$etri', no 'ontra'tures and tre$ors
oni'ity, stren&th ne'>, upper, lo#er extre$ities/- Nor$al $us'le tension, adeuate
stren&th o" the$us'les
ones- Uni"or$ in stru'ture, no de"or$ities, tenderness or ede$a
)oints- 3bsen'e o" tenderness and s#ellin&, has s$ooth $ove$ent, no nodules
an&e o" $otion shoulder and s'apula, elbo#s, hands, a'etabulu$, popliteal, an>les/- 3ble
to per"or$ the exer'ises in "ull ran&e o" $otion, no tenderness, $oves s$oothly
Upper Extre$ities
VNails- no 'yanosis, or 'lubbin&
pal$s- pale
$us'les- si?e is proportional
Hoints in'ludin& ro$/
-interphalan&eal- nor$al an&e o" $otion #ithout de"or$ities
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#rists- "lexion ;0X, extention B0X, radial deviation 40X, ulnar deviation 90X
elbo#s- "lexion 1le- dorsi"lex 40X, plantar "lexion .0X, eversion 40X, inversion 40X
Rnee- "lexion 10X
5ip- "lexion 100X, internal rotation .0X, ext rotation .0X Pulses!
Posterior ibial- . 6 . bilateral eual (orsalis Pedis- . 6 . . bilateral eual
V Capillary e"ill test! 4 se'onds nor$al/
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I*" 'IST O+ NANDA5BASED OR (ORDON5BASED NURSIN( DIA(NOSIS
'IST O+
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#RIORITI8ED
BASIS O+ #RIORITI8ATION
)USTI+I
NURSIN(
DIA(NOSIS
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Circulation
$aslo0
Actual/
+ert/
atient*s
1Air0ay1
&otential
coert
erbali2ation
Breating
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1+ *ati&ue related to the
*ati&ue or #ea>nes
bloodOs de'reased
'hie" 'o$plaint re&
he$o&lobin and
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a"ter her 'esarean d
di$inished oxy&en-
also one o" the si&n
'arryin& 'apa'ity
Iron de"i'ien'y ane
4+ *luid volu$e de"i'it
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hereOs a severe he
related to blood loss
delivery, blood loss
se'ondary to ane$ia
intravas'ular volu$
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repla'e i$$ediatel
hypovole$ia and s
+ is> "or in"e'tion
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5e$o&lobin served
related to de'reased
de"ense, a de'rease
he$o&lobin se'ondary
also $eans thereOs
to iron-de"i'ien'y
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patho&ens to in"e't
3ne$ia+
espe'ially durin& h
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hospital+
.+ (isturbed sleep
pattern related to
hospital noise and
8/9/2019 142224909 Abnormal Uterine Bleeding Iron Deficiency Anemia Secondary Case Study
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li&htnin& se'ondary to
3ne$ia
9+ I$balan'ed nutrition!
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8ess than body
reuire$ent related to
8/9/2019 142224909 Abnormal Uterine Bleeding Iron Deficiency Anemia Secondary Case Study
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inadeuate inta>e o"
essential nutrients
8/9/2019 142224909 Abnormal Uterine Bleeding Iron Deficiency Anemia Secondary Case Study
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se'ondary to 3ne$ia
"or Ine""e'tive
tissue per"usion related
8/9/2019 142224909 Abnormal Uterine Bleeding Iron Deficiency Anemia Secondary Case Study
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to inadeuate blood
volu$e se'ondary to
ane$ia
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B+ 3'tivity intoleran'e
related to i$balan'e
bet#een oxy&en supply
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and de$and in the blood
related to &enerali?ed
#ea>ness se'ondary to
3ne$ia
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=+ is> "or Constipation
related to insu""i'ient
physi'al a'tivity
8/9/2019 142224909 Abnormal Uterine Bleeding Iron Deficiency Anemia Secondary Case Study
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se'ondary to 3ne$ia
;+ is> "or "all related to
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&enerali?ed #ea>ness
se'ondary to 3ne$ia
10+ Sedentary li"estyle
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related to de"i'ient
>no#led&e o" health
bene"its o" proper diet
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In Wei&ht edu'in& pro&ra$ Preter$ irth Y=
#ee>s/
irth delivery via Cesarean se'tion
+- $+DIAB"E .ACT+R!
3&e! 3dult . years old/ 7ender! *Pre&nant/ 5eavy Menstruation 5is
havin& 3ne$ia
Preter$ irth
lood loss6 5e$orrha&e
(e'reased intravas'ular volu$e
(epletion o" iron stores in bone $arro#
Seru$ "erritin #ill be'o$e lo# Y 40-0 $'&68/
he 'o$pensatory in'rease in iron absorption 'auses an in'rease in iron-bindin& 'apa'ity IC6rans"errin le
Seru$ iron "alls to Y 90 T&6d8 and trans"errin saturation to Y
1
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Erythropoiesis is i$paired
8o# 5e$o&lobin belo# 14$&6d8/
8o# 5e$ato'rit elo# @/
edu'tion in oxy&en-'arryin& 'apa'ity o" ed lood 'ell
S$all ed lood 'ell Mi'ro'yti'/ 8ess 5e$o&lobin than 3vera&lood 'ell 5ypo'hro$i'/
Si&ns and Sy$pto$s! *ati&ue6 7enerali?ed #ea>ness 5eada'he6 (i??iness
Pale s>in 'olor or Pallor Sore ton&ue 8i&ht-headedness #hen you
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*I" NURSIN( CARE #'AN
Na$e! Patient 3
(ia&nosis! 3bnor$al Uterine leedin&, 3ne$ia Se'ondary
(ate and ti$e! 3u&ust 44, 4014 11p$-Ba$/
Assessment
Diagnosis
Scientific
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#lanning
Im0lementation
Scientific Rationale
rationale
!ub3ectie
*ati&ue
Iron-
"ong term
Inde&endent
Data
related to
de"i'ien'y
,oal
Interention
JNan&hihina
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the bloodOs
ane$ia is
3"ter 1<
Explain to the 'lient
o redu'e anxiety o"
a>o $ula
de'reased
a
5ours o" duty
the pro'edures and its
patient+
>a&abi, sobra
he$o&lobi
'o$$on a
he patient
purpose
o prepare the patie
ata >asi
n and
ne$ia lo
#ill be able
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the Pro'edure+
pa&duru&o n&
di$inished
# red
o enhan'e
puson >o >aya
oxy&en-
blood 'ell
her
3ssess vital si&ns+
o evaluate "luid sta
si&uro a>o
'arryin&
level/
>no#led&e
and 'ardiopul$onar
nan&hihina+
'apa'ity
'aused by
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about her
response to a'tivity+
Matanda na
se'ondary
insu""i'ien
disease, and
rin >asi a>o
to 3ne$ia
t dietary
to "a'ilitate
Evaluate need "or
o deter$ine the nee
nan&
inta>e and
health
individual assistan'e
"or doin& a'tivities o
nabuntisK as
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absorption
pro$otion+
or assistive devi'e+
$ove$ent+
$ani"ested by
o" iron+
the $other+
!ort Term
%ne o" the
,oal
En'oura&e 'lient to do
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o in'rease a'tivity
+b3ectie
Sy$pto$s
3"ter 1< hours
#hatever possible
as tolerated
Data
o" ane$ia
o" duty,
Pallor,
is
he patient
En'oura&e use o"
o 'onserve ener&y
&enerali?ed
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&enerali?e
#ill be able to
assistive devi'es li>e
other tas>
#ea>ness,
d
verbali?e the
#heel'hair
With heavy
Wea>ness
understandin&
lo'hia rubra
and
o" individual
Instru't patient to sit
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he patient
Iron ri'h "oods e+&+
#ill be able to
liver or ani$al
identi"y "oods
or&ans, e&&, "ish,
ri'h in iron
poultry, lea"y
and the
ve&etables and dried
patient #ill be
"ruits/
able to
verbali?e the
Instru't patien
dosa&e o" her
in'rease her "lu
$edi'ation+
inta>e+
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!ort term
%bserve and $easure
+b3ectie
"luid losses e+&+
3"ter . hours
bleedin&/
o" health
tea'hin&, the
Provide %ral 'are
patient #ill be
able enhan'e
her a'tivities
o" daily livin&
Instru't the *a
as eviden'ed
bathe the patien
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by report o"
other day+
i$proved
sense o"
7ive6ad$inister
ener&y+
$edi'ations as
Pleasurable a'ti
re"o'us ener&y
di$inish "eelin&
unhappiness an
slu&&ishness+
o In'rease the
ody iron o" the prevent ane$ia
in produ'in& $ r
blood 'ells+
o rehydrate the
o deter$ine repla
needs
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*or patientOs 'o$"or to prevent dryness o $u'ous $e$brane+
o provide opti$
'are and to prev
dryness o" s>in+
o *ollo# patientO
therapeuti' re&i$e
instru'ted by the do'tor+
3d$inister lood trans"usion as ordered by the (o'tor+
epla'e ele'trolytes as ordered Insertin& I: "l
ordered/
Collaboratie
Interention!
e"er patient to adiolo&y e'hni'ian "or -ray
ordered by the do'tor+
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stabili?e her #ellnes health+
o repla'e lood vo loss+
o repla'e ele'trolyt prevent dehydration "urthe
'o$pli'ation
*or "urther evaluatio and analysis o" the patient
disease+
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Na$e! Patient 3
(ia&nosis! 3bnor$al Uterine leedin&, 3ne$ia Se'ondary
(ate and ti$e! 3u&ust 4, 4014 11p$-Ba$/
Assessment
Diagnosis
Scientific
#lanning
Im0lementation
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Scientific Rationale
rationale
!ub3ectie
*luid
Iron
"ong term
Inde&endent
Cues
volu$e
de"i'ien'y
,oal
Interention
JMedyo
de"i'it
durin& the
3"ter 1< hours
Explain to the 'lient
o redu'e anxiety o
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nan&hihina pa
related to
pre&nan'y is
o" duty, the
the pro'edures and
patient+
rin a>o pero
blood loss
the 'ause o"
patient #ill be
its purpose
o prepare the patie
din na tulad
se'ondary
abnor$al
able to enhan'e
"or the Pro'edure+
n& >ahapon,
to ane$ia
uterine
her >no#led&e
na>a>atayo
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heavy blood
"urther disease
a>o uha#K as
loss+
prevention+
Esti$ate pro'edural
o $onitor and obs
$ani"ested by
"luid losses and ta>e
other routes o" "luid
the $other+
Massive
!ort Term
note possible routes
losses
*luid
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,oal
o" insensible loss+
+b3ectie
volu$e is
3"ter 1< hours
Cues
loss durin&
o" duty, he
Note 'o$plaints and
%ther si&n and
&enerali?ed
the delivery
patient #ill be
physi'al si&ns
sy$pto$s $ay indi
#ea>ness,
as a result
able to
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asso'iated #ith
serious 'o$pli'atio
#ith lo'hia
the patient
verbali?e the
dehydration s'anty,
rubra
"elt #ea>
understandin&
'on'entrated urine,
and thirsty+
o" individual
'on"usion, $us'le
:ital si&ns!
therapeuti'
#ea>ness, li&ht
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$$65&
"luid repla'e$ent
"ong term
needs+
ob3ectie
3"ter . hours
Instru't patie
o" health
in'rease her "l
tea'hin&, the
inta>e+
patient #ill be
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able to
Maintain a''urate I
de$onstrate
%
behavior to
'orre't de"i'it+
Provide %ral
!ort term
+b3ectie
3"ter . hours
o" health
Instru't the *
tea'hin&,
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to bathe the patient
he patient
every other day+
#ill able o
$aintain
Chan&e position
adeuate "luid
"reuently
volu$e as
eviden'ed by
Chan&e dres
adeuate
"reuently
urinary output
7ive6ad$ini
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$edi'ations as
instru'ted by the
do'tor+
3d$inister lood
trans"usion as
ordered by the
valleys in "luid
o rehydrate t
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o observe the pro& o" the 'urrent status the patient
*or patientOs 'o$"o and to prevent dryn o" $u'ous $e$bra
o provide opti$al 'are and to prevent dryness o" s>in+
o redu'e pressure "ra&ile s>in and tiss
o prote't s>in a
$onitor losses+
o *ollo# pati
therapeuti' re&
stabili?e her #
health+
o repla'e lood
loss+
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(o'tor+
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3d$inister I: "luids
o repla'e ele'troly
as indi'ated
to prevent dehydrat
and "urther
'o$pli'ations+
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Collaboratie
Interention!
e"er patient to
*or "urther evaluati
adiolo&y
and analysis o" the
e'hni'ian "or -ray
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patientOs disease+
as ordered by the
do'tor+
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Scientific Rationale
rationale
!ub3ectie
Iron
"ong term ,oal
Inde&endent
cues
de"i'ien'y
3"ter 1< hours o"
Interention
JEto $edyo
is> "or
durin& the
duty, the patient
Explain to the 'lient
o redu'e anxiety o"
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nan&hihina
In"e'tion
pre&nan'y
#ill be able to
the pro'edures and
patient+
at
related to
is the
enhan'e her
its purpose
o prepare the patien
na&duru&o
de'reased
'ause o"
>no#led&e about
the Pro'edure+
pa rin an&
he$o&lobi
abnor$al
her disease, and
puson >o,
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n
uterine
to "a'ilitate
3ssess vital si&ns
Chan&es in vital si&n
pero di na
se'ondary
bleedin&
health pro$otion
notin& blood pressure
asso'iated #ith "luid
>asin& la>as
to iron-
durin& the
and "urther
volu$e loss or other
n& >ahaponK
de"i'ien'y
labor and
disease
'o$pli'ations+
as
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ane$ia+
resultin&
prevention+
$ani"ested
in heavy
%bserve "or lo'ali?ed
o deter$ine possibl
by the
blood loss+
!ort Term
si&ns o" in"e'tion at
in"e'tion and to avoid
$other+
,oal
insertion sites o"
"urther 'o$pli'ation
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5e$o&lob
3"ter 1< hours o"
invasive sites or I:*
+b3ectie
in served
duty, the patient
insertion sites/ and
Data
as a
#ill able to
#ound site+
&enerali?ed
se'ondary
i$prove #ound
#ea>ness,
de"ense, a
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healin& and #ill
Stress proper hy&iene
3 "irst line o" de"ens
va&inal
de'reased
not $ani"est any
by all 'are&ivers
a&ainst health'are
bleedin&
in
si&n o" in"e'tion+
bet#een therapies and
asso'iated in"e'tions
lo'hia
he$o&lobi
'lients
53Is/
rubra/
n also
"ong term
8/9/2019 142224909 Abnormal Uterine Bleeding Iron Deficiency Anemia Secondary Case Study
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$eans
ob3ectie
E$phasi?e proper use
*or personal prote'tio
:ital si&ns!
thereOs an
3"ter . hours o"
o" personal prote'tive
yoursel" and the patie
!
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P! ;0 'p$
the
able to
the a&en'yOs proto'ol
P! 1106B0
patho&ens
de$onstrate
$$65&
to in"e't
te'hniues in
Maintain steril
the patient
li"estyle 'han&e
te'hniue "or al
espe'ially
to pro$ote sa"e
invasive pro'ed
durin& her
environ$ent
8/9/2019 142224909 Abnormal Uterine Bleeding Iron Deficiency Anemia Secondary Case Study
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stay in the
e'o$$end routine
hospital+
!ort term
sho#er or s'rubs+
+b3ectie
3"ter . hours o"
Instru't the patient
health tea'hin&,
and her relative about
the patient and
proper hand #a
her relative #ill
be able to
Chan&e #ound
de$onstrate
dressin&s usin&
behavior to
proper te'hniu
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prevent and
'han&in& and
redu'e ris> in
disposin& o"
in"e'tion e+&+
'onta$inated
hand #ashin&
$aterials+
and 'han&e o"
dressin&/
Cover perineal
pelvi' re&ion #
usin& a bedpan+
En'oura&e e
a$bulation, dee
8/9/2019 142224909 Abnormal Uterine Bleeding Iron Deficiency Anemia Secondary Case Study
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breathin&, and
'ou&hin& and position
'han&es+
Maintain adeuate
hydration, stand or sit
o redu'e 'onta$
o redu'e ba'terial
'oloni?ation+
asi' in"e'tion and
'onta$ination 'ont
8/9/2019 142224909 Abnormal Uterine Bleeding Iron Deficiency Anemia Secondary Case Study
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o prevent 'onta$ina and redu'in& the o''urren'e o" in"e'tio
o prevent 'onta$ina
*or $obili?ationrespiratory, and
prevention o" asp
respiratory in"e'
o avoid bladder d
and urinary
8/9/2019 142224909 Abnormal Uterine Bleeding Iron Deficiency Anemia Secondary Case Study
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to void+
stasis
8/9/2019 142224909 Abnormal Uterine Bleeding Iron Deficiency Anemia Secondary Case Study
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Provide perineal 'are
o redu'es ris> o"
as'endin& urinary tra
in"e'tion
Provide %ral 'are
*or patientOs 'o$"ort
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to prevent dryness o"
$u'ous $e$brane+
7ive6ad$inister
o *ollo# patientOs
$edi'ations as
therapeuti' re&i$en t
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instru'ted by the
stabili?e her #ellness
do'tor+
health+
3d$inister lood
o repla'e lood vol
trans"usion as ordered
loss+
8/9/2019 142224909 Abnormal Uterine Bleeding Iron Deficiency Anemia Secondary Case Study
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by the (o'tor+
3d$inister I: "luids
o repla'e ele'trolyte
as indi'ated
prevent dehydration a
"urther 'o$pli'ations
Collaboratie
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Interention!
%btain appropriate
*or "urther evaluation
tissue or "luid
analysis o" the patient
spe'i$ens "or
disease+
8/9/2019 142224909 Abnormal Uterine Bleeding Iron Deficiency Anemia Secondary Case Study
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observation and
'ulture and sensitivity
test
8/9/2019 142224909 Abnormal Uterine Bleeding Iron Deficiency Anemia Secondary Case Study
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RE.ERECE!
NurseOs Po'>et 7uide by E+3+ (avis/
Maternal Child 5ealth Nursin& ipedia+or& "or (e"inition o" ter$s/
http!66###+n'bi+nl$+nih+&ov6pub$edhealth6PM500016pre&nan'y6$edi'ines6synto'inon+ht$l
http!66###+s'ribd+'o$6do'6BB101;063ne$ia-NCP
ato&ysiology references
5andboo> o" Medi'al-Sur&i'al Nursin& 11th
Edition by runner Suddhart/
Maternal Child 5ealth Nursin& <th
Edition :olu$e 14 8ippin'ott-Willia$s Wil>ins/
http!66###+$er'>$anuals+'o$6pro"essional6he$atolo&yZandZon'olo&y6ane$iasZ'ausedZby
Zde"i'ientZerythropoiesis6ironZde"i'ien'yZane$ia+ht$l http!66nursin&'rib+'o$6nursin&-notes-
revie#er6$aternal-'hild-health6iron-de"i'ien'y-ane$ia6 http!66###+na$rata+'o6'ase-study-iron-
de"i'ien'y-ane$ia6
5andboo> o" Medi'al-Sur&i'al Nursin& 11th
Edition by runner Suddhart/
8/9/2019 142224909 Abnormal Uterine Bleeding Iron Deficiency Anemia Secondary Case Study
133/133
Maternal Child 5ealth Nursin& <th
Edition :olu$e 14 8ippin'ott-Willia$s Wil>ins/