The document presents a case study of a 31-year-old woman diagnosed with adenomyosis, detailing her symptoms, medical history, and treatment options. It discusses the condition's impact on her quality of life, including heavy menstrual bleeding, pain, and the need for potential surgery. Additionally, the study outlines specific objectives and nursing assessments aimed at providing comprehensive care for patients with adenomyosis.

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Our Lady of Guadalupe College of Nursing Inc.
Case presentation
Adenomyosis
Page 1 of 38

2. Leader: Degamo, Peter
Members:
Cu unjieng, John Paul
Del Carpio, Frederick
Del Monte, Carissa Camille
Esguerra, Lynn
Espanol, R.J.
Famis, Leslee Fay
Farnacio, Ronald
Garcia, Geeanne Marie
Clinical Instructor: Ms. Suson R.N. M.A.N.
I. Introduction
Last March 6, 2013 at VRPMC 5th
floor OB ward, our group chose a 31 yr old client who
has diagnose with adenomyosis. We chose this case because we want to gain knowledge and
understanding about the disease process. This will enable us to give proper heath teachings and
help take care of people close to us experiencing the same disease process.
Adenomyosis is a condition in which the inner lining of the uterus (the endometrium)
breaks through the muscle wall of the uterus (the myometrium). Adenomyosis can cause
menstrual cramps, lower abdominal pressure, and bloating before menstrual periods and can
result in heavy periods. The condition can be located throughout the entire uterus or localized
in one spot. It is considered a benign condition, the frequent pain and heavy bleeding
associated with it can have a negative impact on a woman's quality of life. (Brunner and
Suddarth's Textbook of Medical-Surgical Nursing)
Cause:
• Unknown
Contributing factors:
Page 2 of 38

3. • Middle – aged women
• Women with increased levels of estrogen, and usually disappears after
menopause (12 months after a woman’s final menstrual period), when estrogen
levels decline.
• Multiparous women
• Having had uterine surgery, such as for a cesarean section or to remove fibroids
(Mayo)
Signs and symptoms:
• Heavy, prolonged menstrual bleeding
• Severe menstrual cramps
• Abdominal pressure and bloating
• Pelvic pain during intercourse
Diagnostic Exam:
• MRI -- magnetic resonance imaging -- can be used to confirm a diagnosis of
adenomyosis in women with abnormal uterine bleeding.
• pelvic exam
• Ultrasound of the uterus may help tell the difference between adenomyosis and other
uterine tumors. MRI can be helpful when ultrasound does not give definite results.
Treatment for adenomyosis depends in part on your symptoms, their severity, and whether
you have completed childbearing. Mild symptoms may be treated with over-the-counter
pain medications and the use of a heating pad to ease cramps.
Anti-inflammatory medications - Non steroidal anti-inflammatory drugs (NSAIDs) to relieve
mild pain associated with adenomyosis. NSAIDs are usually started one to two days before the
beginning of your period and continued through the first few of days of your period.
Surgery:
• Over 23% of patients requiring hysterectomy for control of chronic severe pelvic pain
had adenomyosis, and almost half of these women had a tubal ligation performed.
Statistics:
20%of women in Canada have adenomyosis, the exact rate of incidence of
adenomyosis is unknown because a diagnosis can b made only after a pathologist examines the
uterine wall samples obtained during surgery or biopsy.
More than 80% of women with adenomyosis have other uterine disorders as
well. Some 50% have associated fibrous (benign smooth muscle tumors of the uterus);
approximately 11% have endometriosis (endometrial tissue outside of the uterus); and 7% have
endometrial polyps (benign outgrowths of endometrial tissue). The symptoms of these often
obscure the diagnosis of adenomyosis.
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4. II. Objectives
A. General Objectives
After the course of the study, our group aims to formulate a basic case analysis
that would provide essential knowledge and skills in delivering quality health care to
patients diagnosed with Adenomyosis.
B. Specific Objectives
 To conduct a physical assessment appropriate for the client.
 To identify and understand the predisposing and precipitating factors that
contributed to our client’s illness.
 To analyze and determine the anatomy and physiology of the affected systems
 To prioritize problems and develop a plan of care appropriate for the patient
 To implement actions according to the set nursing care plan to address the
needs of the patient
 Evaluate the outcome and effectiveness of the nursing interventions provide.
III. Nursing History
1. Personal Data
a. Name: Ms. L.G
b. Age: 31 yrs old
c. Sex: F
d. Address: Brgy. San Jose, Mandaluyong City
e. Occupation: Company Secretary
f. Religion: Roman Catholic
g. Date and Time of Admission: March 02, 2013
h. Admitting Physician: Dr. A.
2. Chief Compliant: Profuse and prolonged vaginal bleeding
3. History of Present Illness:
Ten years prior to admission, patient had profuse and prolonged vaginal bleeding
consuming 6 fully soaked pads lasting for 2 weeks. She consulted and was diagnosed to have
adenomyosis with adenomyoma. She was given unrecalled pills for 6 months to help regulate
her menses but failed. She was then given unrecalled pills for 10 days which afforded regulation
of menses. She have yearly ultrasound with no increase in menses for 3 yrs. 7 yrs prior to
admission, there was increase in size of the adenomyosis and patient experienced severe
dysmenorrhea with prolonged bleeding for 10 days consuming 8 pads /day, she consulted and
was given Tranexamic acid (hemostan) TID, Mobic, Hemobien TID and trust pills for 6 months
Page 4 of 38

5. which afforded no regulation of menses. Two years prior to admission she was given unrecalled
pills for 10 days, she was advised OR but refused. Patient was lost to follow up until few hrs
prior to admission; she had profuse bleeding with blood cloths consuming more than 10 pads.
Persistence of symptoms prompted consult.
4. Past medical history: (+) infant: imperforated anus
5. Family medical history: HTN/Cardiac = mother
6. OB History:
Menarche: 13
Interval: 28 – 30
Duration: 7 days
Amount: 2 – 8 pads
Symptoms: (+)
IV.GORDON’S FUNCTION HEALTH PATTERN
Patterns of
Functioning
Before Hospitalization After Hospitalization Analysis
Health
Perception/
Health
Management
According to the client,
she had long-time been
diagnosed with
Adenomyosis. She
experiences alternating
episodes of heavy and
prolonged bleeding since
her diagnosis.
Client started taking
hormone pills in 2003 and
stopped 2011 as
treatment for her long-
time diagnosis of
Adenomyosis.
Client reports feeling
uneasy. She states not
feeling healthy at all and is
unprepared for the
surgery which she had
long time avoided.
She continues to have
episodes of intermittent
vaginal bleeding and is
scheduled to have TAHBSO
with Urethral Stenting.
Although the client has
been diagnosed to have
Adenomyosis for over 10
years now, she still
displays hesitancy about
her operation. Client
continues to experience
intermittent vaginal
bleeding necessitating
surgery.
Nursing Diagnosis:
Risk for Fluid Volume
Deficit R/T Adenomyosis
AEB Vaginal Bleeding
Nutritional-
Metabolic
pattern
The client eats 4 times a
day: breakfast, lunch,
snack, and dinner. She
prefers to eat fish,
vegetables and regularly
drinks water (1-2L/day)
and takes multi vitamins
daily.
Client was placed on NPO
upon admission due to
possibility of surgery.
After being stabilized,
client is now on Diet as
Tolerated.
The client was previously
on NPO to prevent
complications from
possible surgery. Now that
the client is stable, client
may eat anything that will
supply her of essential
nutrients as long as she
can tolerate it.
Page 5 of 38

6. Sleep/ Rest
Pattern
The client report having no
problem sleeping. She
sleeps 6-8 hours/day.
Client has a difficult time
sleeping. She reports not
being able to sleep
because she has been
thinking about her
scheduled surgery. She
stated that the discomfort
from abdominal pain also
contributes.
The clients’ anticipation
for her scheduled surgery
has affected her sleeping
patter. The abdominal
discomfort that she’s been
experiencing also added to
her difficulty sleeping.
Nursing Diagnosis:
Altered sleep/rest pattern
due to anticipated surgery
and abdominal pain
Bowel/
Urinary
Elimination
Client has difficulty in
elimination of bowel and
reports using herbal
medicines like drinking
ampalaya juice to help her
move her bowels. Client
reports having a previous
perforated anus and
chronic constipation.
Client moves bowel every
other day and urinates 8
times daily.
The client still feels
constipated and was only
able to move her bowel
once since date of
admission.
Client urinates 6 times a
day.
Client has no problem
urinating but suffers from
chronic constipation
making moving bowel
difficult. Hospitalization
has reduced her activity
affecting peristalsis that
also contributes to bowel
elimination problem.
Activity/
Exercise
Pattern
“Secretary ako sa trabaho
ko kaya marami akong
office work na ginagawa.
Mahilig din ako mag
malling bilang walking
exercise pagkatapos ko
pumasok sa opisina.” As
verbalized by the Client.
Client spends most of her
time resting in bed.
Client has little time to
exercise regularly due to
demanding office hours.
During hospitalization, the
client is mostly confined in
bed due to her condition.
Cognitive-
Perceptual
pattern
The client graduated from
Jose Rizal College and took
BSBM. The client
communicates well.
Client was able to follow
instructions given to her
by the doctor and nurses
but appears to be easily
distracted from the
abdominal pain she felt
during our interview.
Client has good
communication skills but
easily gets distracted
which is brought about by
the pain she is feeling.
Acute pain related to
abnormal uterine
bleeding secondary to
adenomyosis
Page 6 of 38

7. Self-
perception
/Self Concept
Pattern
“Noon, okay naman ako.
Kaya ko i-manage ang
condition ko. Wala naman
akong problema at hindi
ko iniisip yung sakit ko
basta iniinom ko yung
gamut” as verbalized by
the client.
Client is aware of the fact
that she cannot have
children anymore but
appear to be indifferent
about the subject during
the interview. She
answered the question
vaguely and attempted to
change the topic by
complaining about
different things.
“Sino ba naman ang hindi
matatakot kapag alam
mong ooperahan ka” as
verbalized by the client.
The fear and the possible
after effects of the
upcoming surgery make
the client to be hesitant in
verbalizing her feelings
about her condition.
Fear R/T Upcoming
Surgery
Altered disturbed body
image related to loss of
child bearing potential.
Role
/Relationship
Pattern
Client is single and lives
with her parents and has 4
siblings. She is the oldest.
Client reports being close
with her sisters. She helps
her parents financially by
paying the house bills.
Clients sister visits and
watches over her during
her stay in the hospital.
Her sister remained the
client’s source of support.
Client has a good
relationship with her
parents and siblings. They
serve as her support
system especially now that
she is hospitalized.
Sexuality-
Reproductive
Pattern
Client has menstruations
every 28 days lasting 7-8
days.
She is single and reported
having no time for one.
“Busy ako sa work pero
hindi ko naman sinasara
ang sarili ko sa
pagkakaroon ng relasyon
in the future” as verbalized
by the client.
“Ngayon alam ko na hindi
na ko magkakaanak eh
bakit pa ako
magrerelasyon d ba?” as
verbalized by the client.
The client is aware of her
need to undergo surgery
and its end result of loss of
reproductive function.
Sexual Dysfunction R/T
altered reproductive
function secondary to
adenomyosis.
Coping Stress
Pattern
“Kinakausap ko mga
magulang at mga kapatid
ko pag may problema ako.
Nag tutulungan kami sa
mga problema naming.”
As verbalized by the client.
Client’ sister stays with her
during her hospitalization
and tries to comfort her
when she appears
concerned about her
scheduled operation.
The client has strong
support system from her
sisters and has helped her
cope with hospitalization.
Page 7 of 38

8. Value /Belief
Pattern
Client is Roman Catholic
and goes to church
weekly.
Due to hospitalization
client is unable to attend
Sunday mass but reports
praying multiple times a
day for strength.
Clients’ faith remains the
same and though
hospitalization has
stopped her from hearing
mass temporarily, she still
relies on her faith for
strength.
V. PHYSICAL ASSESSMENT
Date and Time Performed: March 06, 2013 – 11:00am
Vital Signs:
Temperature - 36.7˚C
Pulse Rate - 80 bpm
Respiratory Rate - 20 cpm
Blood pressure - 120/60 mmHg
GENERAL SURVEY: The client is 31 years of age, secretary in a company. She is well groomed
and hygienic. She is able to ambulate with ease and slouch posture. She is aware of stimuli from
the environment and within the self. The client was cooperative and can verbalize own
thoughts and answer questions logically and in sequence.
Body Parts Technique
Used
(IPPA)
Findings Analysis
Skin Inspection
Palpation
Color: fair complexion
Symmetry of color: uniform
Edema: no edema
Skin Turgor: good
No lesions, abrasions
No deviation from
normal
Hair Inspection Silky hair,
Thin hair
No infestations noted
No deviation from
normal
Head Inspection
Palpation
Mass/Lesions: no mass/lesions on the scalp
Size and shape: Normocephalic
Facial features: symmetric
Facial movements: symmetric
There is no facial
nerve damage as
evidenced by
Nails Inspection
Palpation
Nail Curvature: convex curvature
Texture: smooth
Nail Bed Color: pinkish
Surrounding Tissue: intact
Capillary refill: less than 2 seconds
No deviation from
normal
Page 8 of 38

9. Eyes Inspection Eyebrows: evenly distributed
Eyelashes: equally distributed
Eyelids: intact
No discharge; No discoloration
sclera is white & clear
Bilateral blinking
Can able to read fine print on a notebook
It shows that there is
no damage in the CN
II, III, IV and VI of the
patient
Ears Inspection Pinna: symmetrical
Color: same as skin color
Hearing acuity: Audible normal voice
No discharge; No tenderness
No lesions or abrasions
No deviation from
normal
Mouth Inspection Lips: dark pink
Teeth: complete set of teeth (16 upper teeth
and 16 in the lower teeth), shiny white
Gums: pinkish, moist, and firm
Tongue: at the midline, pinkish, and movable
The tongue can move
freely which indicate
that the hypoglossal
(CN IX) and
glossopharyngeal
cranial nerve (CN XII)
Neck Inspection
Palpation
Skin intact, no lesions and masses; No
redness;
No deviation from
normal
Thorax Inspection
Palpation
Auscultation
Breathing patterns: normal
Skin: smooth and intact; no tenderness,
lesions and abrasions
shape and symmetry: anterior to transverse
ratio is 1:2
spine is straight, no lumps, no masses,
full & symmetric chest expansion;
No deviation from
normal
Abdomen Inspection
Auscultation
Palpation
Uniform in color, no lesions or abrasions.
Stomach is distended
Normal bowel sound
Tenderness at the epigastric region
The abdominal
distention is caused by
the enlargement of
the uterus which
causes pain
Reproductive
organ
Inspection Vaginal bleeding, light red Vaginal bleeding is due
to the sloughing off of
the uterus
Upper
extremities
Inspection
Palpation
equal in size, No involuntary movements, no
edema, pinkish, symmetrical, fine hair evenly
distributed, both shoulders, arms, elbows,
Smooth, well coordinated movement
IV inserted D5LR 1L x 80
on the left dorsum
hand. No swelling on the IV site
All findings are normal
Page 9 of 38

10. Lower
extremities
Inspection
Palpation
Equal in size, no lesions and abrasions, fine
hair is evenly distributed.
Symmetrical, legs, knees, ankles, & toe can be
moved in different range of motion with
relative ease.
- All findings are
normal
VI. ANATOMY AND PHYSIOLOGY
The Female Reproductive System
The female reproductive system is designed to carry out several functions. It produces
the female egg cells necessary for reproduction, called the ova or oocytes. The system is
designed to transport the ova to the site of fertilization. Conception, the fertilization of an egg
by a sperm, normally occurs in the fallopian tubes. After conception, the uterus offers a safe
and favorable environment for a baby to develop before it is time for it to make its way into the
outside world. If fertilization does not take place, the system is designed to menstruate (the
monthly shedding of the uterine lining). In addition, the female reproductive system produces
female sex hormones that maintain the reproductive cycle. During menopause the female
reproductive system gradually stops making the female hormones necessary for the
reproductive cycle to work. When the body no longer produces these hormones a woman is
considered to be menopausal.
The female reproductive anatomy includes internal and external structures.
The function of the external female reproductive structures (the genital) is twofold: To enable
sperm to enter the body and to protect the internal genital organs from infectious organisms.
The main external structures of the female reproductive system include:
• Labia majora: The labia majora enclose and protect the other external reproductive
organs. Literally translated as "large lips," the labia majora are relatively large and
fleshy, and are comparable to the scrotum in males. The labia majora contain sweat and
oil-secreting glands. After puberty, the labia majora are covered with hair.
• Labia minora: Literally translated as "small lips," the labia minora can be very small or
up to 2 inches wide. They lie just inside the labia majora, and surround the openings to
Page 10 of 38

11. the vagina (the canal that joins the lower part of the uterus to the outside of the body)
and urethra (the tube that carries urine from the bladder to the outside of the body).
• Bartholin’s glands: These glands are located next to the vaginal opening and produce a
fluid (mucus) secretion.
• Clitoris: The two labia minora meet at the clitoris, a small, sensitive protrusion that is
comparable to the penis in males. The clitoris is covered by a fold of skin, called the
prepuce, which is similar to the foreskin at the end of the penis. Like the penis, the
clitoris is very sensitive to stimulation and can become erect.
The internal reproductive organs include:
• Vagina: The vagina is a canal that joins the cervix (the lower part of uterus) to the
outside of the body. It also is known as the birth canal.
• Ovaries: The ovaries are small, oval-shaped glands that are located on either side of the
uterus. The ovaries produce eggs and hormones.
• Fallopian tubes: These are narrow tubes that are attached to the upper part of the
uterus and serve as tunnels for the ova (egg cells) to travel from the ovaries to the
uterus. Conception, the fertilization of an egg by a sperm, normally occurs in the
fallopian tubes. The fertilized egg then moves to the uterus, where it implants to the
uterine wall.
• Uterus (womb): The uterus is a hollow, pear-shaped organ that is the home to a
developing fetus. The uterus is divided into two parts: the cervix, which is the lower part
that opens into the vagina, and the main body of the uterus, called the corpus. The
corpus can easily expand to hold a developing baby. A channel through the cervix allows
sperm to enter and menstrual blood to exit.
Uterus consists of three divisions:
• Body or corpus – the uppermost part and forms the bulk of the organ.
• Isthmus – is a short segment between the body and the cervix.
• Cervix – is the lowest portion the uterus.
Uterine wall consists of three layers:
• Endometriun layer – an inner one of mucous membrane. It is the one important for
menstrual function.
• Myometrium or muscle layer – serves the important function of constricting the tubal
junctions and preventing regurgitation of menstrual blood into the tubes.
• Perimetrium or the outermost layer – serves the purpose of adding strength and
support to the structure.
Page 11 of 38

12. VII. Pathophysiology
Page 12 of 38
Predisposing Factor
• Age (31 y/o)
Endometrial cells invade the myometrium
Endometrial tissues deposits in the myometrium
Myometrium becomes enlarged
Symptomatic
Growth of endometrial tissues
Adenomyosis
Prolonged increase of
estrogen levels
Thickening of Endometrium and becomes
highly vascularized
Thickened endometrium sloughs off causing an
increase menstrual blood flow
Enlarged uterus extending to
the GIT
Abdominal swelling
Abnormal vaginal bleeding occurs

13. VIII. LABORATORY/DIAGNOSTIC EXAMINATION
1. Blood Test (March 2, 2013)
Page 13 of 38

14. Page 14 of 38
Examination Result Reference Values Analysis
Hemoglobin 6.1 12.0 – 16.0 g/dl Indicates a decrease
of iron containing
protein of RBC that
carries oxygen to the
tissue due to
bleeding.
Hematocrit 21.9 38 – 47 % The result indicates
an excessive loss of
erythrocytes due to
bleeding.
RBC 3.54 4.0 – 6.0 10^6/ul An indication that
the patient is
suffering from
anemia due to
bleeding.
Mean Corpuscular
Hemoglobin
17.2 26 – 34 pg Indicates that the
weight of Hgb in the
blood is decrease due
to blood loss.
Mean Corpuscular
Volume
61.9 80 – 100 fl The size of
erythrocyte become
smaller than normal
due to blood loss.
Mean Corpuscular
Hemoglobin
concentration
27.9 31 – 37 g/dl A low concentration
of Hgb in the blood
is due to blood loss.
WBC 33.77 4.5 – 11.0 10^3/ul Increase production
of WBC indicates
the presence of
bacterial infection.
Neutrophils 92.7 50 -70 % In the presence of
bacteria, neutrophils
also produced to help
WBC fight bacteria
through ingestion or
phagocytosis
Lymphocytes 7.1 20 – 40 % An indicative of
decrease production
of antibodies due to
infection
Monocytes 3.1 0 – 7% No deviation from
normal
Eosinophils 4.1 0.0 – 5.0 % No deviation from
normal
Basophils 0.0 0.0 - 1..0 % No deviation from
normal
Platelet 328 150 – 400 10^3 /
ul
No deviation from
normal

15. Remarks: Platelet Adequate
2. Activated Partial Thromboplastine Time (March 2, 2013 ; 11:08pm)
Examination Result Reference Values Analysis
Patient 29.4 25 – 35 seconds No deviation from normal
Control 29.6 Seconds No deviation from normal
3. Blood Bank Section (March 2, 2013 ; 12:15 am)
Test Name Result
Blood Typing: (-)ABO (+)RH Type: “A” Rh (D) Positive
Analysis: Use to know the blood type of the patient for possible blood transfusion.
4. Chemical Examination (March 2, 2013 ; 11:58pm)
Examination Result Reference Values Analysis
Potassium 3.3 3.5 – 5.1mmol/L No deviation from normal
Creatinine 67.8 50.4 – 98.1mmol/L No deviation from normal
BUN 6.7 2.5 – 6.7mmol/L No deviation from normal
5. Urinalysis Report (March 3, 2013 ; 12:57am)
Physical Characteristics
Examination Results Reference Values Analysis
Color Dark Yellow Yellow Blood is mix in the urine that
turns out abnormal result.
Page 15 of 38

16. Transparency Hazy Clear Blood is mix in the urine that
turns out abnormal result.
Reaction 5.0 4.6 -8.0 No deviation from normal
Specific Gravity 1.025 1.016 – 1.029 No deviation from normal
Chemical Examination
Examination Results Reference Values Analysis
Leukocytes 2+ (75 WBCs/Ul) Negative The presence of leukocytes
in the urine is due to the
presence of bleeding from
the vagina that makes an
altered result.
Nitrite Negative Negative No deviation from normal
Urobilinogen Normal Negative No deviation from normal
Protein 2+ (100mg/dl) Negative A protein is present in the
urine due to vaginal bleeding
it alters the result of the test.
Blood 1+ Negative A vaginal bleeding gives a
false result indicating a
presence of blood in the
urine.
Ketone 2+ (100mg/dl) Negative A presence of ketone in the
urine due to vaginal bleeding
it alters the result of the test
Bilirubin Negative Negative No deviation from normal
Glucose Negative Negative No deviation from normal
Microscopic Examination
Page 16 of 38

17. Examination Result Unit Reference
Range
Result Unit Reference
Range
RBC 3.0 /hpt 0 – 2 16.5 /uL 0 – 11
WBC 14.3 /hpt 0 – 3 79.7 /uL 0 – 17
Bacteria 51.0 /hpt 0 – 50 283.3 /uL 0 – 278
Epithelial cells 22.5 /hpt 0 – 3 125.1 /uL 0 – 17
Casts 0.00 /hpt 0 - 3 0.00 /uL 0 - 1
Analysis: RBC, WBC, Bacteria, Epithelial cells – Elevated values indicates a contamination of
RBC into the urine due to vaginal bleeding.
Pregnancy Test: Negative
6. Blood Cross Matching (March 3, 2013)
Cross Matching
Pt. Type: “A” RH Positive Blood Component: Packed RBC
Donors Type: “A” RH Positive Blood Bank Number:
: VRPMC 21336 at 1:35am
: VRPMC 21314 at 6:00am
: NVBSP 2013-0014456 at 9:03am
: PRC RIZAL 2011-166326 at 2:38pm
Cross Matching: Compatible in all Phases
Analysis: All the blood supplies to be transfused are compatible with the patient blood
type.
7. Chest X-ray (PA and AP)
Interpretation:
Poor Inspiratory film
Page 17 of 38

18. Lungs are clear, pulmonary vessels are within normal limit.
Heart is not enlarged.
Diaphragm and sulci are intact
The visualized bony and soft tissue structures are normal.
Impression: No Significant chest findings
Analysis: To check the condition of the lung and to seek approval from the cardiologist that
the patient is cleared from any complication prior to surgery.
8. Blood Test (March 4,2013 ; 6:08am)
Examinations Results Reference Values Analysis
Hemoglobin 10.5 12.0 – 16.0 g/dl The iron containing protein
of RBC is still below normal
values indicates bleeding
still present.
Hematocrit 32.4 38 – 47 % An indication that there is
still inadequate blood due
to bleeding.
RBC 4.16 4.0 – 6.0 10^6/ul RBC is already in normal
values indicating a recovery
from anemia.
Mean
Corpuscular
Hemoglobin
25.2 26 – 34 pg The weight of Hgb is still
more light or smaller than
normal.
Mean
Corpuscular
Volume
77.9 80 – 100 fl Slight lower values indicate
the size of erythrocyte is
still smaller from normal
(microcytic).
Mean
Corpuscular
Hemoglobin
concentration
32.4 31 – 37 g/dl The Hgb concentration
regain to normal value.
WBC 27.39 4.5 – 11.0 10^3/ul High value indicates
bacterial infection is still
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19. present due to bleeding.
Neutrophils 84.6 50 -70 % Still higher amount
produced to help fight
bacteria by phagocytosis.
Lymphocytes 5.7 20 – 40 % Indicates that the body
protection from infection
still inadequate
Monocytes 9.4 0 – 7% Indicates the presence of
bacteria does remove
debris of foreign particle
from the circulation.
Eosinophils 0.1 0.0 – 5.0 % No deviation from normal
BasoPhils 0.2 0.0 - 1..0 % No deviation from normal
Platelet 174 150 – 400 10^3 /
ul
No deviation from normal
Remarks: Platelet Adequate
9. Blood Bank Section (March 4,2013 ; 19:30)
Cross Matching
Pt. Type: “A” RH Positive Blood Component: Packed RBC
Donors Type: “A” RH Positive Blood Bank Number: VRPMC 21305
Cross Matching: Compatible in all Phases
Analysis: The blood supplies to be transfused are compatible with the patient blood type.
10. Chemical Examination (March 4, 2013)
Examination Result Reference Value Analysis
Potassium 3.5 3.5 – 5.1 mmol/L No deviation from
normal
Calcium 1.92 2.10 – 2.55 mmol/L Indicate a low
protein level in blood
Page 19 of 38

20. 11. Blood Test (March 6, 2013 ; 12:21am)
Examinations Results Reference Values Analysis
Hemoglobin 12.6 12.0 – 16.0
g/dl
No deviation from normal
Hematocrit 38.7 38 – 47 % No deviation from normal
RBC 4.82 4.0 – 6.0
10^6/ul
No deviation from normal
Mean
Corpuscular
Hemoglobin
26.1 26 – 34 pg No deviation from normal
Mean
Corpuscular Vol.
80.3 80 – 100 fl No deviation from normal
Mean
Corpuscular
Hemoglobin
concentration
32.6 31 – 37
g/dl
No deviation from normal
WBC 20.71 4.5 – 11.0
10^3/ul
High value indicates
bacterial infection is still
present.
Neutrophils 81.9 50 -70 % Still higher amount
produced to help fight
bacteria by phagocytosis.
Lymphocytes 7.1 20 – 40 % Indicates that the body
protection from infection
still inadequate
Monocytes 9.9 0 – 7% Indicates the presence of
bacteria does remove
debris of foreign particle
from the circulation.
Eosinophils 0.8 0.0 – 5.0 % No deviation from normal
BasoPhils 0.3 0.0 - 1..0 % No deviation from normal
Platelet 242 150 – 400
10^3 / ul
No deviation from normal
IX. Medical Intervention
Date & Time Ordered Medical Operaions Classification Rationale
Page 20 of 38

21. March 02 2013
11:10 pm
Admit under the service
of Dr.A
Therapeutic To secure and observe the
client condition, to give
proper intervention and for
further evaluation.
Monitor vital sign every
hour & record
Therapeutic To monitoring the client’s
condition, with gradual
intervals.
Diet as Tolerated (DAT) Therapeutic Will provide the client
essential nutrients with
the foods that she can
tolerate
IVF# 1 Hydrate 300cc
PNSS then re-hydrate to
30gtts/min.
Therapeutic To maintain the client’s
hydration status
Give Tranexamic Acid
1grm IV every 8 hours
Therapeutic Anti-fibrinolytic
To control abnormal
uterine bleeding
Pad count Therapeutic Will give a rough estimate
of the amount of blood
loss of the client as well as
providing close monitoring
Insert foley catheter &
monitor output
Therapeutic Accurate monitoring of
client’s urine output. With
decrease in urine output
indicating possible
hypovolemia caused by
prolonged bleeding
11:35 pm For blood transfusion of
4 units PRBC properly
type & cross-matched X 4
hours
Therapeutic To replace the client’s
blood loss as well as
increasing the oxygen-
carrying capacity of the
client's blood.
Give Premarin
0.625mg/tab 2tabs. Q 6
hours until feeding stop.
Therapeutic Hormone therapy to
control heaving bleeding
Give Calcium Gluconate
1amp. TIV after 3rd
unit
of PRBC
Therapeutic PRBC contain traces of
citrate which binds with
calcium lowering ionized
plasma calcium
concentration. Calcium
gluconate was ordered to
prevent possible
hypocalcemia post BT
Page 21 of 38

22. Repeat CBC 6 hours post
transfusion
Diagnostic To check if the transfusion
is effective and to evaluate
the composition and
concentration of the
cellular components of
blood.
11:45pm Give cefuroxime (Zejen)
1.58 TIV (-)ANST then
750mg IV every 8 hours
Therapeutic To prevent infection
March 03,2013
5:40 am
Increase Tranexamic acid
to 2gm TIV every 8 hours
Therapeutic To achieve desired
therapeutic effect of
controlling abnormal
uterine bleeding
Increase Premarin
0.625mg/tab 4tabs now
then every 6 hours
Therapeutic To achieve desired
therapeutic effect of
controlling abnormal
uterine bleeding
Start IVF D5H2O iL + 20
mEq KCL @ 30gtts
x3cycle
Therapeutic
6:35am For endometrial biopsy
now
Diagnostic To rule out other possible
causes of abnormal
uterine bleeding
For CP clearance for
possible hysterectomy
Diagnostic To assess if the client can
tolerate such procedure
6:45am Hold Premarin Therapeutic In preparation for possible
hysterectomy that may
increase the risk of clot
formation
NPO Therapeutic In preparation for
possible hysterectomy
7:50am Give omeprazole 40mg
OD IV
Therapeutic Will serve as an anti-reflux
medication before a
surgery to prevent
aspiration
Give Plasil 1amp. Every 8
hours for vomiting
Therapeutic Symptomatic relief of
vomiting
Pls. Submit endometrial
curetting’s for
histopathology
Diagnostic To determine the
anatomical pathology of
the endometrial tissue
obtained
Page 22 of 38

23. 8am Resume Premarin Therapeutic Control abnormal uterine
bleeding
NPO except meds Therapeutic In preparation for possible
surgery
Admit to MICU
(medicine ICU)
Therapeutic Allow close monitoring of
the client’s condition
9:15am For ECG & chest X-ray Diagnostic .
Continue BT Therapeutic Replace blood loss thus
preventing hypovolemia
IVF to ff: PNSS 1L at KVO Therapeutic Provide access for future
need of BT
Decreased traxenamic
acid 500mg IV every 8
hours
Therapeutic Adjust treatment in
accordance to the client’s
need and condition
6:15pm May transfer to room
@7pm
Therapeutic Client’s condition is more
stable that do not
necessitate monitoring
from MICU
Pls. Monitor vital sign
every 1 hour & record
until stable.
Therapeutic For close monitoring of the
client’s condition
Pls. Monitor urine output
every 1 hour & refer if <
30cc/hr
Therapeutic Urine output provides an
accurate indication of the
client’s hydration status.
Urine output of less than
30cc/hr may indicate more
bleeding that may lead to
hypovolemia
Watch out for untoward
s/sx such as vaginal
bleeding, difficulty of
breathing, palpitation,
hypogastric pain
Therapeutic These are signs and
symptoms of embolism
that may result from
uncontrolled bleeding
May have DAT Therapeutic Provision of needed
nutrition with foods that
the client can tolerate
For CBC @6am Diagnostic To assess level of all blood
components
Refer CBC 6hours post BT
ordered 32 13
Diagnostic To assess effectiveness of
BT
Pls. Give nalbuphine Therapeutic Relief of moderate to
Page 23 of 38

24. (Nubain) 1amp. IV severe pain associated
with Adenomyosis
March 04, 2013
5:40am
Paracetamol 1amp. TIV
now
Therapeutic To relieve elevated body
temperature
Start arcoxia 120mg OD
& algesia 1tab. TID p.o.
Therapeutic To continue symptomatic
relief of moderate to
severe pain associated
with Adenomyosis
For potassium serum
determination
Diagnostic To note potassium level
post administration of KCL
on 3/3/2013
Meds: a. premarin 0.625mg
4tab OD IV
b. may shift tranexamic
IV to 500g 2 tab p.o
every 6 hours
c. sangobion 1 tab. OD
d. arcoxia 120mg OD x
2days
e.algesia 1 tab TD x 3days
f. centrum 1 cap. OD
Therapeutic a. hormonal therapy to
control bleeding
b. client is able to tolerate
oral medication to control
bleeding
c. organic iron supplement
d. relief of pain associated
with Adenomyosis
e. relief of pain associated
with Adenomyosis
f. supplement
May shift cefuroxime IV
to cefuroxime 500g TID
Therapeutic Client is able to tolerate
oral medication needed
prophylaxis for infection
12:50pm CARDIO.
-Suggest transfusion of 2
more unit of PRBC prior
to hysterectomy
Therapeutic In preparation for possible
blood loss during the
surgery thus preventing
hypovolemia
10:00pm hemostan IV 500mg
every 8 hours
Therapeutic To treat and prevent
further bleeding
Repeat CBC 12 hours
after the 6th
unit of PRBC
Diagnostic Assess effectiveness of BT
as well as blood
composition and the need
for further BT
March 05, 2013
6:00am
CBC @ 8pm post BT Diagnostic Assess blood composition
and the need for
additional BT
For TAHBSO 7:30 am
march 07,2013 with
consent
Therapeutic Provide definite relief of
bleeding
2:25pm
ANESTHESIA:
Pre. meds
Pre-op order.
NPO post-midnight on
Therapeutic NPO in preparation for
TAHBSO
Page 24 of 38

25. the day of operation
(3/7/13)
a. nalbuphine 10mg
b. diphenhydramine
50mg
Therapeutic a. will prolong effect of
anesthesia during surgery
b. prophylaxis for allergic
reaction
Page 25 of 38

26. IX. Drug Study
Generic
name
Brand
name
Classification Dosage Mechanism of
action
Indication Contraindication Adverse Reaction Nursing
Consideration
Cefuroxime Cefuroxime
Sodium
(Zinacef
[Parenteral])
Antibiotic
cephalosporin
750mg
q8 IV
Second-
generation
cephalosporin
that inhibits
cell-wall
synthesis,
promoting
osmotic
instability;
usually
bactericidal.
Perioperative
Prevention
Contraindicated
in patients
hypersensitive to
drug.
Use with caution
in breast-feeding
women and in
patients with
history of colitis
or renal
sufficiency.
CV: phlebitis, thrombophlebitis
GI: pseudomembranous colitis,
nausea, anorexia, vomiting,
diarrhea
Hematologic: transient
neutropenia, eosinophilia,
hemolytic anemia,
thrombocytopenia
Skin: maculopapular and
erythematous rashes, urticaria,
pain, induration, sterile abscesses,
temperature elevation, tissue
sloughing at intramuscular
injection site
Before
administering,
make sure
patient is not
allergic to
penicillins or
cephalosporins.
Absorption of
cefuroxime
axetil is
enhanced by
food.
High-fat meals
increased drug
bioavailability.
Page 26 of 38

27. Generic
name
Brand
name
Classification Dosage Mechanism of
action
Indication Contraindication Adverse
Reaction
Nursing Consideration
Tranexamic
acid
Hemostan
Anti-
fibrinolytic,
antihemorrhagi
c
500 mg
q8 IV
Exerts its
antifibrinolytic
effect through the
reversible blockade
of lysine-binding
sites on plasminogen
molecules.
Inhibits endometrial
plasminogen
activator and thus
prevents fibrinolysis
and the breakdown
of blood clots.
Treating
heavy
menstrual
bleeding
Allergic reaction
to the drug or
hypersensitivity
1. Presence
of blood clots
(eg, in the leg,
lung, eye,
brain), have a
history of
blood clots, or
are at risk for
blood clots
2. Current
administration
of factor IX
complex
concentrates or
anti-inhibitor
coagulant
concentrates
Nausea,
vomiting,
loss of
appetite,
headache,
impaired
renal
insufficiency,
and
hypotension.
Inform the client that he/she
should inform the physician
immediately if the following
severe side effects occur:Severe
allergic reactions such as rash,
hives, itching, dyspnea, tightness
in the chest, swelling of the
mouth, face, lips or tongue
- Swallow Tranexamic Acid
whole with plenty of liquids. Do
not break, crush, or chew before
swallowing.
- The medication can be taken
with or without meals.
- For women who are taking
Tranexamic acid to control heavy
bleeding, the medication should
only be taken during the
menstrual period.
Page 27 of 38

28. Generic
name
Brand
name
Classification Dosage Mechanism
of action
Indication Contraindication Adverse
Reaction
Nursing Consideration
Arcoxia Etoricoxi
b
NSAIDs 120 mg
OD x2
days PO
Analgesic,
anti-
inflammatory
Relief of
acute pain
Elderly people
History
of disorders
affecting
the stomach
or intestines, such
as ulceration
or bleeding
Decreased kidne
y function
Decreased liver
function
Headache, Dizzi
ness
Disturbances of
the gut such as
diarrhea,
constipation,
nausea, vomiting
,
indigestion, flatu
lence
or abdominal
pain
Excessive
fluid retention in
the body tissues,
resulting in
swelling (edema)
High blood
pressure(hyperte
nsion)
Weakness or loss
of strength
(asthenia
Teach patient to take medicine
or medications as physicians ordered.
Tell the patient for the possible effects of
drug prior to its adverse reactions and consider
such reactions mentioned as normal.
Provide the patient with the proper
management upon taking medications.
Tell the patient to seek for help if no
such effects of drug are noted or that
if symptoms prior to his conditions are still
noted.
Tell patient to maintain his normal diet
and the possible consequences
Of the drugs effect concerning on his appetite.
Page 28 of 38

29. Generic
name
Brand
name
Classification Dosage Mechanism
of action
Indication Contraindication Adverse Reaction Nursing Consideration
Omeprazole Losec, Anti-secretory
drug
proton pump
inhibitor
40 mg
OD IV
Gastric acid-
pump
inhibitor:
Suppresses
gastric acid
secretion by
specific
inhibition of
the hydrogen
potassium
ATPase
enzyme
system at the
secretory
surface of the
gastric
parietal cells;
blocks the
final step of
acid
production.
Treatment
of
heartburn
or
symptoms
of GERD
Hypersensitivity
to omeprazole or
its components
-Use cautiously
with pregnancy,
lactation.
CNS: Headache,
dizziness, asthenia,
vertigo, insomnia,
apathy, anxiety,
paresthesia, dream
abnormalities
DERMATOLOGIC:
Rash,
inflammation,
urticaria, pruritis,
alopecia, dry skin
GI: Diarrhea,
abdominal pain,
nausea, vomiting,
constipation, dry
mouth, tongue
atrophy
RESPIRATORY: URI
symptoms, cough,
epistaxis
-Take the drug before meals. Swallow
the capsules whole; do not chew,
open, or crush them. If using the oral
suspension, empty packet into a small
cup containing 2 table spoons of
water. Stir and drink immediately, fill
cup with water and drink the water.
Do not use any other liquids or food
to dissolve the packet.
-Have regular medical follow up visits.
-Report severe headache, worsening
of symptoms, fever, chills, severe
diarrhea.
Page 29 of 38

30. Generic
name
Brand
name
Classification Dosage Mechanism
of action
Indication Contraindication Adverse
Reaction
Nursing Consideration
Paracetamol Biogesic, Analgesics
(Non-opiod)
Antipyretics
1 tab
TIDx3d
ays
PO
Paracetamol
reduces the
synthesis of
prostaglandin
s which are
responsible
for the
mediation of
pain and
fever.
Mild to
moderate pa
in
Fever
Hypersensitivity Indigestion
Nausea
Allergic
reactions
Hives
Rash
Drug fever
Assess patient’s pain or temperature
before therapy.
Assess the patient’s drug history and
calculate the total dosage accordingly.
Tell the patient not to use the drug for
fever that is higher than 103.1F. lasts
longer than 3 days.
Warn patient that high doses or long
term use can cause liver damage.
Tell patient to keep track of daily drug
intake
Page 30 of 38

31. Generic
name
Brand
name
Classification Dosage Mechanism
of action
Indication Contraindication Adverse
Reaction
Nursing Consideration
Multivita
mins
Centrum Vitamins and
Minerals
1 tab
OD PO
These
vitamins are
necessary for
normal
growth and
development.
Many act as
coenzymes
or catalysts
in numerous
metabolic
processes
For dietary
supplement
Hypersensitivity
to a vitamin or
any mineral (such
as fluoride,
calcium, iron,
zinc and others)
Tiredness, loss
of appetite,
indigestion,
nausea,
staining of
teeth,
constipation,
diarrhea, black
stool
Watch for any signs of allergic
reactions
Should be taken with food. Take during
or after meal
Encourage to comply with physician’s
recommendations.
Instruct to notify side effects of
medications immediately
Page 31 of 38

32. Generic
name
Brand
name
Classification Dosage Mechanism
of action
Indication Contraindication Adverse
Reaction
Nursing Consideration
Multivita
mins
Sangobion Vitamins and
Minerals/ Anti
- anemics
1 tab
OD PO
These
vitamins are
necessary for
normal
growth and
development.
Many act as
coenzymes
or catalysts
in numerous
metabolic
processes
.
Anemia pro
phylaxis in
blood
donors.
Fe accumulation;
disorders in Fe
utilization
Diarrhea,
constipation,
stomach
cramps, black
stools
hives; difficulty
breathing;
swelling of
your face, lips,
tongue, or
throat.
Should be taken with food. Take during
or after meals
Watch out for any signs of allergic
reactions
Encourage to comply on medications
Instruct to notify side effects of
medications immediately
Page 32 of 38

33. Generic
name
Brand
name
Classification Dosage Mechanism
of action
Indication Contraindication Adverse Reaction Nursing Consideration
Calcium
Gluconate
Cal-G Antacid
Electrolyte
Neutralizes
or reduces
gastric
activity.
Dietary
supplemen
t when
calcium
intake is
inadequate
.
Prevention
of
hypocalce
mia during
exchange
transfusion
s.
Contraindicated
with allergy to
calcium, renal
calculi,
hypercalcemia,
ventricular
fibrillation during
cardiacrescucitatio
nand patients with
the risk of existing
digitalis toxicity.
Use cautiously
with renal
impairment,
pregnancy,
lactation.
CV: Slowed heart
rate, tingling, “heat
waves”(rapid IV
administration);
peripheral
vasodilation, local
burning
METABOLIC:
Hypercalcemia
(anorexia, nausea,
vomiting,
constipation,
abdominal pain,
dry mouth, thirst,
polyuria), rebound
hyperacidity and
milk alkali
syndrome
(hypercalcemia,
alkalosis, renal
damage with
calcium carbonate
used as an anracid).
Do not administer oral drugs within 1-2
hr of antacid administration.
Have patient chew antacid tablets
thoroughly before swallowing; follow
with a glass of water or milk.
Give calcium carbonate antacid 1 and 3
hour after meals and at bedtime.
Monitor serum phosphorus levels
periodically during long term oral
therapy.
Page 33 of 38

34. Nursing Diagnosis Interpretation
1. Fear related to upcoming surgery.
2. Sexual Dysfunction R/T Altered
reproductive function secondary to
Adenomyosis.
3. Fluid Volume Deficit R/T Adenomyosis
AEB Vaginal bleeding
4. Acute pain related to abnormal uterine
bleeding secondary to adenomyosis.
5. Altered disturbed body image related to
loss of child bearing potential.
1. The fear of the “unknown” is a common
concern of a preoperative client. The
mental preparation of a client before
surgery should be a main concern in
providing nursing care. Verbalizations and
clarification of what to expect about the
surgery is vital part in preventing or
reducing chance of complications during
surgery.
2. The client’s disease is affecting her quality
of life and should be addressed
accordingly. Surgery is needed in order to
stop the bleeding. Helping the client be
prepared for it is a main focus of care.
3. On admission client suffered from profuse
uterine bleeding. It was managed to be
kept to a minimal but client still continues
to have episodes of bleeding. Her
condition should be stabilized before
undergoing surgery to prevent further
complications.
4. Pain from the client can address by
conservative management. Encouraging
verbalization and comfort measures can
readily be done by the client.
5. Post-op concern of the client is her
inability to bear a child. This can be
address by having a support system from
family members be involved in
encouraging acceptance.
Page 34 of 38

35. XIII. Nursing Care Plan
ASSESSMENT NURSING
DIAGNOSIS
INFERENCE GOAL OF CARE INTERVENTION RATIONALE EVALUATION
Subjective Data:
 “Sino ba naman ang
hindi matatakot
kapag alam mong
ooperahan ka?” as
verbalized by the
client
 Verbalized sleep
disturbance
Objective Data:
 Easily distracted
 Facial tension
 Episodes of refusing
care
Fear R/T
Upcoming
Surgery
Uncontrolled
Bleeding
Scheduled
for TAHBSO
with Urethral
Stenting
Fear of the
unknown
During the
shift, client will
be able to
demonstrate
healthy ways
of dealing with
fear
Independent:
 Identified the client’s perception of the
threat presented by the situation
 Established a therapeutic relationship
with the client conveying empathy
 Encouraged verbalization of fears
 Explored coping skills previously used by
the client to relieve fear & reinforced
these skills
 Explained procedures & issues that
involves the client using non-medical
terms with calm, slow speech
 For better
understanding of the
client’s situation and
will serve as the basis
for other interventions
 To gain the client’s trust
so that she feels safe to
verbalize her feelings of
fear
 The client needs to talk
about her feelings to
begin resolution
 Methods of coping with
fear that have been
successful in the past
are likely to be helpful
again
 Client will feel less
anxious thus decreasing
fear when she knows
what to expect
Goal was
partially met.
During the shift,
the client was
able to verbalize
her feelings
about her
scheduled
surgery and was
cooperative
during our
assessment but
still reports
apprehension in
undergoing the
surgery.
Page 35 of 38

36. Page 36 of 38
ASSESSMENT NURSING DIAGNOSIS INFERENCE GOAL OF CARE INTERVENTION RATIONALE EVALUATION
Subjective
Data:
 “Ngayon alam
ko na hindi na
ko
magkakaanak
eh bakit pa ako
magrerelasyon
diba?” as
verbalized by
the client
Objective Data:
 Prolonged
vaginal
bleeding
 Scheduled for
TAHBSO with
Urethral
Stenting
Sexual Dysfunction
R/T Altered
reproductive
function secondary
to Adenomyosis
Adenomyosis
Uncontrolled
bleeding
Altered
reproductive
function
Sexual
Dysfunction
During the shift, the client will be
able to express feelings about
the alteration in her sexual
function
Independent:
 Provided factual
information about
the client’s
condition and it’s
implication to her
sexuality
 Encouraged and
accepted
expressions of
concern, anger,
and fear about her
condition as well
as her scheduled
operation
 Actively listened to
the client’s
expressions of
concern and fear
 By doing so, the client is
made aware that
although she do not have
the capability to
conceive, it does not
mean that she cannot
have relationships
 The client needs to talk
about these feelings to
begin resolution
 Active listening supports
the client without
intrusive advice giving
Goal partially
met. Client
was able to
partly
verbalize her
feelings with
the student
nurse but
remain
reserved with
the
information
that she
provided.

37. ASSESSMENT NURSING DIAGNOSIS INFERENCE GOAL OF CARE INTERVENTION RATIONALE EVALUATION
Objective
Data:
 Vaginal
bleeding
 Received
blood
transfusion
therapy of
PRBC
Risk for Fluid Volume
Deficit R/T
Adenomyosis AEB
Vaginal bleeding
Adenomyosis
Lining cells of the
uterus grows
directly into the
muscle wall of the
uterus
When lining cells of
the uterus bleed at
the time of
menstrual period,
these misplaced
cells in the muscle
bleed as well
Prolonged bleeding
Risk for Fluid
Volume Deficit
During the 8
hour shift, the
client will be
free from
untoward
complications
of bleeding
Independent:
 Monitored V/S routinely,
including B/P, PR, and RR
 Monitored I/O closely as ordered
and report urine output <30cc/hr
 Assessed skin color and
moisture, urinary output, and
level of consciousness
Dependent:
 Blood transfusion – 1U of PRBC
properly typed & crossed match
 Changes in V/S
particularly B/P, PR, &
Temp maybe used as a
rough estimate of blood
loss
 Urine output gives an
accurate picture of the
client’s fluid status. Urine
output of <30cc/hr is a
good indication of the
presence of fluid volume
deficit
 Changes in these signs
may be indicative of
blood loss affecting
systemic circulation
 In replacement of blood
loss from the circulation,
preventing hypovolemia
Goal met. The
client
remained free
from
untoward
complications
of bleeding
Page 37 of 38

38.  Monitored Hgb, Htc, RBC level as
ordered
 Scheduled for TAHBSO with
Urethral Stenting
 Aids in establishing blood
replacement needs and
monitoring the
effectiveness of Blood
transfusion therapy
 TAHBSO with Urethral
Stenting will provide
permanent cure of the
client’s condition
Page 38 of 38