JMJ Marist Brothers

NOTRE DAME OF MARBEL UNIVERSITY

Alunan Avenue, Koronadal City, South Cotabato

PARTIAL HYDATIDIFORM MOLE

A Case Study
Presented to the Faculty of Nursing Department
College of Arts and Sciences

In Partial Fulfillment of the Requirements in

NCM-N 109 B Care of Mother, Child At-Risk or with Problems

Maclaine Mia Yonnick F. Demegillo

Kristine Angelica M. Aguirre
Kaye Angelie G. Daguiwag
Zahara A. Datusataviran
Thea Vanice L. Demetrio
Ava Loraine D. Estrabon
Audre Cyle B. Ballerta
Mohaniejane K. Abdul
Kenneth A. De Panay
Ana Mae D. Abellera
Dawn Marie F. Alair
Lovely E. Benson
Donnah S. Factor
Oliver G. Palac

May 13, 2022

 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

ACKNOWLEDGEMENT

The researchers would like to acknowledge the contribution of the following:

To Notre Dame of Marbel University, specifically for the College of Arts and

Sciences, for becoming an avenue of quality education molding student nurses

towards becoming registered nurses.

To the program coordinator of the nursing department, Mrs. Annaleah

Caberoy, RN, MAN, and the clinical coordinator, Mrs. Lennie Anne Flores, RN,

MAN for ensuring that the student nurses become competent and well-founded in

performing their roles in giving out their care.

To the Clinical Instructors, Rosielie Lopez, RN, Bianey Mae Ranes, RN, and

Mari-Angeli Valencia, RN, for their critiques, suggestions, guidance, and shared

knowledge towards the realization of this paper.

To the client, who willingly participated in the conduct of this study. Your

time, effort, participation, and patience throughout the duration of the assessment

have played a huge part in the completion of this paper.

To the researchers’ family and friends, for their unending support and

motivation. Above all, to God Almighty, the source of power, heavenly wisdom,

knowledge, and strength. To all of you, thank you.

THE RESEARCHERS

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

TABLE OF CONTENTS

Title page ……………………………………………………………………………..... i

Acknowledgement …………………………………………………………………….. ii

Table of Contents ……………………………………………………………………... iii

List of Tables …………………………………………..…………………………….… v

List of Figures ………………………………………………………………………… vii

Chapter 1 Introduction ………………………………………………………………... 1

Background of the Study ……………………………………………………... 1

Statement of Objectives ………………………………………………………. 2

Scope and Delimitation ……………………………………………………….. 3

Chapter 2 Review of Related Literature …………………………………………….. 5

Anatomy and Physiology ……………………………………………………... 5

Chapter 3 Methodology ……………………………………………………………… 14

Chapter 4 Data Presentation, Interpretation, and Analysis ……………………… 16

Initial Data Base ……………………………………………………………… 16

Nursing Health History ………………………………………………………. 17

Past and Present Health History …………………………………… 17

Activities of Daily Living ……………………………………………... 19

Physical Assessment ………………………………………………………... 24

General Survey ………………………………………………………. 24

Cephalocaudal Assessment ………………………………………... 25

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Pathophysiology ……………………………………………………………... 29

Medical and Nursing Management ………………………………………… 34

Medical Management ……………………………………………...... 34

Laboratory Results …………………………………………………… 34

Drug Studies ………………………………………………………….. 51

Problem List ………………………………………………………...... 76

Nursing Care Plans ………………………………………………….. 77

Chapter 5 Summary, Conclusion, and Recommendation ……………………..... 86

Prognosis ……………………………………………………………... 86

Appendix A Readiness to Learn ………………………………………………….... 93

Appendix B Learning Contract ……………………………………………………... 96

Appendix C Consent for Study ……………………………………………………. 103

References ………………………………………………………………………….. 104

Curriculum Vitae ……………………………………………………………………. 107

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

LIST OF TABLES

Table 1 Demographic Data of Patient A.B. ……………………………………….. 16

Table 2 Vital Signs upon Assessment …………………………………………...... 24

Table 3 HBsAg Qualitative Result …………………………………………………. 37

Table 4 Blood Typing/Rh Typing Result …………………………………………... 38

Table 5 ꞵ-hCG Blood Pregnancy Test (Quantitative) Result ………………….... 39

Table 6 ꞵ-hCG Blood Pregnancy Test (Quantitative) Result ………………….... 40

Table 7 Pregnancy Test (Qualitative) Result ……………………………………... 40

Table 8 Urinalysis Result ………………………………………………………….... 41

Table 9 Complete Blood Count (CBC) Result …………………………………..... 44

Table 10 Complete Blood Count (CBC) Result …………………………………... 46

Table 11 Activated Partial Thromboplastin Time (aPTT) Result ……………….. 49

Table 12 Partial Thromboplastin Time (PTT) Result with INR ………………….. 50

Table 13 List of Ordered Drugs of Patient A.B. …………………………………... 51

Table 14 Drug Study of Cefuroxime ……………………………………………….. 52

Table 15 Drug Study of Diphenhydramine ………………………………………... 55

Table 16 Drug Study of Paracetamol (Naprex) …………………………………... 57

Table 17 Drug Study of Ketorolac (Dyrolac) …………………………………….... 60

Table 18 Drug Study of Nalbuphine (Nubain) …………………………………….. 62

Table 19 Drug Study of Ferrous Sulfate …………………………………………... 66

Table 20 Drug Study of Methylergonovine maleate (Methergine) ……………… 69

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Table 21 Mefenamic Acid (Ponstel) ……………………………………………...... 72

Table 22 Nursing Care Plan on Acute pain ……………………………………….. 77

Table 23 Nursing Care Plan on Impaired physical mobility ……………………... 80

Table 24 Nursing Care Plan on Risk for injury …………………………............... 84

Table 25 Health Education on Medication ………………………………………… 87

Table 26 Health Education on Exercise …………………………………………… 89

Table 27 Health Education on Treatment …………………………………………. 89

Table 28 Discharge Health Education ……………………………………............. 90

Table 29 Health Education on Follow-up Care …………………………………… 91

Table 30 Health Education on Diet ………………………………………………… 92

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

LIST OF FIGURES

Figure 1 The Organ of the Female Reproductive System ………………………. 5

Figure 2 The Uterus, Myometrium, and Endometrium …………………………... 7

Figure 3 The Menstrual Cycle …………………………………………………….... 9

Figure 4 The Fallopian Tube ………………………………………………………. 10

Figure 5 The Ovary ...……………………………………………………………….. 11

Figure 6 The Cervix ……………………………………………………………….... 12

Figure 7 The Vagina ………………………………………………………………... 13

Figure 8 Pathophysiology of Partial Hydatidiform Mole ………………………… 29

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

CHAPTER 1

INTRODUCTION

Background of the Study

One of the most vital aspects of society is health. Health is the state of

being physically, emotionally, mentally, socially, and spiritually well. The world

encounters problems that undermine health especially, maternal health.

Pregnancy is a joyful yet tough journey as it has a corresponding risk to both the

mother and child. Globally, the incidence of maternal and child morbidity and

mortality persists and needs to be mitigated. Maternal health is at risk because

pregnancy-related complications may develop due to a multitude of factors.

The World Health Organization (1948) defined maternal health as the

health of women during pregnancy, childbirth, and the postnatal period. Over the

years, the health-sector top global agenda is to improve maternal health

outcomes including the proper management of pregnancy-related diseases. For

instance, Gestational Trophoblastic Disease (GTD), a group of rare tumors that

occur during pregnancy in the fetal chorion, are among the conditions that affect

maternal health outcomes. According to the Cleveland Clinic (2018), the most

common type of GTD is molar pregnancy, commonly known as Hydatidiform

mole or H-mole. Molar pregnancy falls into two categories: complete and partial.

In complete molar pregnancies, the tissue that makes up the placenta is

abnormal, and no embryo is formed. On the other hand, partial molar pregnancy

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

occurs when an abnormal placenta is formed along with an embryo. Thus, the

main difference between complete and partial mole is the formation of fetal

tissue, which is only present in the partial mole. Both types of molar pregnancy

are usually benign but a complete molar pregnancy is more likely to become

malignant or cancerous.

In the United States, H-mole occurs in about 1 in 2,000 pregnancies.

Meanwhile, there is a high incidence rate of H-mole in Asian countries among

women aged under 17 or over 35 (Ramirez & Salvo, 2020). In North America,

Europe, and Southeast Asia, the incidence of H-mole is 1 to 2 in every 1000

pregnancies. Locally, according to the case report of Lagare and Lu-Lasala

(2019), the incidence of H-mole in the Philippines is 1 in 250 pregnancies in the

Southern Philippines Medical Center (SPMC).

Consequently, the researchers conducted this case study to evaluate the

case management of the respondent with partial hydatidiform mole.

Statement of Objectives

The study aims to present a case analysis of Patient A.B. with the

condition of partial hydatidiform mole.

Specifically, the study seeks to:

1. Present the patient pertinent data and information, including the initial data

base, health history, clinical data, laboratory results, etc.;

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

2. Elaborate on the pathophysiology of the patient condition, including the

predisposing and precipitating factors, clinical manifestations, signs and

symptoms, complications, diagnostic procedure, and the nursing and

medical management;

3. Present the result and implications of the patient diagnostic examination

and laboratory results;

4. Create a list of drug studies prescribed to the patient that is relevant to the

management of partial hydatidiform mole;

5. Enumerate the nursing problems of the case study and construct a

nursing care plan according to the priority of concern;

6. Summarize the discharge plans and health education provided to the

patient; and

7. Evaluate and discuss the overall health outcome or prognosis of the

patient.

Scope and Delimitation

The respondent of the study is a 41-year-old female with a clinical case of

partial hydatidiform mole. The case study will focus on analyzing the case

management of the patient’s condition of partial hydatidiform mole and the

researchers will not include the patient's type II diabetes mellitus because it is not

related to the hydatidiform mole. The time allotment of the case study manuscript

is from April 11, 2022, until May 6, 2022. The respondent resides in Polonuling,

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Tupi, South Cotabato. Due to the ongoing COVID-19 pandemic, face-to-face

interaction will be limited, hence, the researchers will utilize online platform

utilities to obtain the personal health records of the patient.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

CHAPTER 2

REVIEW OF RELATED LITERATURE

Reproductive System

Anatomy and Physiology

The organs of the female reproductive system include the uterus, ovaries,

fallopian tube, and vagina. The main function of the female reproductive system

is to produce egg cells, known as ova or oocytes, to be fertilized. The ovaries

also produce hormones that help the reproductive organs to mature and regulate

the menstrual cycle. The uterus provides the fertilized eggs a nourishing

environment to develop into healthy offspring (U.S. National Institutes of Health,

National Cancer Institute, 2020).

Figure 1

The Organ of the Female Reproductive System

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Uterus

The uterus is a muscular, pear-shaped hollow organ that extends from the

vaginal opening to the cervix. It is located in the pelvis between the bladder and

the rectum. The uterus plays three important functions: menstruation, pregnancy,

and childbirth. When a fertilized egg implants into the uterine wall, it provides an

environment for the fertilized egg to develop into a fetus, which subsequently

grows throughout pregnancy until birth (Ameer, 2021).

The wall of the uterus is made up of three layers. The most superficial

layer is the serous membrane, or perimetrium, which consists of epithelial tissue

that covers the exterior portion of the uterus. The middle layer, or myometrium, is

a thick layer of smooth muscle responsible for uterine contractions. The muscle

fibers run horizontally, vertically, and diagonally, allowing powerful contractions

during labor and the less powerful contractions (or cramps) that help to expel

menstrual blood during a woman’s period. It is also thought that myometrial

contractions facilitate the transport of sperm through the female reproductive

tract (Williams, 2020).

Lastly, the innermost layer of the uterus is called the endometrium. The

endometrium contains a connective tissue lining, the lamina propria, which is

covered by epithelial tissue that lines the lumen. Structurally, the endometrium

consists of two layers: the stratum basalis and the stratum functionalis. The

stratum basalis layer is part of the lamina propria and is adjacent to the

myometrium; this layer does not shed during menses. In contrast, the thicker

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

stratum functionalis layer contains the glandular portion of the lamina propria and

the endothelial tissue that lines the uterine lumen. It is the stratum functionalis

that grows and thickens in response to increased levels of estrogen and

progesterone.

In the luteal phase of the menstrual cycle, special branches off of the

uterine artery called spiral arteries supply the thickened stratum functionalis. This

inner functional layer provides the proper site of implantation for the fertilized

egg, and—should fertilization not occur—it is only the stratum functionalis layer

of the endometrium that sheds during menstruation (Crithchley & Maybin, 2019).

Figure 2

The Uterus, Myometrium, and Endometrium

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Menstrual Process

According to Thiyagarajan et al. (2021), A female's reproductive system

undergoes regular cyclic changes that can be viewed as periodic preparation for

pregnancy and fertilization, its most notable feature is the periodic vaginal

bleeding that occurs with the shedding of the uterine mucosa. A menstrual cycle

begins with the first day of a woman’s menstruation (follicular phase) and starts

over again when the next period begins. Throughout a monthly menstrual cycle,

the body makes different amounts of chemicals called hormones such as

Gonadotropin-releasing hormone (GnRH), Follicle-stimulating hormone (FSH),

Luteinizing hormone (LH), Estrogen, Progesterone, and Testosterone.

These changing hormone levels regulate the menstrual cycle. The

menstrual cycles often change as a woman gets older. A normal cycle lasts

between 24 and 38 days. Ovulation happens about 14 days before your period

starts. If the average menstrual cycle is 28 days, then the ovulation period is

around day 14, and the most fertile days are days 12, 13, and 14. A pregnancy

test can be done to determine if you are pregnant which measures the level of

human chorionic gonadotropin (hCG), a hormone normally produced early in

pregnancy (Ramirez & Salvo, 2020).

The follicular phase begins with menstruation and concludes with

ovulation. The pituitary gland secretes follicle-stimulating hormones in response

to a signal from the brain. This hormone causes the ovary to generate five to

twenty follicles which are tiny nodules or cysts on the surface of the ovary.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Ovulation is induced by high amounts of LH within two days. Waves of tiny, hair-

like projections guide the egg into the fallopian tube and the uterus. The average

egg has a lifespan of about 24 hours. It will perish unless it comes into contact

with sperm at this period. Then in the luteal phase of the menstrual cycle, special

branches off of the uterine artery called spiral arteries supply the thickened

stratum functionalis. This inner functional layer provides the proper site of

implantation for the fertilized egg, and if fertilization does not occur, the stratum

functionalis layer will shed (Crithchley & Maybin, 2019).

The corpus luteum subsides towards the completion of the luteal phase if

fertilization does not occur during the cycle. Consequently, the hormone

production decreases as a response that causes the uterine lining to shed.

Figure 3

The Menstrual Cycle

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Fallopian Tube

The fallopian tubes, also known as oviducts are hollow seromuscular

organs that serve as channels for oocyte transport and fertilization conduits. It

has a diameter of less than 1 mm and is about 11 to 12 cm long.

The three anatomical regions of the fallopian tube are the isthmus,

ampulla, and infundibulum. The first segment, closest to the uterus, is the

isthmus. The second segment is the ampulla and it is the most common site for

fertilization. The final segment, located farthest from the uterus, is the

infundibulum, a funnel-shaped opening that is surrounded by finger-like

projections called fimbriae, it catches and channels the released oocyte each

menstrual cycle (Han & Sadiq, 2021).

Figure 4

The Fallopian Tube

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Ovaries

The ovaries are located in a shallow depression, called the ovarian fossa,

they are held loosely in place by peritoneal ligaments. They are about the size of

an almond and contain 700,000 immature eggs. At puberty, the eggs begin to

develop and mature inside the ovarian follicles. This process is commonly known

as ovulation, and it is part of the menstrual cycle.

The ovaries are covered on the outside by a layer of simple

cuboidal epithelium called germinal (ovarian) epithelium – this is the visceral

peritoneum that envelops the ovaries. Underneath this layer is a

dense connective tissue capsule called the tunica albuginea. The ovaries are

distinctly divided into an outer cortex and an inner medulla. The cortex appears

denser and more granular due to the presence of numerous ovarian follicles in

various stages of development. The medulla is a loose connective tissue with

abundant blood vessels, lymphatic vessels, and nerve fibers (West, 2021).

Figure 5

The Ovary

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Cervix

The cervix is the lower portion (or the "neck") of the uterus and it is

approximately 1 inch long and 1 inch wide. The cervix functions as the entrance

for sperm to enter the uterus. During menstruation, the cervix opens slightly to

allow menstrual blood to flow out of the uterus. It also performs other roles, like

producing cervical mucus, to form a protective barrier against ascending

infections.

Conception occurs when sperm is able to fertilize an egg. Before

ovulation, the cervix produces a clear mucus, which helps sperm travel through

the cervix. After conception, cervical mucus begins to thicken to form a cervical

"plug" that protects the developing embryo from infection. During labor, the cervix

stretches (efface) and dilates as the uterus contracts to expel the baby

(Cornforth, 2021).

Figure 6

The Cervix

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Vagina

The vagina is a 7–10 cm long elastic, muscular tube that extends from the

vaginal orifice to the opening of the uterus or cervix. The main functions of the

vagina are to provide a passageway to discharge menstruation; deliver a baby;

receive the penis during sexual intercourse. The Bartholin glands provide natural

lubrication in the vagina to keep the mucosal lining moist and reduce friction

during sex. The mucous membrane of the vagina also provides lubrication by the

fluid that transudates through the vaginal wall. Moreover, the vaginal microbiome

creates an acidic environment, which helps to protect the vagina against

pathogens (Gold & Shrimanker, 2021).

Figure 7

The Vagina

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

CHAPTER 3

METHODOLOGY

This study will utilize a case study approach to comprehensively analyze

the clinical case of the respondent with a partial hydatidiform mole. The study

approach will enable the researchers to provide in-depth evaluation and insights

into the clinical case.

According to Tenny et al. (2021), a qualitative study is a type of research

that explores and provides deeper insights into real-world problems. It gathers

participants' experiences, perceptions, and behavior. It answers the how’s and

why’s instead of how many or how much. Thus, the case study approach will aid

in comprehensively presenting the care plan and treatment process of the clinical

case of the respondent.

The respondent is a 41-year-old female who resides in Polonuling, Tupi,

South Cotabato. The respondent was admitted on April 25, 2021, and discharged

on April 27, 2021, with the final diagnosis of partial hydatidiform mole. Due to the

ongoing COVID-19 pandemic, face-to-face interaction will be limited to ensure

the safety of the researchers and the respondent. Hence, the researchers will

utilize e-mail services (Gmail) and online platform utilities such as Schoology and

Messenger to collect the health records of the respondent and as a

communication tool between the researchers. The health records collected will

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

be uploaded in google docs to utilize the collaboration feature that will allow the

researchers to view and edit the manuscript simultaneously.

The researchers' online method of data gathering and data processing will

allow the researchers to conduct their case studies in their respective residences

to maintain COVID-19 safety precautions.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

CHAPTER 4

DATA PRESENTATION, INTERPRETATION, AND ANALYSIS

Initial Data Base

Table 1

Demographic Data of Patient A.B.

Name Patient A.B.

Age 41 years old

Birthdate February 21, 1980

Place of Birth General Santos City

Address Polonuling, Tupi, South Cotabato

Sex Female

Civil Status Married

Religion Roman Catholic

Occupation Government Employee

Nationality Filipino

Educational Attainment College Graduate

Date of Admission April 25, 2021

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Time of Admission 6:41 a.m.

Chief Complaint Vaginal bleeding, abdominal discomfort,

nausea and vomiting

Admitting diagnosis G3P2 PU Threatened Abortion vs.

Hydatidiform-mole

Final Diagnosis G3P2 PU Hydatidiform mole, Partial

Nursing Health History

Past and Present Health History

Past Health History. Patient A.B., a 41-year-old female, stated that they

have limited resources because her father was a farmer and her mother was a

fish vendor. In addition, the patient and her family lived in the mountainous area

of Polonuling, Tupi, South Cotabato, far from clinics, hospitals, and other

healthcare facilities. Where she stated that they have difficulty accessing medical

attention. In 2010, her mother was diagnosed with lung cancer and died 2 years

later.

In terms of reproductive health, the patient stated she began having

menstrual periods at the age of ten and she usually changes her sanitary pad

three times each day, and she sometimes doubles the sanitary pad since she

experiences heavy blood flow. In addition, the patient has an irregular menstrual

cycle as she experiences delays for 2 weeks and sometimes stops for 2 - 3

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

months every 3 years as she stated. Despite the irregular menstruation and

heavy blood flow, the patient did not seek an OB-GYN for a checkup, instead,

she endured the pain she felt, as stated.

The patient was married in September 2014 and his husband's blood type

is O+ and her blood type is A. The patient obstetrical history is G2 T2 P0 A0 L2,

which both children delivered through a cesarean section. The indication of her

cesarean section was due to gestational diabetes which was diagnosed during

her first pregnancy.

Two months prior to admission, it was noted that the patient's last day of

menstrual period (LMP) was on February 14, 2021. The patient verbalized that

she vomited once upon waking up on February 28. Then one week thereafter,

the patient was vomiting once every two days subsequently. The patient was

unable to seek medical attention because she did not have free time as

verbalized. On the day of April 25th, 2021, the patient was admitted to the

hospital because at 5:45 am, the patient experience nausea and vomiting, and

saw she was bleeding vaginally, with "black, round fragments or clots'' coming

out with the blood.

Present Health History. On the 25th of April, 2021, due to vaginal

bleeding, nausea, vomiting, and abdominal discomfort, Patient A.B. 41 years old,

was brought into the Emergency Room (ER) via a wheelchair. The patient stated

that she woke up at 5:45 a.m. nauseated and felt abdominal pain. When she

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

entered the bathroom, she noticed that she had been bleeding vaginally, with

"black, circular fragments or clots'' coming out with the blood.

The ER nurse took her vital signs and the blood samples were obtained

for laboratory tests. Upon physical examination of the abdomen, it was soft and

tender in both lower quadrants and the patient's fundal height was 3 cm below

the umbilicus. Before the patient was transferred to the OB ward, she underwent

a chest x-ray and a stat ultrasound of her entire abdomen.

Activities of Daily Living

Health Perception and Health Management

Before Hospitalization. Patient A.B. takes Buscopan whenever she has

significant discomfort from dysmenorrhea. She did not consult a doctor when she

experienced vomiting these past few days, and she never thought that she was

pregnant.

During Hospitalization. Patient A.B. take the medications that the doctor

prescribed and she also listens attentively when the nurse provides an

explanation about the drug being given.

Nutrition and Metabolism

Before Hospitalization. Patient A.B. likes vegetables, particularly

ampalaya and kangkong. The patient did not take breakfast prior to admission.

During Hospitalization. Upon admission, the physician ordered NPO for

Patient A.B.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Elimination

Before Hospitalization. Patient A.B. did not experience any discomfort

when urinating. She urinates every work break, specifically during the noon

break. The patient stated she defecates once every day in the early morning or

once every two days as stated.

During Hospitalization. Patient A.B. did not experience any discomfort

when urinating. Her physician ordered the patient to keep on complete bed rest

without bathroom privileges and to place a bedside commode in her room. The

patient wears a diaper and it was changed every 2 hours.

Activity and Exercise

Before Hospitalization. Patient A.B. do not exercise. At home, the patient

makes breakfast for her two children and does household chores. She does not

get tired easily as verbalized. After completing home duties, she watches dramas

or visits her neighbor. The patient does not consider house chores as a form of

exercise. For her, physical activities include running, walking, and biking.

During Hospitalization. Patient A.B. was on complete bed rest without

bathroom privileges during the post-dilation and curettage as ordered by her OB

doctor.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Sleep and Rest

Before Hospitalization. During office days, Patient A.B. goes to bed at 10

p.m. or 11 p.m. and wakes up around 4:00 a.m. She used to get up around 5:30

a.m. on weekends. The patient often slept for about an hour or two after doing

her housework.

During Hospitalization. Patient A.B. was able to sleep during the night of

April 25, 2021, since she was a little drowsy as a result of the anesthesia. She

does not feel comfortable because of the lines attached to her. She stated every

time a nurse enters the room her sleep was disturbed.

Cognition

Before Hospitalization. Patient A.B. is able to see clearly even without

the use of eyeglasses. She knows different dialects, including Tagalog, English,

Bisaya, and Ilonggo.

During Hospitalization. Patient A.B. was awake and coherent. She was

able to provide complete answers to all of the questions being asked by the

nurse. She understood what the doctor and nurse explained as she verbalized.

Self-perception and Self-concept

Before Hospitalization. Patient A.B. perceives herself as a mother who

embodies the idealistic characteristics of a mother, to be a loving and caring

mother. The patient stated she is committed to provide a wonderful life for her

children. If her children have problems, she is willing to listen and discuss them.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

During Hospitalization. Patient A.B. has difficulties making medical

decisions. Hence, she asks her husband for assistance in decision-making.

Roles and Relationship

Before Hospitalization. Patient A.B. stated she has many friends and

she gets along well with her coworkers in the office. In the family, she and her

husband, together with their children, have a good relationship. When her

children have any problems, they come to her for help. During her spare time,

she likes to have a quick visit to her neighbor, who also happens to be her

college best friend. Moreover, since she grew up in Polonuling, Tupi, South

Cotabato, she was very familiar with the neighbors.

During Hospitalization. Patient A.B. received a visit from a neighbor

yesterday just before they took her into the operating room. Due to the hospital

regulations, her two children were unable to pay her a visit. However, she and

her children were able to communicate via video call after her operation. The

attending caregiver of the patient during hospitalization was her husband.

Sexuality

Before Hospitalization. Patient A.B. does not use any form of birth

control. Moreover, she stated that on February 14, 2021, when her menstrual

period halted since then, she taught that she was only experiencing menopause

and did not seek medical attention.

During Hospitalization. Patient A.B.'s husband is always at her side but

he leaves from time to time if he needs to buy medication or food.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Coping and Stress Tolerance

Before Hospitalization. Patient A.B. tends to finish all of her tasks at

work within the day because she feels more stressed if she crams.

Moreover, she gets stressed out at home because she is the only one

responsible for completing the household tasks and she can't help but raise her

voice. However, she chose to understand their situation because her two children

are still young and have needs that she must fulfill.

During Hospitalization. She just thinks that her family was beside her

when she was admitted. She gives her full trust to her doctors and nurses.

Patient A.B. felt stressed when her doctor asked her if she had any plan of

getting pregnant again because the doctor told her they might remove her uterus.

However, she was able to compose herself because only the dilation and

curettage were performed.

Values and Beliefs

Before Hospitalization. Patient A.B. is a Roman Catholic. Every Sunday,

she and her family go to church in their neighborhood to attend mass. In the

evening, Patient A.B. and her family pray together. She always teaches her

children to pray first before eating. Moreover, the patient does not believe in

hilots and she stated she will always seek professional health care.

During Hospitalization. Patient A.B. prayed before being transferred to

the surgery room. After the operation, she thanked the Lord that her surgery went

well and nothing wrong happened to her.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Physical Assessment

General Survey (April 26, 2021)

Appearance. Patient A.B. was received by the attending student nurse

lying in bed in a semi-fowler’s position, awake, conscious, and coherent. She has

an ongoing IVF of #4 D5LR 1L at 25 gtts/min in her left metacarpal vein at 90 cc

IVF. The IV site was patent and no signs of ecchymosis, swelling, or oozing pus

were noted.

Mental Status. The patient is awake, conscious, and coherent. The

patient is responsive to verbal commands and is able to localize and locate the

pain she’s experiencing. However, the patient stated that she feels dizzy but still

answers the questions accurately and precisely. Further, she stated that she

understands all the explanations given by the attending physician and nurses.

Vital Signs upon Assessment

Table 2

Patient A.B.’s Vital Signs upon Assessment (April 26, 2021, 8:00 a.m.)

Patient’s vital signs Results Normal Range

Temperature 36.9 ̊C 36.1 ̊C – 37.2 ̊C

Pulse rate 95 bpm 60 – 100 bpm

Respiratory rate 22 cpm 12 – 20 cpm

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Blood pressure 130/80 mmHg Systolic: 84 – 120

Diastolic: 54 – 80

Oxygen saturation 98% 95% – 100%

Table 2 presents the patient’s vital signs during the assessment. The

following results were: temperature of 36.9 ̊C, pulse rate of 95 bpm, respiratory

rate of 22 cpm, blood pressure is 130/80 mmHg and O2 saturation of 98%. All in

all, the patient's vital signs were normal except for her blood pressure and

respiratory rate because her systolic BP is slightly elevated.

Cephalocaudal Assessment

Skin. Generally, the skin color of Patient A.B. is light brown. Upon

assessing the skin, there were no lesions, masses, discoloration, or swelling. Her

skin has a good turgor which immediately returns back once released.

Hair and Scalp. The hair of the patient is black and evenly distributed.

The length is about mid-back long. Her hair is clean and with no presence of

dandruff, scars, and lesions. There is no presence of alopecia as evidenced by

full and intact hair.

Nails. Her nails are slightly trimmed and nail plates are firmly attached.

The capillary refill test was less than 2 seconds in the hands and feet.

Head and Neck. The head of Patient A.B. is round, symmetrical, and in

the midline. Also, the eyes, eyebrows, and ears are symmetrical. The size of the

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

head is appropriately proportionate to the body. Upon palpation, the head and

the neck are not tender with no lesions or masses noted and the lymph nodes

were nonpalpable.

Eyes. The eyes of Patient A.B. are clear, bright, and in parallel alignment.

There is no crusting in the eyelashes and no lesions or edema on the eyelids.

The pupils were equally round and reactive to light, and both pupils

accommodates.

Ears. The ears of Patient A.B. are symmetrical. Auricles are not tender

with no presence of lesions and lumps. Both ear canals are clean and have no

presence of cerumen. The patient's hearing is intact upon the watch tick test.

Nose. The size and shape of the nose is symmetrical and at the midline;

no deformities. A nasogastric tube was attached to her right nostrils.

Mouth. The teeth of the patient are complete with a total number of 32

with good occlusion and, not loose; no cavities were noted. The lips and gums

are pink, smooth, and moist without any lesions or masses. The tongue is pinkish

and moist but its surface has a generalized bump appearance. The uvula is at

the midline and symmetrical; pink, moist, and intact, with no lesions and

discoloration. The hard and soft palate is pink, intact, and moist. The hard palate

surface has ridges while the soft palate is smooth. Tonsils were pinkish,

symmetrical, and has a clean crypt; no signs of inflammation or exudates.

Chest and Lungs. The scapula is symmetric and non-protruding.

Resonance was noted upon percussion and auscultation on the posterior and

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

anterior thorax; no adventitious sounds were noted. No signs of respiratory

distress were noted such as retractions.

Axillae. The axillae of the patient have no palpable nodes and unusual

odor. There are no hairs and lesions.

Peripheral Vascular System. Varicose veins are evident on the lower leg

of the patient. Capillary bed refill returns in less than 2 seconds. The brachial

artery and dorsalis pedis were easily palpable and elastic. Blood pressure was

taken at 12 pm and it was 120/90 mmHg.

Abdomen. The abdomen of the patient has a saggy belly; no lesions or

masses were noted. During auscultation, bowel sounds were present in four

quadrants with high pitch heard every 5-15 seconds. Upon percussion, the

abdomen was tympanitic in all four quadrants. During palpation, the fundus was

3 cm below the umbilicus. The lower abdomen was tender with a pain scale of

5/10.

Lower and Upper Extremities. No tenderness, swelling, or nodules were

noted on the patient’s lower extremities and upper extremities. The patient’s

palms are warm to the touch and her lower legs both have varicose veins.

Cardiovascular. Upon auscultation at 12 pm, the heart rhythm was

regular and at the rate of 91 bpm. No murmurs were noted.

Genitourinary. The patient stated she does not feel any discomfort when

urinating. Her urine is often pale in color. During the visit, a spot of lochia rubra

was noted in the patient’s diaper.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Musculoskeletal. The posture of the patient is erect and midline. There

are no signs of kyphosis or scoliosis. The patient's extremities were in a full

range of motion (ROM) when she was instructed to perform range motion

exercises.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Pathophysiology

Figure 8

Pathophysiology of Partial Hydatidiform Mole

PREDISPOSING FACTORS PRECIPITATING FACTORS

• Asian • Pregnancy
• Female • Low protein intake
• Women older than 35 years
old
• Women with blood type A or
AB.

Fertilization of normal egg

by two sperms

Triploid (n=69)

Abnormal growth of
trophoblastic tissue (benign)
with residual fetal tissue

Abnormal development of Placental tissue forms a

fetus (nonviable) mass in the uterus

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Diagnostic Signs and

Tests: Partial Hydatidiform Symptoms:
Mole
- Physical and - Vaginal bleeding
pelvic examination with “dark, circular
- Chest X-ray fragments or clots”
- Pelvic Ultrasound - Nausea and
- Biopsy vomiting
- Pregnancy Test - Abdominal pain
- ꞵ hCG blood tests - Fundal height is
greater than
expected (as for
gestational age)

Medical and If not treated:

If treated
Laboratory
management:

- Dilation and GOOD PROGNOSIS Persistent ↑hCG level

Curettage
- ꞵ hCG monitoring

Pharmacologic Tx: Malignant trophoblastic

Antibiotics tissue
Cefuroxime
Cefurex

Pain POOR PROGNOSIS

analgesics
Ketorolac
Nalbuphine
Mefenamic
acid

Others:
FeSO4
Methylergo
novine
maleate
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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Gestational Trophoblastic
Neoplasia (GTN)

invade surrounding Cancer cells

tissue (myometrium) metastasize to other
organs

INVASIVE MOLE CHORIOCARCINOMA PLACENTAL-SITE

TROPHOBLASTIC
TUMOR (PSTT)
&
Persistent vaginal
EPITHELIOID
bleeding
TROPHOBLASTIC
TUMOR (ETT)

↑ MATERNAL MORBIDITY

In rare instances, in partial moles, two sperms have been reported to

fertilize a single egg; "double fertilization" is considered to occur in around 1% of

human pregnancies. In this case scenario, the existence of triploid occurs after

two spermatozoa fertilize an ovum. Triploid refers to the existence of an extra set

of chromosomes in the cell, for a total of 69 chromosomes instead of the

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

standard 46. During conception, either the father or the mother contributes an

additional pair of chromosomes (XXX, XYY, and XXY). While in a complete mole,

an empty egg is fertilized by one or two sperm, and all of the genetic material is

from the father. In this situation, the chromosomes from the mother’s eggs are

lost or inactivated and the father’s chromosomes are duplicated. After

conception, abnormal growth of trophoblastic tissue occurs, and fetal tissues will

be detected in a partial mole while in the complete mole there is no formation of

fetal tissue. In a partial mole, a fetus develops however it is deformed and will not

survive, instead, a mass of multiple microscopic cysts will develop called H-mole.

The H-mole has a grape-like appearance radiographical appearance.

The predisposing factors of the patient are her gender, Asian descent,

extreme age (over 35-years-old), and blood type A since women with the blood

types A or AB are more likely to develop Gestational Trophoblastic Disease

(GTD). On the other hand, pregnancy is recognized as the precipitating factor for

the condition. Despite molar pregnancy is extremely rare, the presence of the

following factors predisposes the patient to an increased risk of molar pregnancy.

Patient A.B. suffered from various indications and symptoms associated

with the hydatidiform mole, including vaginal bleeding with clots, nausea and

vomiting, abdominal discomfort, and a fundal height greater than expected based

on the mother’s gestational age. A variety of diagnostic procedures were done to

establish the existence of the patient's problems, including a physical and pelvic

examination, chest X-ray, pelvic ultrasound, biopsy, and hCG blood tests. The

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

hydatidiform mole is treated by evacuation, through dilation and curettage (D&C).

After the D&C treatment, hCG monitoring should be performed. The patient will

have a good prognosis if the condition is treated and managed properly. If the

condition is not treated, the abnormal trophoblastic tissue will continue to

proliferate and it can develop into a malignant cancer cell, which is a form of

Gestational Trophoblastic Neoplasia (GTN). The main indicator of persistent

proliferation of trophoblastic tissue is the persistent rise of hCG level.

Gestational Trophoblastic Neoplasia (GTN) is a type of trophoblastic

disease that is usually malignant. It will invade the uterus or the middle layer of

the uterine wall (myometrium), where cancer cells may spread to other organs,

resulting in invasive mole, choriocarcinoma, Placental-site Trophoblastic Tumor

(PSTT), and Epithelioid Trophoblastic Tumor (ETT), which increases the risk for

maternal morbidity if not prompted. In women who have invasive moles, there

may be a sign of persistent heavy vaginal bleeding because of the penetration of

molar tissue in the myometrium or uterine vasculature.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Medical and Nursing Management

Medical Management

On April 25, 2021, Patient A.B., 41 years old, was rushed into the

Emergency Room (ER) at 6:30 a.m. via a wheelchair due to vaginal bleeding,

nausea and vomiting, and abdominal discomfort. The patient verbalized that

when she got in the toilet, she saw that she had been bleeding vaginally, with

“dark, circular fragments of clots” coming out with the blood. The patient was

admitted to the Obstetric (OB) ward for further monitoring and evaluation with an

admitting diagnosis of G3P2 PU Threatened Abortion vs. Hydatidiform-mole.

Laboratory Results

Chest X-ray. A chest X-ray is a non-invasive imaging test that uses a

small dose of radiation to create a black-and-white image of the organs, tissues,

and bones underlying the chest area. The Chest X-ray test is not used only for

detecting diseases or abnormalities but also to monitor the condition of the

patient postoperatively. In the case scenario, the procedure was conducted after

the molar pregnancy was diagnosed to scan the stage of the disease or detect if

a tumor metastasize to the lungs.

1. Chest X-ray AP. was done on April 25, 2021, at 7:00 a.m., no significant

findings or any abnormalities.

IMPRESSION. Essentially negative chest radiograph.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Pelvic Ultrasound. A pelvic ultrasound is a non-invasive imaging test that

uses a transducer to send high-frequency sound waves to produce images of the

organs, tissues, and surrounding structures within the pelvis. The procedure can

be used to help diagnose the cause of pelvic pain and abnormal menstrual

bleeding; detect tumors, cysts, or extra fluid in the pelvis; monitor the condition of

the fetus during pregnancy and evaluate pregnancy complications. In the case

scenario, the pelvic ultrasound procedure was perform to view the uterine cavity

of the patient as an adjunct evaluation of being positive to pregnancy and a

history of bleeding with dark, circular framgments of clots.

2. Pelvic Ultrasound. was done on April 25, 2021, at 7:00 a.m.

IMPRESSION. Fetal demise (crown-rump length: 7mm) with placental

hydropic change and fetal hydropic regeneration; Greatly enlarged

placenta relative to the size of the uterine cavity.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Biopsy. A biopsy is a procedure that involves the extraction of sample

cells or tissues for examination under a microscope. It can help determine

suspected areas of abnormal tissue whether it is cancer or another pathological

condition. There are many types of biopsies such as needle biopsy, bone biopsy,

skin biopsy, surgical biopsy, and many others. The test was conducted to identify

the residual tissue inside the patient uterus if it is a malignant cancer cell.

3. Biopsy. was done on April 26, 2021, at 1:40 p.m., the biopsy

histopathologic result showed the presence of fetal/embryonic tissue, focal

hydropic swelling of villi, focal trophoblastic hyperplasia, mild trophoblastic

atypia, and a triploid karyotype.

SPECIMEN. uterine tissue

GROSS EXAMINATION.

Fetal/embryonic tissue: Present

Hydropic swelling of villi: Focal

Trophoblastic hyperplasia: Focal

Implantation-site trophoblast: mild atypia

Karyotype: Triploid

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Serologic Test. A serologic test or antibody test is a blood test that

checks for the presence or level of specific antibodies. It can detect antibodies

against microorganisms such as the hepatitis B virus through the HBsAg screen

or identify an autoimmune disorder. Antibodies are immune proteins that are

formed when it detects foreign protein antigens through past infections or

vaccination. The serologic test is not used to diagnose current infection because

it could take 1 to 3 weeks before the body can make antibodies for the specific

invading pathogen. In the case scenario, a HBsAG test was performed to

determine if the patient has an active hepatitis B infection. Which allow us to

instill blood and bodilty fluid precautions to avoid hepatitis B.

4. HBsAg (qualitative)

Table 3

HBsAg Qualitative Result

HBsAg

04/25/2021 6:50 a.m.

Examination Result Remarks

HBsAg Non-reactive Negative to hepatitis B

infection

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Blood Compatibility Test. A blood compatibility test determines your

ABO blood group and Rh type. The test includes ABO-Rh typing, antibody

screening, and cross-matching. In the case scenario, it was indicated before

transfusing blood to prevent blood incompatibility and to determine her ABO-Rh

incompatibility with the fetus.

5. Blood Typing/Rh Typing

Table 4

Blood Typing/Rh Typing Result

Blood Typing/Rh Typing

04/25/2021 6:50 a.m.

Examination Result

ABO A

Rh POSITIVE

Pregnancy Blood Test. A pregnancy blood test is used to determine

whether a woman is pregnant by detecting human chorionic gonadotropin (hCG),

a hormone produced around 6 days after fertilization. There are two types of

pregnancy blood tests: qualitative and quantitative (β-hCG). The qualitative test

determines the presence of hCG in the blood and it will give a simple “yes” or

“no'' answer whether you’re pregnant. On the other hand, the quantitative (β-

hCG) test measures the exact amount of hCG level in the blood.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

In the case scenario, the quantitative test was indicated after the

qualitative test to determine the amount of hCG level which could provide a

clinical significance such as a presence of molar pregnancy.

6. ꞵ - hCG Blood Pregnancy Test (Quantitative)

Table 5

ꞵ - hCG Blood Pregnancy Test (Quantitative) Result

ꞵ - hCG Blood Pregnancy Test (Quantitative)

04/25/2021 6:50 a.m.

Examination Result Reference value Remarks

ꞵ - hCG Blood 240,516 An hCG level of less The hCG level (>100,000

Pregnancy mIU/mL than 5 mIU/mL is mIU/mL ) suggest an

Test negative; anything exuberant trophoblastic

above 25 mIU/mL is growth which indicate a

positive. molar pregnancy

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Table 6

ꞵ - hCG Blood Pregnancy Test (Quantitative) Result

ꞵ - hCG Blood Pregnancy Test (Quantitative)

04/26/2021 9:25 a.m.

Examination Result Reference value Remarks

ꞵ - hCG Blood 96,463 An hCG level of less Normal. The patient hCG

Pregnancy mIU/mL than 5 mIU/L is level decrease from

Test negative; anything 240,516 mIU/mL to 96,463

above 25 mIU/mL is mIU/mL due to dilatation

positive. and curettage procedure.

7. Pregnancy Test (Qualitative)

Table 7

Pregnancy Test (Qualitative) Result

Pregnancy Test (Qualitative)

04/25/2021 6:50 a.m.

Examination Result Remarks

Pregnancy POSITIVE POSITIVE for pregnancy. Which suggest the

Test (serum) patient vaginal bleeding with the presence of clots

as threatened abortion. In addition, a serum hCG

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

test (quantitative) will be performed as an adjunct

evaluation to check the patient hCG levels.

Urinalysis. A urinalysis is a non-invasive urine test that examines the

physical, chemical properties, and microscopic view of the urine. The test is used

to evaluate your overall health condition and to diagnose or monitor a medical

condition. In the case scenario, urinalysis was performed to assessed the patient

condition and monitor the presence of pre-eclampsia.

8. Urinalysis

Table 8

Urinalysis Result

Urinalysis

04/25/2021 7:02 a.m.

Examination Result Remarks

Urine Color Amber yellow Mildly dehydrated (needs to rehydrate).

Normal urine color ranges from pale yellow

to deep amber. The more diluted or

concentrated the urine indicates

dehydration.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Urine Clarity Cloudy Mildly dehydrated (needs to rehydrate).

Normal urine is clear and if it is cloudy, it

could indicate dehydration or other

problems such as infection.

Glucose Negative Normal (no glucose detected in the urine)

Albumin Negative Normal (no albumin detected in the urine)

Mucus Few Normal (a small amount of mucus in the

Threads urine is normal but a large amount of mucus

or mucus that changes color (ex. yellow)

may indicate a UTI or other medical

condition)

Sq. Epithelial Rare Normal (a small amount of sq. epithelial

Cells cells in the urine is normal but a large

amount may indicate the sample is

contaminated or it is a sign of infection (ex.

UTI), kidney disease, or other serious

medical condition)

Red Blood 2/HPF Normal (2-5 RBCs/HPF is normal but a high

Cells number may indicate urinary tract problems

such as UTI).

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

White Blood 2-5/HPF Normal (2-5 WBCs/HPF is normal but a

Cells high number may indicate infection)

pH 5.5 Normal (4.5 - 8 urine pH is normal but an

abnormal pH level could form kidney

stones)

Specific 1.005 Normal (1.005 - 1.025 urine specific gravity

Gravity indicates good renal concentrating ability)

Complete Blood Count (CBC). A complete blood count (CBC) is a blood

test that measures several components and features of blood. It includes the red

blood cells (RBCs), white blood cells (WBCs), platelets, the concentration of

hemoglobin, and the hematocrit. The test is used to evaluate your overall health

condition and a wide range of disorders including anemia, infection, and bleeding

problems. In the case scenario, the test was performed to evaluate the

hemodynamics of the patient, specifically, to evaluate for anemia and

thrombocytopenia.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

9. Complete Blood Count (CBC)

Table 9

Complete Blood Count (CBC) Result

Complete Blood Count (CBC)

04/25/2021 6:50 a.m.

Examination Result Reference value Remarks

Hemoglobin 110 120 - 160 g/L Below the normal range (the

patient have anemia due to

vaginal bleeding)

Hematocrit 35.2 36 - 46 Slightly below the normal

range (the patient have

anemia)

Erythrocytes 4.0 4.2 - 5.4 x 1012/L Low RBC count (the patient

(RBC) have anemia)

RBC Indices

MCV 82.00 80 - 100 fL Within the normal range (The

patient’s average red blood

cell size normal)

MCH 29.3 26 - 32 pg/cell Within the normal range (the

average amount of

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

hemoglobin in the patient

RBCs is normal)

MCHC 32.7 32 - 36 g/dL Within the normal range (the

average amount of

hemoglobin in the patient

RBCs is normal)

Leukocytes 9.78 4.0 -11.0 x 109/L Within the normal range (the

(WBC) patient’s white blood cell is

within the normal range)

Differential

Count

Segmented 0.60 0.56 - 0.66 Normal (no active infection in

Neutrophils the patient’s body)

Lymphocytes 0.30 0.22 - 0.40 Normal (no active infection in

the patient’s body)

Monocytes 0.04 0.04 - 0.06 Normal (no active infection in

the patient’s body)

Eosinophil 0.01 0.01 - 0.04 Within the normal range (no

active parasitic infection)

Basophil 0 0.00 - 0.01 Normal (no occurrence of

allergic reaction)

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Platelet Count 297.00 144 - 440 x 109 /L Within the normal range (no

risk for uncontrolled bleeding

and abnormal clotting

formation)

Table 10

Complete Blood Count (CBC) Result

Complete Blood Count (CBC)

04/25/2021 11:40 p.m.

Examination Result Reference value Remarks

Hemoglobin 118 120 - 160 g/L Below the normal range (the

patient have anemia due to

vaginal bleeding)

Hematocrit 35.7 36 - 46 Slightly below the normal

range (the patient have

anemia)

Erythrocytes 4.2 4.2 - 5.4 x 1012/L Low RBC count (the patient

(RBC) have anemia)

RBC Indices

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

MCV 83.00 80 - 100 fL Within the normal range (The

patient’s average red blood

cell size normal)

MCH 28.4 26 - 32 pg/cell Within the normal range (the

average amount of

hemoglobin in the patient

RBCs is normal)

MCHC 33.5 32 - 36 g/dL Within the normal range (the

average amount of

hemoglobin in the patient

RBCs is normal)

Leukocytes 10.21 4.0 -11.0 x 109/L Within the normal range (the

(WBC) patient’s white blood cell is

within the normal range)

Differential

Count

Segmented 0.81 0.56 - 0.66 Normal (no active infection in

Neutrophils the patient’s body)

Lymphocytes 0.08 0.22 - 0.40 Normal (no active infection in

the patient’s body)

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Monocytes 0.11 0.04 - 0.06 Normal (no active infection in

the patient’s body)

Eosinophil 0.01 0.01 - 0.04 Within the normal range (no

active parasitic infection)

Basophil 0 0.00 - 0.01 Normal (no occurrence of

allergic reaction)

Platelet Count 263.00 144 - 440 x 109 /L Within the normal range (no

risk for uncontrolled bleeding

and abnormal clotting

formation)

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Coagulation Test. A coagulation study is a procedure to test your blood’s

ability to form a clot. It can be used to detect bleeding disorders, and abnormal

clotting formation (ex. thrombosis), monitor patient response to anti-clotting or

pro-clotting therapies, or establish a person’s risk of bleeding before surgery. The

test may include measuring the prothrombin time (PT), activated partial

thromboplastin time (aPTT), and the calculation of the international normalized

ratio (INR). In the case scenario, coagulation profile was performed to assess the

patient risk for uncontrolled bleeding prior to dilatation and curretage

(D&C)procedure.

10. Activated Partial Thromboplastin Time (aPTT)

Table 11

Activated Partial Thromboplastin Time (aPTT) Result

Activated Partial Thromboplastin Time (aPTT)

04/25/2021 9:15 a.m.

Examination Result Remarks

Control Time 30.2 seconds Within the normal range (the patient body

can form blood clots within the average

time)

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Patient Time 31.1 seconds Within the normal range (the patient body

can form blood clots within the average

time)

11. Partial Thromboplastin Time (PTT) with INR

Table 12

Partial Thromboplastin Time (PTT) Result with INR

Partial Thromboplastin Time (PTT) with INR

04/25/2021 9:15 a.m.

Examination Result Remarks

Control Time 11.3 seconds Within the normal range (the patient body

can form blood clots within the average

time)

Patient Time 11.4 seconds Within the normal range (the patient body

can form blood clots within the average

time)

% Activity 95.9% Normal

INR 0.98 Normal (an INR ≤ 1.5 indicates that the

patient is at low risk of bleeding and can

proceed with the dilatation and curettage

procedure safely)

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Drug Studies

The following list of drugs are medications prescribed for Patient A.B.,

the date of prescription is also indicated.

Table 13

List of Ordered Drugs of Patient A.B.

Date Doctor’s order

April 25,
Cefuroxime 750mg IVTT now then q8H ANST
2021
Diphenhydramine 50 mg IVTT pre-BT

Paracetamol (Naprex) 300 mg IVTT pre-BT

Ketorolac (Dyrolac) 30 mg IVTT q8H x 3 doses then PRN for pain

Nalbuphine (Nubain) 2mg slow IV push q8H PRN for

breakthrough pain >7/10 or itchiness

April 26,
FeSO4 1 tab OD now then OD ac AM
2021
Methylergonovine maleate (Methergine) 1 tab PO TID

Mefenamic acid 500mg 1 tab TID PRN for pain

April 27,
FeSO4 1 tab PO OD ac AM
2021
Methergine 1 tab PO TID x 7 days

Cefurex 500mg/tab 1 tab x 5 days

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

1. Cefuroxime

Table 14

Drug Study of Cefuroxime

Date ordered April 25, 2021

Doctor’s order Cefuroxime 750mg IVTT now then q8H ANST

Date ordered April 27, 2021

Doctor’s order Cefurex 500mg/tab 1 tab x 5 days

Generic name Cefuroxime

Trade Name Ceftin, Zinacef, Cefurex

Classifications

Therapeutic Anti-infectives

Pharmacologic Second-generation cephalosporins

Actions It binds to specific penicillin-binding proteins (PBPs)

located inside the susceptible bacteria cell wall which

inhibits bacterial cell wall synthesis causing cell lysis or

cell death.

Indications Used to treat broad-spectrum infections including

respiratory tract infections, skin and skin structure

infections, bone and joint infections, urinary tract

infections, meningitis, gonorrhea, and early Lyme

disease.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Contraindications Known hypersensitivity to cephalosporins and

penicillins.

Interactions Drug-Drug: Alcohol ingestion may cause a disulfiram-

like reaction; anticoagulants, antiplatelet agents,

thrombolytics, and NSAIDs may ↑ risk of bleeding;

Antacids may ↓ absorption rate; aminoglycosides or

loop diuretics may ↑ risk of nephrotoxicity.

Adverse effect CNS: Seizures (high doses); GI: Pseudomembranous

colitis, diarrhea, nausea, and vomiting; Derm: rashes,

urticaria; Hemat: agranulocytosis, bleeding,

eosinophilia, hemolytic anemia, neutropenia,

thrombocytopenia; Misc: anaphylaxis, serum sickness,

superinfections

Nursing 1. Before initiating therapy, obtain a history of

responsibilities previous use of and reactions to penicillins or

cephalosporins.

2. Evaluate antibiotic skin testing accordingly.

3. Observe for signs and symptoms of anaphylaxis

such as RESP: dyspnea, wheezing; Derm: skin

reactions (hives, itchiness, flushing); CV:

hypotension, weak pulse, chest pain; CNS:

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

dizziness, anxiety (feeling of “impending doom”) ;

GI: nausea, diarrhea, vomiting, abdominal cramps;

keep epinephrine and/or resuscitation equipment

close by in the event of an anaphylactic reaction;

Notify health care provider accordingly.

4. Monitor bowel function (diarrhea, abdominal

cramping, fever, and bloody stools) for signs of

pseudomembranous colitis; refer accordingly to the

health care provider.

5. Monitor prothrombin time and assess for signs of

bleeding such as epistaxis (nose bleeding), easy

bruising, and oozing blood on the IV site.

6. Instruct the patient to avoid alcohol intake and other

interacting drugs that may ↑ the risk of bleeding and

nephrotoxicity.

Rationale It was prescribed as preoperative antimicrobial

prophylaxis before the patient dilation and curettage

(D&C) procedure.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

2. Diphenhydramine

Table 15

Drug Study of Diphenhydramine

Date ordered April 25, 2021

Doctor’s order Diphenhydramine 50 mg IVTT pre-BT

Generic name Diphenhydramine

Trade Name Benadryl, Banophen, Genahist, Sominex, Unisom

Classifications

Therapeutic Anticholinergic agent, antihistamine, anxiolytics, and

sedatives/hypnotics

Pharmacologic Antihistamines

Actions It blocks the effects of histamine at the H1 receptor,

reducing allergic reaction symptoms. It also acts as an

antimuscarinic to H1 receptor.

Indications Relief of symptoms associated with allergies; to treat

motion sickness, insomnia, Parkinson-like reactions;

and premedication before blood transfusion.

Contraindications Known hypersensitivity, angle-closure glaucoma, and

acute attacks of asthma. Should not be used in

premature or newborn infants.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Interactions Drug-Drug: Additive sedation when used concurrently

with alcohol, antidepressants, opioids,

sedative/hypnotics, and other CNS-depressant drugs.

MAO inhibitors and TCAs may ↑ anticholinergic

effects.

Adverse effect CNS: drowsiness, dizziness; EENT: blurred vision,

tinnitus; CV: hypotension, palpitations; GI: anorexia,

dry mouth, constipation, nausea; Derm:

photosensitivity; Resp: dyspnea, thickened bronchial

secretions

Nursing 1. Monitor VS routinely and observe for signs of

responsibilities overdose and/or anaphylaxis such as difficulty

breathing and skin rashes; refer accordingly.

2. Assess LOC periodically and instill safety

precautions such as raising both bedside rails.

3. Caution the patient to avoid using concurrent

alcohol or CNS-depressant drugs.

4. Caution the patient that it may cause drowsiness;

advise to avoid activities requiring alertness.

5. Advise the patient to ↑ fluid intake and eat bulk-

forming foods to prevent constipation.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Rationale It was ordered as premedication before blood

transfusion along with Paracetamol (Naprex) to

ameliorate febrile non-hemolytic transfusion reactions

(FNHTR) and allergic reactions to blood products.

3. Paracetamol (Naprex)

Table 16

Drug Study of Paracetamol (Naprex)

Date ordered April 25, 2021

Doctor’s order Paracetamol (Naprex) 300 mg IVTT pre-BT

Generic name Paracetamol

Trade Name Naprex

Classifications

Therapeutic Antipyresis, analgesia

Pharmacologic Nonopioid analgesics

Actions Inhibits the synthesis of prostaglandins to induce

analgesic and anti-inflammatory effects. Antipyretic

action is due to direct action on heat-regulating centers

in the brain.

Indications To reduce fever and provide pain relief.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Contraindications Known hypersensitivity to Naproxen and liver

dysfunction

Interactions Drug-Drug: Hepatotoxicity additive when used

concurrently with alcohol, isoniazid, rifampin, rifabutin,

phenytoin, barbiturates, carbamazepine, and other

hepatotoxic substances. NSAIDs and ACE inhibitors

may ↑ the risk of renal impairment. Anticoagulation

therapy may ↑ risk of bleeding. Propranolol and other

β-blockers may ↓ antihypertensive effect. May ↓ effects

of lamotrigine and zidovudine.

Adverse effect CNS: headache, dizziness, drowsiness; CV:

hypertension, palpitations; GI: hepatotoxicity (↑ doses),

constipation, nausea, vomiting; GU: renal failure (↑

doses/chronic use); Derm: Steven-Johnson syndrome,

pruritus, urticaria; Hemat: neutropenia, pancytopenia

Nursing 1. Assess overall health status and alcohol usage

responsibilities before administering acetaminophen. Obtain the

patient medication history to determine possible

drug-drug interactions.

2. Monitor vital signs routinely and evaluate the

therapeutic regimen.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

3. Ensure the patient does not exceed the 4g

recommended dose of acetaminophen. Advice to

avoid taking concurrently with salicylates or NSAID

as directed by a health care provider.

4. Observe signs of hepatotoxicity such as skin rash,

jaundice, fatigue, nausea and vomiting, stomach

pain, loss of appetite, and dark-colored urine;

advise the patient to notify the health care provider

if the following symptoms occur.

5. Keep acetylcysteine (Acetadote) as an antidote if

overdosage occurs; Notify the health care provider

accordingly.

Rationale It was ordered as premedication before blood

transfusion along with diphenhydramine to ameliorate

febrile non-hemolytic transfusion reactions (FNHTR)

and allergic reactions to blood products.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

4. Ketorolac (Dyrolac)

Table 17

Drug Study of Ketorolac (Dyrolac)

Date ordered April 25, 2021

Doctor’s order Ketorolac (Dyrolac) 30 mg IVTT q8H x 3 doses then

PRN for pain

Generic name Ketorolac

Trade Name Dyrolac

Classifications

Therapeutic NSAIDs agent (non-selective)

Pharmacologic Pyrroziline carboxylic acid

Actions Inhibits key pathways in prostaglandin synthesis by

blocking COX-2 enzymes that mediate inflammation

and pain.

Indications Short-term management of moderate to severe pain

(not to exceed 5 days total for all routes combined)

Contraindications Known hypersensitivity to ketorolac and cross-

sensitivity with other NSAIDs may occur; active or

history of peptic ulcer disease or GI bleeding; renal

impairment; Perioperative active pain from coronary

artery bypass graft (CABG); cerebrovascular bleeding;

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Concurrent use of pentoxifylline or probenecid; OB:

Chronic use in 3rd trimester may cause constriction of

ductus arteriosus. May inhibit labor and ↑ maternal

bleeding at delivery.

Interactions Drug-Drug: ↑ adverse GI effects when used

concurrently with other NSAIDs, potassium

supplements, corticosteroids, or alcohol. Probenecid

and pentoxifylline ↑ risk of adverse reactions. May ↑

risk of toxicity from serum lithium and methotrexate

levels. ↑ risk of bleeding in patients undergoing

anticoagulant therapy or thrombolytic agents. Ace II

inhibitors may ↑ the risk of renal impairment.

Adverse effect CNS: stroke, drowsiness, dizziness, headache; Resp:

asthma, dyspnea; CV: myocardial infarction, edema,

pallor; GI: GI bleeding, nausea, diarrhea, dyspepsia;

Derm: Toxic epidermal necrolysis, Stevens-Johnson

syndrome, pruritus, urticaria; Hemat: prolonged

bleeding time; Misc: anaphylaxis, injection site pain

Nursing 1. Before therapy, assess the patient’s overall health

responsibilities condition. Evaluate the risk of adverse reactions to

the patient’s condition such as drug-drug

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

interactions. Notify the health care provider

accordingly.

2. Perform and evaluate antibiotic skin testing.

3. Assess the patient's pain to evaluate the

therapeutic effects of the drug regimen.

4. Assess for rash and other signs of allergic reaction

such as troubled breathing and chest pain; Notify

the health care provider accordingly.

5. Caution the patient to avoid concurrent use of

alcohol, aspirin, or other NSAIDs; advice to notify

the health care provider before taking OTC drugs.

6. Caution the patient that it may cause drowsiness;

advise to avoid activities requiring alertness.

7. Advise the patient to notify the health care provider

if rash, visual disturbances, edema, black stools,

persistent headache, or influenza-like syndrome

(chills, fever, malaise, pain) occurs.

Rationale It was prescribed as needed to alleviate the patient's

abdominal pain due to uterine tissue injury secondary

to post-dilation and curettage (D&C) procedure or by

some other factors.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

5. Nalbuphine (Nubain)

Table 18

Drug Study of Nalbuphine (Nubain)

Date ordered April 25, 2021

Doctor’s order Nalbuphine (Nubain) 2mg slow IV push q8H PRN for

breakthrough pain >7/10 or itchiness

Generic name Nalbuphine

Trade Name Nubain

Classifications

Therapeutic Opioid analgesia

Pharmacologic Opioid agonist

Actions It binds to opiate receptors in the CNS, where they act

as an agonist of endogenously occurring opioid

peptides (enkephalins and endorphins), causing

alteration to the perception of and response to pain.

Has partial antagonist properties, which may result in

opioid withdrawal in physically dependent patients.

Indications Management of moderate to severe pain.

Contraindications Known hypersensitivity to opioids agents or bisulfites;

Patients physically dependent on opioids (may

precipitate withdrawal).

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Interactions Drug-Drug: Additive sedative effect when used

concurrently with alcohol, antihistamines,

antidepressants, sedative/hypnotics, phenothiazines,

MAO inhibitors, and other drugs with CNS depressant

properties. Avoid concurrent use with other opioid

analgesic agonists (may diminish analgesic effect).

Adverse effect CNS: sedation, drowsiness, dizziness, headache;

EENT: blurred vision, tinnitus; Resp: respiratory

depression; CV: orthostatic hypotension, palpitations;

GI: constipation, dry mouth, nausea, vomiting; Derm:

sweating, clammy feeling; Misc: physical and

psychological dependence, and tolerance

Nursing 1. Before administering, clarify all ambiguous orders;

responsibilities have a second practitioner verify the original order,

dose calculations, and infusion pump settings (to

prevent accidental overdose of opioid analgesics).

2. Routinely check the patient level of consciousness

and vital signs. Assess BP and respirations before

and periodically during administration.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

3. Assess bowel function routinely. Advise the patient

to ↑ fluid intake and eat bulk-forming foods to

prevent constipation.

4. Monitor intake and output ratios; assess for urinary

retention and inform the health care provider

accordingly.

5. Keep naloxone as an antidote to reverse

respiratory depression or coma when overdosage

occurs.

6. Caution the patient to call for assistance when

ambulating and to avoid activities requiring

alertness.

7. Advise the patient to make position changes slowly

to minimize orthostatic hypotension.

8. Caution the patient to avoid concurrent use of

alcohol and other drugs with CNS depressant

properties.

Rationale It was prescribed to alleviate the patient's pain when

she experiences moderate-to-severe pain (7/10)

threshold and to prevent skin damage due to

excoriation (skin-picking).

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

6. Ferrous Sulfate

Table 19

Drug Study of Ferrous Sulfate

Date ordered April 26, 2021

Doctor’s order FeSO4 1 tab OD now then OD ac AM

Date ordered April 27, 2021

Doctor’s order FeSO4 1 tab PO OD ac AM

Generic name Ferrous sulfate

Trade Name Chem-Sol, Hemocyte, PureFe Plus, Slow-Fe, Fer-inSol

Classifications

Therapeutic Antianemics

Pharmacologic Iron supplements

Actions It provides a sufficient amount of iron to support normal

red blood cell (RBC) production. The iron combines

with porphyrin and globin chains to form hemoglobin,

which is the oxygen-carrier of RBC. .

Indications Used to treat or prevent iron deficiency anemia.

Contraindications Known hypersensitivity or intolerance to ferrous

sulfate; Hemochromatosis, hemosiderosis, or other

condition of iron overload; Anemia not due to iron

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

deficiency (ex. Hemolytic anemias); products

containing alcohol, tartrazine, or sulfites.

Interactions Drug-Drug: Oral iron supplements may ↓ the

absorption of other medications including tetracyclines,

bisphosphonates, fluoroquinolones, levothyroxine, and

mycophenolate mofetil, penicillamine, levodopa, and

methyldopa. Concurrent administration of H2

antagonists, proton pump inhibitors, and

cholestyramine may ↓ absorption of iron. Avoid taking

ferrous sulfate with antacids or calcium supplements

may ↓ iron absorption (wait at least 1 – 2 hours before

or after administration).

Food-Drug: Avoid dairy products, milk, caffeine-

containing foods, and beverages (calcium ↓ iron

absorption). Ferrous sulfate should be taken at least

two hours before or after meals (may ↓ absorption).

May take food rich in or fortified with vitamin C (↑ iron

absorption).

Adverse effect CNS: febrile seizures (children), dizziness; CV:

hypotension; GI: nausea, constipation, dark stools,

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

diarrhea, epigastric pain; Derm: flushing, urticaria;

Misc: staining of teeth

Nursing 1. Assess nutritional status and dietary history to

responsibilities determine the nutritional-related cause of anemia

and the need for patient teaching.

2. Inform the patient that iron oral supplements are

most effectively absorbed if administered 1 hour

before or 2 hours after meals. If gastric irritation

occurs, advise the patient to take a small amount of

food.

3. Assess bowel function for constipation and

diarrhea. Caution the patient that it may cause

stools to turn black.

4. Advise the patient to drink in moderation and eat

bulk-forming foods.

5. Observe for early signs of overdose (epigastric

pain, fever, nausea, vomiting, and diarrhea). Notify

the health care provider accordingly.

Rationale The oral iron supplement was prescribed to manage

the patient's anemia.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

7. Methylergonovine maleate (Methergine)

Table 20

Drug Study of Methylergonovine maleate

Date ordered April 26, 2021

Doctor’s order Methylergonovine maleate (Methergine) 1 tab PO TID

Date ordered April 27, 2021

Doctor’s order Methergine 1 tab PO TID x 7 days

Generic name Methylergonovine maleate

Trade Name Methergine

Classifications

Therapeutic Oxytocic

Pharmacologic Ergot alkaloids

Actions It acts directly on the uterine and vascular smooth

muscles to increase the tone, rate, and amplitude of

rhythmic contraction, producing rapid and sustained

tetanic uterine contractions which shorten the third

stage of labor and reduce or prevent blood loss.

Indications Used to prevent and control uterine atony and

hemorrhage during postpartum or postabortion.

Contraindications Known hypersensitivity to methylergonovine; patients

with hypertension or toxemia; OB: should not be used

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

to induce labor and during pregnancy; Lactation: do

not breastfeed during treatment and for 12 hours after

the last dose; Concurrent use of potent CYP3A4

inhibitors.

Interactions Drug-Drug: Enhance vasoconstrictive effect may

result when used with vasopressors, such as

dopamine, or beta-blockers. Potent CYP3A4 inhibitors

such as macrolide antibiotics (ex. Clarithromycin),

protease inhibitors (ex. ritonavir), and antifungal (ex.

ketoconazole) may ↑ levels and ↑ risk of ischemia;

should not be used concurrently with

methylergonovine. Less potent CYP3A4 inhibitors

(e.g., saquinavir, nefazodone, fluconazole, fluoxetine,

fluvoxamine, zileuton, or clotrimazole) may ↑ level and

should be used with caution. CYP3A4 inducers (e.g.,

nevirapine, rifampicin) and Anesthetics may ↓

methergine oxytocic properties. May ↓ antianginal

effect of nitrates.

Drug-Food: Grapefruit juice may ↑ level; use with

caution.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Adverse effect CNS: stroke, dizziness, headache; EENT: tinnitus;

Resp: dyspnea; CV: hypertension, arrhythmias, chest

pain, palpitations; GI: nausea, vomiting; GU: cramps;

Derm: diaphoresis; Neuro: paresthesia; Misc: allergic

reactions.

Nursing 1. Monitor BP, HR, and uterine tone frequently during

responsibilities medication administration. Watch out for signs of

hemorrhage; if uterine atony occurs, massage the

patient’s fundus; notify the health care provider

immediately.

2. Monitor intake and output ratios. Notify the health

care provider when vaginal bleeding occurs.

3. Advise the patient to notify health care

professionals when the following signs occur:

vaginal bleeding, a tingling sensation in the

extremities, and difficulty breathing or chest pain.

4. Caution the patient that the medication may cause

menstrual-like cramps.

5. Caution the patient that the medication may cause

dizziness; Encourage the patient to request

assistance if needed.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

6. Caution the patient to avoid smoking because it ↑

the vasoconstrictive effect.

Rationale The medication was prescribed to the patient to

prevent hemorrhage or to reduce blood loss from post-

dilation and curettage (D&C) procedure.

8. Mefenamic Acid (Ponstel)

Table 21

Drug Study of Mefenamic Acid (Ponstel)

Date ordered April 26, 2021

Doctor’s order Mefenamic acid 500mg 1 tab TID PRN for pain

Generic name Mefenamic Acid

Trade Name Ponstel

Classifications

Therapeutic Analgesics

Pharmacologic NSAIDs

Actions It binds non-selectively both cyclooxygenase isoforms

(COX-1 and COX-2), inhibiting the action of

prostaglandin synthetase, which are involved not only

in pain sensitivity, inflammation, and fever, but also in

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

hemostasis, kidney function, pregnancy maintenance,

and gastric mucosa protection.

Indications For the treatment of primary dysmenorrhea and to

alleviate mild-to-moderate pain in patients ≥ 14 years

of age.

Contraindications Known hypersensitivity to mefenamic acid; for

treatment of peri-operative pain in coronary artery

bypass graft (CABG) surgery; active acute ulceration,

chronic inflammation of upper/lower GI tract, and pre-

existing renal disease; should not be given to patients

who have experienced asthma, urticaria, or allergic-

type reactions after taking aspirin or other NSAIDs.

Interactions Drug-Drug: NSAIDs may ↓ the antihypertensive effect

of ACE inhibitors. Concurrent use of aspirin or other

NSAIDs may ↑ the risk of adverse effects. May ↓

efficacy of diuretics. May ↑ risk of toxicity from serum

lithium and methotrexate. ↑ risk of bleeding in patients

undergoing anticoagulant therapy or thrombolytic

agents.

Adverse effect CNS: stroke, malaise, dizziness, drowsiness; EENT:

blurred vision, tinnitus; Resp: asthma (r/t aspirin

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

sensitivity), dyspnea; CV: tachycardia, hypertension,

edema, CHF; GI: abdominal pain, nausea, diarrhea,

dyspepsia, GI bleeding, ulceration, and perforation;

Derm: Toxic epidermal necrolysis, Steven-Johnson

syndrome, rash/urticaria; Hemat: prolonged bleeding,

anemia; GU: impaired renal function; F and E:

hyperkalemia; Misc: anaphylaxis, jaundice,

unexplained weight gain

Nursing 1. Before therapy, assess the patient’s overall health

responsibilities condition. Evaluate the risk of adverse reactions to

the patient’s condition such as drug-drug

interactions. Notify the health care provider

accordingly.

2. Assess the patient's pain to evaluate the

therapeutic effects of the drug regimen.

3. Caution the patient that it can cause drowsiness;

Advise to avoid activities requiring alertness.

4. Caution the patient to avoid concurrent use of

alcohol, aspirin, or other NSAIDs; advice to notify

the health care provider before administering OTC

drugs.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

5. Advise the patient to notify the health care provider

if rash, visual disturbances, edema, unusual

bleeding (epistaxis, rectal bleeding), or influenza-

like syndrome (chills, fever, malaise, pain) occurs.

6. Advice the patient to administer the medication as

prescribed (500mg 1 tab TID PRN for pain) and

with food to prevent side effects.

Rationale It was prescribed to ease the patient's complaints of

back pain and abdominal pain.

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Problem List and Nursing Care Plan

1. Acute pain related to injury to uterine tissues secondary to dilatation and

curettage
2. Impaired physical mobility related to pain in the lower back and lower
abdomen
3. Risk for injury related to impaired sensory function secondary to dizziness
4. Risk for infection related to dilatation and curettage
5. Risk for activity intolerance related to physical deconditioning secondary to
complete bed rest

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Table 22

Nursing Care Plan on Acute pain

ASSESSMENT NURSING BACKGROUND NURSING

NEEDS INTERVENTIONS RATIONALE EVALUATION
CUES DIAGNOSIS INFORMATION OBJECTIVES
Subjective: P Acute pain In the NANDA After 2hrs of Independent: 4-26-21
H related to 2018-2020, nursing 9 a.m.
- “Masakit sa Y Herdman, H. & interventions, 1. Maintain a 1. To
bandang S injury to Kamisuru, S. the patient will quiet, promote 1. GOAL
baba ng likod I uterine (2018) defined be relieved of comfortable comfort and MET.
ko pati sa O Acute pain as pain. environment, relaxation
tissues
puson doc.” L an unpleasant and encourage The patient
as verbalized secondary Specifically, the patient to 2. To verbalized
O sensory or
by the to the patient will maintain bed evaluate “meron pa
G emotional
patient. be able to: rest. the effects ring sakit
I dilatation experience
of mga 3 over
C associated
and 1. Verbalize a 2. Evaluate the treatment 10 pero okay
A with actual or
curettage decrease of patient's pain modalities. lang naman
Objective: L potential tissue
pain from 5 to periodically. kasi naka
damage, 3. To
3 over 10. bed rest lang
- pain scale of N characterized 3. Encourage redirect the
5/10 (7 a.m.) E as a sudden or ako.”
2. VS within the patient to patient's
E slow onset of the normal practice attention
- The patient D any intensity range. relaxation and help
was S from mild to techniques such alleviate
grimacing in severe, with a PR = 60 - 100 as deep pain.
pain and duration of bpm breathing
less than 3 exercises or

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

rubbing her months. BP = 120/80 other modalities 2. GOAL

back. According to mmHg she preferred. MET.
Husney, A.
- tender (2021), a 3. Perform 4. Assist and 4. To The patient
hypogastric patient may activities to advise the promote VS as
area experience relieve pain patient to comfort and follows:
backache, such as change bed
- BP 120/90 prevent BP - 120/80
menstrual-like breathing positions.
mmHg exercise. bedsores. mmHg
cramps, and
- PR 98 bpm pass small PR - 96 bpm
Dependent:
clots of blood 5. To
for the first few 5. Administer relieve pain 3. GOAL
days of post- medications as and provide MET.
dilatation and prescribed. comfort.
curettage The patient
procedure. In - Ketorolac practices
the case (Dyrolac) 30 mg deep
scenario, the IVTT q8H PRN breathing
patient was for pain exercises
experiencing and guided
moderate - Nalbuphine imagery to
lower back (Nubain) 2mg distract
pain and slow IV push herself from
hypogastric q8H PRN for pain.
pain related to breakthrough
pain >7/10 or She uses a
injury to pillow under
uterine tissues itchiness
her knees to
secondary to keep her

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

dilatation and spine neutral

curettage and she
procedure. changes bed
positions left
and right in
sims’
position. The
patient
tolerated
changing
bed positions
with no
apparent
signs of
distress.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Table 23

Nursing Care Plan on Impaired physical mobility

ASSESSMENT NURSING BACKGROUND NURSING INTERVENTION

NEEDS RATIONALE EVALUATION
CUES DIAGNOSIS INFORMATION OBJECTIVES S
Subjective: P Impaired In the NANDA After 3hrs of Independent: 04-26-2021
H physical 2018-2020, nursing 10 a.m.
- The patient Y Herdman, H. & interventions, 1. Provide 1. To
verbalized S mobility Kamisuru, S. the patient safety prevent falls 1.GOAL MET.
“Gusto ko I related to (2018) defined will be precautions and injury.
sana mag-CR O Impaired relieved of (ex. raise both the patient
pain in the
kaso masakit L physical pain and can bedside rails, 2. To verbalized
sa bandang lower back evaluate the “medyo okay
O mobility as perform self- lower the
baba ng likod G and lower limitation in care height of the effects of na ang
ko pati sa I abdomen independent, activities. bed) treatment pakiramdam
puson doc. C purposeful modalities. ko, out of 3
Sumasakit A movement of Specifically, 2. Evaluate the over 10 ang
kung patient's pain 3. To sakit sa baba
L the body or of the patient
gumagalaw periodically. enable the ng likod at
one or more will be able
ako.” patient to puson.”
N extremities. In to:
3. Provide a request for
E the case
1. Verbalize a call bell. assistance. 2. GOAL
E scenario, the
decrease of Explain to the MET.
Objective: D patient’s pain in
pain from 5 to patient to call
S the lower back The patient
3 and below for help if
- pain scale of and lower can
over 10. assistance is
5/10 (7 a.m.) abdomen limits independently
needed.
her movement take her

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

- The patient to perform self- 2. Perform 4. Monitor 4. meals and

was grimacing care activities ADLs elimination Immobility empty her
in pain and independently independently status. causes bladder using
rubbing her such as as tolerated constipation the bedside
back. toileting. and will 5. Assess the and reduces commode.
request patient’s ability the motility The patient’s
- Tender assistance if to perform self- of the husband
hypogastric needed. care activities; gastrointesti disposed of
area. re-evaluate nal tract. her waste in
3. Utilize regularly. the bathroom.
therapeutic 5. To She often
activities to 6. Encourage evaluate asks for
relieve pain the patient to and monitor supervision if
such as eat food rich in the patient's
her husband
music fiber and drink ability to
or nurse is
therapy. plenty of perform available.
water. self-care
activities. The patient
7. Educate the
gets up in bed
caregiver to 6. To and takes her
promote maintain time before
independence, hydration
reaching the
but intervene and prevent bedside
when the hardening commode as
patient needs of stool as observed.
support to well as skin There was no
perform self- breakdown incidence of
care activities.

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

8. Encourage and falls or

the patient to irritation. injuries.
utilize
therapeutic 7. To
measures provide a
sense of 3. GOAL
such as music
autonomy MET.
therapy.
and
The patient
Dependent: intervene in
was able to
a suitable
9. Provide a utilize
level of
bedside therapeutic
assistive
commode as activities
care.
ordered; teach specifically
the patient 8. To lessen music
how to use it. the patient’s therapy, to
perception divert
10. Administer of pain. It attention.
medications as provides
prescribed. Patient
alternative
verbalized “
ways to
- Ketorolac guminhawa
divert the
(Dyrolac) 30 kahit papaano
patient’s
mg IVTT q8H yung
attention.
PRN for pain pakiramdam
9. Serves ko kasi di ko
- Nalbuphine na naiisip
as a
(Nubain) 2mg yung sakit.
portable
slow IV push Tanging yung
toilet that
q8H PRN for
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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

breakthrough will be lyrics lamang

pain >7/10 or placed near ng mga
itchiness the patient’s paborito kong
bed. kanta ang
aking naiisip.“
10. To
relieve pain
and provide
comfort.

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Table 24

Nursing Care Plan on Activity intolerance

ASSESSMENT NURSING BACKGROUND NURSING

NEEDS INTERVENTIONS RATIONALE EVALUATION
CUES DIAGNOSIS INFORMATION OBJECTIVES
Subjective: P Risk for In the NANDA After 3hrs of Independent: 4-26-21
H injury 2018-2020, nursing 10 a.m.
- The patient Y Herdman, H. & interventions, 1. Maintain a 1. To
verbalized S related to Kamisuru, S. the patient will quiet, promote 1. GOAL
“Gusto ko I impaired (2018) defined recognize risk comfortable comfort and MET.
sana mag- O risk for injury for injury and environment, relaxation
sensory
CR kaso L as susceptible maintain safety and encourage The patient
medyo function the patient to verbalized
O to physical precautions.
nahihilo pa G secondary damage due to maintain bed “Mag tawag
ako.” I to dizziness environmental Specifically, the rest. lang po ako
C conditions patient will be ng tulong
able to: 2. Provide 2. To kapag
A interacting with prevent falls
safety kailangan,
Objective: L the individual’s and injury.
1. Recognize precautions (ex. kasi baka
adaptive and
susceptibility raise both matumba pa
- BP 120/90 N defensive
for falls and bedside rails, ako at
mmHg E resources. In
injury. lower the height mabagok
E the case
of the bed). yung ulo ko.”
D scenario, the 2. Demonstrate Place items
S patient is at behaviors to within the
risk for injury avoid injury patient’s reach.
because of such as 2. GOAL
dizziness. MET.

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

maintaining 3. Provide a call 3. To enable The patient

bed rest. bell. Explain to the patient maintained
the patient to to request bed rest.
3. Remain free call for help if for Side rails
from injuries. assistance is assistance. were raised
needed. and there is
a bedside
4. Advise the 4.To prevent commode to
family members the patient facilitate her
to stay with the from elimination.
patient at all accidentally
times. falling. 3. GOAL
MET.
5. Monitor VS 5. To assess
especially BP the patient's The patient
condition. was free
from injuries.
There were
Dependent:
no
6. Provide a 6. Serves as incidences of
bedside a portable falls and
commode as toilet that will injuries. The
ordered; teach be placed patient BP
the patient how near the was 120/80
to use it. patient’s mmHg.
bed.

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

CHAPTER 5

SUMMARY, CONCLUSION, AND RECOMMENDATION

Prognosis

The researchers’ overall prognosis for the patient’s health management is

good. The condition of Patient A.B. was treated promptly: the pain, bleeding, and

anemia was managed and monitored throughout the therapy; the patient was

evaluated for signs of preeclampsia (assessments and urinalysis) and pulmonary

edema (chest X-ray); the attending physician was able to roll out a final diagnosis

through a combination of clinical (pelvic examination), laboratory (β-hCG blood

tests), and imaging data (ultrasound); the hydatidiform mole was evacuated

(D&C procedure) and the patient’s hCG levels will be monitored (β-hCG blood

test) and follow-up further. According to the attending physician, Dr. M.G., the

patient’s prognosis was good. All in all, the patient’s condition was managed and

will be monitored furthermore to evaluate the persistent rise of the hCG level

which could indicate cancer or gestational trophoblastic neoplasia (GTN).

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Discharge Planning with Health Teaching

Medication

Table 25

Health Education on Medication

Nursing action Rationale

Educate the patient about home To keep the patient well informed

medications including the therapeutic about the prescribed home

effects, side effects/adverse effects, medications.

and other relevant information.

Advise the patient to inform the health To prevent untoward adverse effects

care provider before taking OTC due to drug interactions.

drugs.

Caution the patient about the adverse To enable the patient to be informed

effects of the prescribed home and take necessary measures when

medications. medication adverse effects occur.

Advise the patient to notify the health To provide immediate measures and

care provider or call emergency if manage the patient's condition

rash, difficulty breathing, persistent promptly.

bleeding, dizziness, visual

disturbances, and other concerning

adverse effects occur.

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Encourage the patient to take food To promote drug efficacy.

rich in or fortified with vitamin C to ↑

iron absorption.

Advise the patient to document the To provide relevant information and

time, frequency, color, odor, and other manage her condition accordingly.

characteristics of vaginal discharge or

bleeding. Report to the health care

provider accordingly.

Advise the patient to avoid grapefruit To prevent the effect of Methergine to

juice because it may ↑ level of potentiate and decrease the risk of

Methergine. adverse effects such as hypertension.

Instruct the patient to avoid alcohol To prevent drug interactions and

intake and smoking due to the risk of promote health.

drug interactions.

Encourage the patient to have a To keep the patient medication

personal medication container and organized and prevent medication

attach a printed list of medication errors.

orders and other relevant information.

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Exercise

Table 26

Health Education on Exercise

Nursing Action Rationale

Caution the patient to avoid strenuous Engaging in strenuous activity during

activities during the period of recovery recovery may cause strain on the body

(approximately 2-3 days) from the D&C and excessive pressure on the pelvis

procedure. which can cause vaginal bleeding.

Advise the patient to ambulate as To enhance the patient’s recovery by

tolerated. Request for assistance as improving blood circulation.

needed.

Treatment

Table 27

Health Education on Treatment

Nursing action Rationale

Emphasize the importance of proper To reinforce patient compliance and to

drug regimen adherence. promote safety and health

- FeSO4 1 tab PO OD ac am management.

- Methergine 1 tab PO TID x 7 days

- Cefurex 500mg/tab 1 tab x 5 days

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Health Education

Table 28

Discharge Health Education

Nursing action Rationale

Advise the patient to seek medical To evaluate the patient's condition

attention if she experiences a problem and provide necessary treatment.

with her reproductive health including

menstrual problems.

Inform the patient and her husband It is recommended to wait for 6-12

that they will need to use an effective months before trying to become

birth control method to prevent pregnant while the hCG levels are

pregnancy for 6-12 months while the being monitored (Mayo Clinic, 2021),

patient's condition is being monitored. because according to the study by

Cavaliere et al. (2009), the risk of

persistent or recurrent GTD is

greatest in the first 12 months after

evacuation, with most cases

presenting within 6 months.

Caution the patient to avoid douching, Decrease the risk of infection and

using tampons, or engage in penile- allow the cervix to return to its normal

vaginal intercourse for a week. closed state.

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Caution the patient that she may To keep the patient well informed and

experience backache, menstrual-like to alleviate anxiety if the symptoms

cramps, and pass small clots of blood occurred.

for the first few days of post-dilatation

and curettage. Notify the health care

provider accordingly.

Instruct the patient to notify her health Early reports of signs and symptoms

care provider if she experiences can be given immediate attention to

severe back pain, heavy bleeding, or prevent the worsening of the

any unusual signs and symptoms. condition.

Advise the patient to sleep at least 7-8 To promote comfort and adequate

hours and rest periodically. rest.

Follow-up Care

Table 29

Health Education on Follow-up Care

Nursing action Rationale

Inform the patient that the purpose of To reinforce the patient's

her follow-up care is to monitor and understanding and compliance with

evaluate her condition for persistent follow-up check-ups.

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

abnormal growth of trophoblastic

tissue or GTN.

- Follow-up: May 10, 2021, 10 a.m. at

Medical Plaza.

- Repeat CBC, and β-hCG on May 10.

Please bring results on follow-up.

Diet

Table 30

Health Education on Diet

Nursing action Rationale

Advise the patient to rehydrate as To counteract the side effects of

often and eat bulk-forming foods to FeSO4 or iron supplements.

prevent constipation.

Advise the patient to eat a balanced Proper nutrition helps manage the

nutritious diet and limit fat intake or patient's condition and health.

cholesterol.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

APPENDIX A

Readiness to Learn

____ Semester SY ____

SELF-ASSESSMENT TOOL ON
STUDENTS READINESS TO LEARN

Name: _________________ Course/ Year: ____________________

Instruction: Rate yourself on the skills or competencies identified below

according to its current importance and current skill rating.

Skill or competency Current Current skill

importance rating
1-very 1-excellent
2-fairly 2-good
3-not very 3-adequate
4-unimportant 4-poor

Life skills: Organization of

time and resources in your life,
co-operation in working with
others, available support
network

Independence: Autonomy,
self-motivation, self-reliance,
resourcefulness, initiative, and
judgment

"Basic” skills: Literacy,

numeracy, graphicity, computer
literacy, etc.

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Skill or competency Current Current skill

importance rating
1-very 1-excellent
2-fairly 2-good
3-not very 3-adequate
4-unimportant 4-poor

Information skills: Ability to

find information by: using
libraries; abstracts; community
resources; interpreting data,
charts, tables, timetables, etc.

Study skills: Organization of

material for projects, note-
taking and reading for different
purposes, understanding
assignment requirements

Learning to learn: Awareness

of task demands, flexibility,
self-knowledge of learning
preferences, awareness of
learning process, self-
evaluation

Planning skills: Ability to

design a plan of strategies for
meeting learning needs, ability
to carry out a plan
systematically and sequentially

Problem development
skills: Ability to formulate
questions that are answerable
through various research
activities (projects, library,
readings)

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Skill or competency Current Current skill

importance rating
1-very 1-excellent
2-fairly 2-good
3-not very 3-adequate
4-unimportant 4-poor

Analytical skills: Ability to

select and use most effective
means of acquiring information,
ability to analyze and organize
information, ability to select
most relevant and reliable
information sources

Communication skills: Ability

to write reports, essays,
instructions, discourse, display
data, etc.

Evaluation skills: Ability to

collect evidence of
accomplishments and have it
evaluated, ability to accept
constructive feedback from
others

Completion skills: Ability to

identify problem areas, ability
to revise work, commitment to
completing units and program

AVERAGE RATING

Interpretation: An average rating of 1-3 in each column indicates readiness for

independent study. An average rating higher than 3 indicates that you may need
to seek out some help in certain skill areas as you progress through your unit.

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

APPENDIX B

Learning Contract

SELF-DIRECTED LEARNING (SDL) CONTRACT

Subject: NCM-N 109 B (RLE– 306 Hours) Care of the Mother, Child at Risk; Unit of Study: Case Study
or With Problems (Acute and Chronic) SDL: 61.2-91.8 hours (Hydatidiform mole with Diabetes Mellitus)

Roles: Students 1. Propose a written learning contract of what you want to learn and how you plan to learn it.
2. Develop a detailed schedule that reflects your work on contract activities based on targeted dates.
3. Take the initiative to contact your advising instructor immediately to get the assistance you need
4. Meet with your advising instructor regularly to review progress and discuss material.

Instructor 1. Assist in developing learning contract and ensure its completion and good quality.
2. Recommend learning resources, such as books, journals, people, agencies, library materials.
3. Be available as a resource for information, but allow the student to take initiative in asking for
assistance with learning.
4. Meet regularly with the student to review progress, share ideas, and encourage learning.
5. Evaluate the student’s work as described in the learning contract.

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

GOAL: To conduct a comprehensive case study utilizing the knowledge and skills learned in NCM-N 109A and
NCM-N 109B.
How are
Advising
How are you going to learn Target Date How are you going you going
faculty
Objectives to know that you to prove
(What are you going to it? of member
learn?) (Activities, Resources, and
Completion have learned it? that you
Strategies) (Evidence/Output)
feedback
learned it? (Evaluation)
(Verification)

1. Evaluate our a. Accomplishment of April 22, a. Able to The outputs CI: Mari-
readiness to Readiness to learn 2022 evaluate our will be Angeli
learn and our template. readiness to presented Valencia,
learning (Individually) learn for the to the RN
needs for the SDL task and advising
unit. b. Review of learning the faculty for
resources related to submission of updates on
2. Fill out the Hydatidiform Mole. our self- progress.
SDL contract assessment
and submit it c. Completion of the tool within its
within its Learning contract. (As specified due
specified due a whole) date.
date.
b. List of
references for
the case
study.

c. Filled out

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

learning
contract with
the signature
of CI and
student.

3. Gather and d. Consolidating the April 22, d. Data and The outputs CI: Mari-
organize the data gathered 2022 information will be Angeli
patient’s data accordingly to its are sorted presented Valencia,
and charts for chapter. accordingly to to the RN
the case their Chapter. advising
study. e. Beginning of write- faculty for
ups: e. Submission of updates on
4. Construct the Chapters 1, 2, progress.
case study ⮚ Chp 1 (Abdul, and 3 (draft)
manuscript Estrabon) within its
based on the specified due
prescribed ⮚ Chp 2 (Benson, date.
format. Alair)

⮚ Chp 3
(Datusataviran)

5. Cont.’s of f. Cont.’s of write-ups: April 26, f. Submission of The outputs CI: Mari-
consolidating 2022 the initial draft will be Angeli
the data and ⮚ Chp 4 of the case presented Valencia,
constructing study to the RN

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

the case I. IDB, NHH, manuscript advising

study Physical within its faculty for
manuscript. assessment (De specified due updates on
Panay, date. progress.
Demegillo,
Daguiwag)

II. Pathophysiology
(Factor,
Demetrio)

⮚ Chp 5 (As a
whole)

⮚ Cover Page &

Table of Contents
(Palac)

⮚ Acknowledgement
(Demegillo)

⮚ References, and
Appendices
(Palac)

g. Submission of
consolidated case

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

study manuscript.
(Palac)

6. Final editing h. Final editing of the May 9, g. The final case The outputs CI: Mari-
of the case study 2022 study will be Angeli
manuscript manuscript. (As a manuscript presented Valencia,
Contents, whole) was fully to the RN
Cover Page, accomplished advising
Table of i. Submission of Final and submitted faculty for
Contents, Manuscript Output. on its updates on
References, (Palac) specified due progress.
and date.
Appendices.

I have reviewed and find acceptable the above learning contract

100
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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

101
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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

APPENDIX C

Consent for Study

CERTIFICATE OF CONSENT

I, _______________________, father/ mother/ guardian of ____________

allow my son/ daughter to be a participant for the procedure:

________________________________________________________________
(Name of Procedure)

By being a participant, my son/ daughter will be the simulated “patient” of a

2nd year Bachelor of Science in Nursing student who will perform the procedure
mentioned above. I am aware that these procedures will entail risks and benefits
that were thoroughly explained to me by the student nurse, and the procedure may
also involve steps that are less likely to be comfortable.

If any complications will occur to me while on the activity specified above, I

fully give my trust to the Nursing Department and the Clinical Instructor assigned
for interventions deemed necessary for alleviation of these complications but will
not hold the school, the department, and the instructor liable of the incident.

________________________ ____________
Parent/ Guardian’s signature Date

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

References

Ameer, M., Fagan, S., Sosa-Stanley, J., & Peterson, D. (2021). Anatomy,

Abdomen and Pelvis, Uterus. Statpearls Publishing. https://www.ncbi.nlm

.nih.gov/books/NBK470297/

Cavaliere, A., Ermito, S., Dinatale, A., & Pedata, R. (2009). Management of

molar pregnancy. Journal of prenatal medicine, 3(1), 15–17. https://www.

ncbi.nlm.nih.gov/pmc/articles/PMC3279094/

Cornforth, T. (2022, April 25). What to Know About Cervix Function and Female

Health. Verywell Health. https://www.verywellhealth.com/what-is-the-

cervix-352058

Critchley, H., Maybin, J., Armstrong, G., & Williams, A. (2020). Physiology of the

Endometrium and Regulation of Menstruation. https://doi.org/10.1152/

physrev.00031.2019

Dilation and curettage (D&C). (2021, October 19). Mayo Clinic. https://www.mayo

clinic.org/tests-procedures/dilation-and-curettage/about/pac-20384910

Female Reproductive System. (2020). U.S. National Institutes of Health, National

Cancer Institute. https://training.seer.cancer.gov/anatomy/reproductive

/female/

Gestational Trophoblastic Disease. (n.d.). Abramson Cancer Center. Retrieved

May 3, 2022, from https://www.pennmedicine.org/cancer/types-of-cancer/

gestational-trophoblastic-disease

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Gold, J., Shrimanker, I. (2021, July 26). Physiology, Vaginal. Statpearls

Publishing. https://www.ncbi.nlm.nih.gov/books/NBK545147/

Han, J., Sadiq N. (2021). Anatomy, Abdomen and Pelvis, Fallopian Tube.

Statpearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK547660/

Herdman, H. & Kamitsuru, S. (2018). Nanda International Nursing Diagnoses:

Definitions and classification 2018-2020 (11thed.).New York, NY: Thieme

Publishers. Nursing Diagnoses Definitions & Classification 2018-2020.pdf

Husney, A. (2021, June 16). Dilatation and Curettage: What to expect at Home.

MyHealth.Alberta.ca. https://bit.ly/3LFVBOm

Lagare, J., & Lu-Lasala, L. (2019). Complete hydatidiform mole with coexisting

live fetus: case report. SPMC J Health Care Serv. 2019;5(1):6.

http://n2t.net/ark:/76951/jhcs5u8d5t

Markman, M. (2022, March 8). Gestational trophoblastic disease risk factors.

Cancer Treatment Centers of America. https://www.cancercenter.com/

cancer-types/gestational-trophoblastic-disease-gtd/risk-factors

Molar Pregnancy. (2018, July 13). Cleveland Clinic.

https://my.clevelandclinic.org/health/diseases/17889-molar-pregnancy

Molar pregnancy. (2021, May 13). Mayo Clinic.

https://www.mayoclinic.org/diseases-conditions/molar-

pregnancy/diagnosis-treatment/drc 20375180

Ponstel. (2017, February 2). RxList. https://www.rxlist.com/ponstel-drug.htm

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Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

Ramirez, P., & Salvo, G. (2020). Hydatidiform Mole. MSD Manual.

https://www.msdmanuals.com/home/women-s-health-issues/cancers-of-

the-female-reproductive-system/hydatidiform-mole

Telleen, S. (2018, April 3). Anatomy and Physiology of the Female Reproductive

System. OpenStax. https://cnx.org/contents/nMy6SWSQ@5/Anatomy-

and-Physiology-of-the-Female-Reproductive-System

Tenny, S., Brannan, G., Brannan, J., & Sharts-Hopko, N. (2021, May 30).

Qualitative Study. Statpearls Publishing. https://www.ncbi.nlm.nih.gov

/books/NBK470395/

Thiyagarajan D., Basit H., & Jeanmonod R. (2021). Physiology, Menstrual Cycle.

Statpearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK500020/

Vallaerand, A.H. & Sanoski, C.A. (2014). Davis's Drug Guide for Nurses (14th

ed). Philadelphia, PA. F. A. Davis Company. Davis's Drug Guide for

Nurses, 14 edition.pdf

West, M., (2020, October 7). Female reproductive organ anatomy. Medical News

Today. https://www.medicalnews.com/articles/female-reproductive-organ-

anatomy

WHO. (1948). Maternal Health. World Health Organization.

https://www.who.int/health-topics/maternal-health#tab=tab_1

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 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

CURRICULUM VITAE

MOHANIEJANE K. ABDUL
Barangay Ramcor
General Salipada K. Pendatun, Maguindanao 9618
Mobile No.: +639509465270
Email: [email protected]

PERSONAL INFORMATION
Age : 20 years old
Sex : Female
Date of Birth : May 02, 2001
Civil Status : Single
Religion : Islam
Nationality : Filipino

EDUCATIONAL ATTAINMENT

College : Notre Dame of Marbel University

Alunan Avenue, Koronadal City, South Cotabato
Bachelor of Science in Nursing
(2020 - Present)

High School : Notre Dame of Katiko, Inc.

Katiku, President Quirino, Sultan Kudarat
(2014-2020)

Elementary : Katiku Central Elementary School

Katiku, President Quirino, Sultan Kudarat
(2008-2014)

107
 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

ANA MAE D. ABELLERA

Purok Namnama, Poblacion Lambayong
Lambayong, Sultan Kudarat 9802
Mobile No.: +639457898300
Email: [email protected]

PERSONAL INFORMATION

Age : 20 years old

Sex : Female
Date of Birth : December 23, 2001
Civil Status : Single
Religion : Roman Catholic
Nationality : Filipino

EDUCATIONAL ATTAINMENT

College : Notre Dame of Marbel University

Alunan Avenue, Koronadal City, South Cotabato
Bachelor of Science in Nursing
(2020 - Present)

High School : Notre Dame of Tacurong College

Lapu-lapu Street, Tacurong City, Sultan Kudarat
(2018-2020)
Notre Dame of Lambayong Inc.
Purok Inanama, Poblacion Lambayong, Sultan Kudarat
(2014-2018)

Elementary : Lambayong Central Elementary School

Purok Pag-asa, Poblacion Lambayong, Sultan Kudarat
(2008-2014)

108
 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

(2008-2014)

KRISTINE ANGELICA M. AGUIRRE

Purok Abrenica, Brgy. G.P.S
Koronadal City, South Cotabato 9506
Mobile No.: +639154323228
Email: [email protected]

PERSONAL INFORMATION

Age : 20 years old

Sex : Female
Date of Birth : July 11, 2001
Civil Status : Single
Religion : Roman Catholic
Nationality : Filipino

EDUCATIONAL ATTAINMENT

College : Notre Dame of Marbel University

Alunan Avenue, Koronadal City, South Cotabato
Bachelor of Science in Nursing
(2020-Present)

High School : Koronadal National Comprehensive High School

Rizal St., Poblacion, Koronadal City, South Cotabato
(2014-2019)

Elementary : Mary Land School Incorporated

Baldostamon Village, Zone IV, Koronadal City, South Cotabato
(2006-2014)

109
 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

DAWN MARIE F. ALAIR

Brgy. Poblacion, Norala, South Cotabato
Mobile No.: 09364794250
Email: [email protected]

PERSONAL INFORMATION

Age : 19 years old

Sex : Female
Date of Birth : December 19, 2001
Civil Status : Single
Religion: : Roman Catholic
Nationality : Filipino

EDUCATIONAL ATTAINMENT

College : Notre Dame of Marbel University

Alunan Avenue, Koronadal City, South Cotabato
Bachelor of Science in Nursing
(2020 – Present)

High School : Norala National High School

Brgy. Poblacion, Norala, South Cotabato
(2014-2020)

Elementary : Norala Alliance Christian School

Brgy. Poblacion, Norala, South Cotabato
(2009-2020)

110
 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

CYLE B. BALLERTA
Prk. Masinadyahon, Brgy. Liwanay
Banga, South Cotabato 9511
Mobile No.: +639296052462
Email: [email protected]

PERSONAL INFORMATION

Age : 20 years old

Sex : Female
Date of Birth : August 17, 2001
Civil Status : Single
Religion : Roman Catholic
Nationality : Filipino

EDUCATIONAL ATTAINMENT

College : Notre Dame of Marbel University

Alunan Avenue, Koronadal City, South Cotabato
Bachelor of Science in Nursing
(2020 - Present)

High School : Koronadal National Comprehensive High School

Rizal St., Poblacion, Koronadal City, South Cotabato
(2014-2018)

Elementary : Purok Sison Elementary School

Bonifacio St., Poblacion, Surallah, South Cotabato
(2008-2014)

111
 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

LOVELY E. BENSON
Prk. Ramos, Brgy. Sta. Cruz
Koronadal City, South Cotabato 9506
Mobile No.: +639508055917
Email: [email protected]

PERSONAL INFORMATION
Age : 21 years old
Sex : Female
Date of Birth : April 15, 2001
Civil Status : Single
Religion : Roman Catholic
Nationality : Filipino

EDUCATIONAL ATTAINMENT

College : Notre Dame of Marbel University

Alunan Avenue, Koronadal City, South Cotabato,
Bachelor of Science in Nursing
(2020 - Present)

High School : Notre Dame Siena College of Tacurong Inc.,

Tacurong City, Sultan Kudarat
(2014 – 2016)
Notre Dane of Marbel University IBED Inc,
Koronadal City, South Cotabato
(2016 - 2018)

Elementary : Notre Dame Siena College of Tacurong Inc.,

Tacurong City, Sultan Kudarat
(2008-2014)

112
 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

KAYE ANGELIE G. DAGUIWAG

Purok 3, Brgy. Didtaras
Lambayong, Sultan Kudarat 9802
Mobile No.: +639179981604
Email: [email protected]

PERSONAL INFORMATION

Age : 20 years old

Sex : Female
Date of Birth : December 27, 2001
Civil Status : Single
Religion : Pentecost
Nationality : Filipino

EDUCATIONAL ATTAINMENT
College : Notre Dame of Marbel University
Alunan Avenue, Koronadal City, South Cotabato
Bachelor of Science in Nursing
(2020 - Present)

High School : Notre Dame of Tacurong College

Lapu-lapu Street, Tacurong City, Sultan Kudarat
(2014-2018)

Elementary : Notre Dame of Tacurong College

Lapu-lapu Street, Tacurong City, Sultan Kudarat
(2010-2014)
St. Joseph Learning Center
Purok Namnama, Poblacion Lambayong, Sultan Kudarat
(2008-2010)

113
 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

ZAHARA A. DATUSATAVIRAN
Block 9 Lot 38, San Antonio Village Phase 2
Koronadal City, South Coatabto 9506
Mobile No.: +639972430308 / +639469198399
Email: [email protected]

PERSONAL INFORMATION

Age : 20 years old

Sex : Female
Date of Birth : December 15, 2001
Civil Status : Single
Religion : Islam
Nationality : Filipino

EDUCATIONAL ATTAINMENT
College : Notre Dame of Marbel University
Alunan Avenue, Koronadal City, South Cotabato
Bachelor of Science in Nursing
(2020 - Present)

High School : Notre Dame of Marbel University - Integrated Basic Education

Koronadal City, South Cotabato
(2018-2020)
Notre Dame Siena School of Marbel
Alunan Avenue, Koronadal City, South Cotabato
(2014-2018)

Elementary : Notre Dame Siena School of Marbel

Alunan Avenue, Koronadal City, South Cotabato
(2010-2014)

114
 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

KENNETH A. DE PANAY
Zone 1, Diego Silang St., Barangay Libertad,
Surallah, South Cot., 9512
Mobile No.: +639612327017
Email: [email protected]

PERSONAL INFORMATION
Age : 21 years old
Sex : Male
Date of Birth : November 1, 2000
Civil Status : Single
Religion : Roman Catholic
Nationality : Filipino

EDUCATIONAL ATTAINMENT

College : Notre Dame of Marbel University

Alunan Avenue, Koronadal City, South Cotabato
Bachelor of Science in Nursing
(2020 - Present)

High School : Notre Dame of Marbel University - IBED

Brgy. Sto. Niño, Koronadal City, South Cotabato
(2017-2020)
Notre Dame of Surala
Zone 1, Barangay Libertad, Surallah
(2014-2017)

Elementary : Notre Dame of Surala

Zone 1, Barangay Libertad, Surallah
(2008-2014)

115
 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

MACLAINE MIA YONNICK F. DEMEGILLO

Purok Sampaguita, Barangay Buenaflor
Tacurong City, Sultan Kudarat 9800
Mobile No.: +639559005640
Email:[email protected]

PERSONAL INFORMATION

Age : 20 years old

Sex : Female
Date of Birth : October 17, 2001
Civil Status : Single
Religion : Alliance
Nationality : Filipino

EDUCATIONAL ATTAINMENT
College : Notre Dame of Marbel University
Alunan Avenue, Koronadal City, South Cotabato
Bachelor of Science in Nursing
(2020 - Present)

High School : Notre Dame of Marbel University - Integrated Basic Education

Koronadal City, South Cotabato
(2018-2020)
Tacurong National High School
New Isabela, Tacurong City, Sultan Kudarat
(2014-2018)

Elementary : New Isabela Central Elementary School

New Isabela, Tacurong City, Sultan Kudarat
(2011-2014)

116
 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

THEA VANICE L. DEMETRIO

Blk. 5, Lot 31, Megaland Subdivision, Carpenter Hill
Koronadal City, South Cot., 9506
Mobile No.: +639659187350
Email: [email protected]

PERSONAL INFORMATION
Age : 21 years old
Sex : Female
Date of Birth : April 20, 2001
Civil Status : Single
Religion : Episcopal
Nationality : Filipino

EDUCATIONAL ATTAINMENT

College : Notre Dame of Marbel University

Alunan Avenue, Koronadal City, South Cotabato
Bachelor of Science in Nursing
(2020 - Present)

High School : Notre Dame of Marbel University - IBED

Brgy. Sto. Niño, Koronadal City, South Cotabato
(2018-2020)
Lebak Legislated National Highschool
Pob. 3, Lebak, Sultan Kudarat
(2014-2018)

Elementary : Don Marcelino Concha Memorial Elementary School

Brgy. Taguisa, Lebak, Sultan Kudarat
(2008-2014)

117
 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

AVA LORAINE D. ESTRABON

Purok Mabuhay, Barangay Benitez
Banga, South Cotabato 9511
Mobile No.: +639292331276
Email: [email protected]

PERSONAL INFORMATION

Age : 20 years old

Sex : Female
Date of Birth : June 14, 2001
Civil Status : Single
Religion : Roman Catholic
Nationality : Filipino

EDUCATIONAL ATTAINMENT

College : Notre Dame of Marbel University

Alunan Avenue, Koronadal City, South Cotabato
Bachelor of Science in Nursing
(2020 - Present)

High School : Banga National High School

Barangay Benitez, Banga, South Cotabato
(2014-2018)

Elementary : Banga Central Elementary School

Barangay Benitez, Banga, South Cotabato
(2008-2014)

118
 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

DONNAH S. FACTOR
Purok Rizal, Barangay Guinsang-an
Santo Niño, South Cotabato 9509
Mobile No.: +639554752734
Email: [email protected]

PERSONAL INFORMATION

Age : 20 years old

Sex : Female
Date of Birth : December 27, 2001
Civil Status : Single
Religion : Roman Catholic
Nationality : Filipino

EDUCATIONAL ATTAINMENT

College : Notre Dame of Marbel University

Alunan Avenue, Koronadal City, South Cotabato
Bachelor of Science in Nursing
(2020 - Present)

High School : Norala National High School

Barangay Poblacion Norala, South Cotabato
(2014-2018)

Elementary : Norala Central Elementary School

Barangay Poblacion Norala, South Cotabato
(2008-2014)

119
 JMJ Marist Brothers
Notre Dame of Marbel University
Alunan Avenue, City of Koronadal
College of Arts and Sciences
NURSING DEPARTMENT

OLIVER G. PALAC
Prk. Bagong Silang, Brgy. Sta. Cruz
Koronadal City, South Cotabato 9506
Mobile No.: +639292211154
Email: [email protected]

PERSONAL INFORMATION

Age : 20 years old

Sex : Male
Date of Birth : October 30, 2001
Civil Status : Single
Religion : Roman Catholic
Nationality : Filipino

EDUCATIONAL ATTAINMENT

College : Notre Dame of Marbel University

Alunan Avenue, Koronadal City, South Cotabato
Bachelor of Science in Nursing
(2020 - Present)

High School : Koronadal National Comprehensive High School

Rizal St., Poblacion, Koronadal City, South Cotabato
(2014-2018)

Elementary : Koronadal Central Elementary School 1

Rizal St., Poblacion, Koronadal City, South Cotabato
(2008-2014)

120