Nursing care for Patients with Septic Shock Caused by Criminal Abortion using Gordon’s Functional Health Patterns: A case study

Abstract

Back ground: Abortion is defined as the termination of a pregnancy prior to 28 week gestation or fetus weight less than 1,000 grams. The abortion can cause several complications such as massive blood loss, uterus perforate, cervical injury, acute blood congestion in uterine cavity, septicemia, the fragments of placenta may stuck inside the uterine, which can cause shock due to massive blood loss . Therefore, to prevent those complications, it is very crucial for nurses to keep track of signs and symptoms and provide treatments in timely manner.
Objective: The purposes of this report were to study the prognosis, health problems, treatments, and patient outcomes.
Sample and setting: The purposive sampling method was used to select 1 patient diagnosed with criminal abortion with septic shock. The patient was recruited from Gynaecology unit at Sisaket hospital.
Study design: The retrospective data collection was employed. Data were gathered from the patient’s medical record
Results: A single Thai woman aged 19 reported that she was underwent a criminal abortion at 7 weeks gestation of pregnant G2P0A1L0. The procedure was done by vaginal injection. 3 hour prior to admit to the hospital, patient had high temperature, chill foul smell leaked water from vagina vertigo and severe abdominal pain. Patient admitted to the Community hospital and suffered from shock. (BP 60/30 mmHg). She was treated with Intravenous fluid 2,000 ml and antimicrobial and then was transferred to Sisaket hospital. She was still hypotention (BP 80/50 mmHg). She received 0.9% Normal Saline Solution 200 cc/hr for 3 hr then 100 cc/hr to maintain blood pressure. In addition she was provided oxygen 5 L/min via nasal cannular, and Ringer lactate solution vein drip 100 cc/hr. Dilation and Curettage (D&c) was a selected treatment and covered by empirical antibiotic. Later on, the patient clinical improved. In summary, Septic shock caused by criminal abortion is a crisis condition. It is very important for nurses to be able to perform health assessment and diagnoses health problems in this population. Majory Gordon’s 11 health patterns is a helpful assessment tool in guiding nurses to detect patients’ problems and manage those in timely manner, hence reduced mortality rate in this population. The patient’s health problems were: 1) actual: septic shock associated to septicemia, 2) actual: ineffective tissue perfusion related to progression of shock with decreased red blood cell to transport oxygen to tissues, 3) actual: fluid and electrolyte imbalance, 4) actual: uterus infection secondary to criminal abortion, 5) actual: alter in comfort due to abdominal pain, and 6) actual: anemia due to acute blood loss. In summary, patient received treatments for septic shock and nursing cares according to patient’s condition. Finally, patient was safe from septic shock, complications, and those mentioned health problems.
Conclusion: In order to provide nursing care for correcting shock, nurses must have knowledge of characteristics of septic shock and initiate nursing care plan to provide cares and observe patients closely.