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INTRODUCTION REPORT

ON "ABORTION INCOMPLIT"

IN THE NIFAS 2

Hospital Dr H. MOCH ANSARI SALEH Banjarmasin

In stacking

by

M Ridho Hidayatullah

(161 440 111 052)

D3 STUDIES PROGRAM OF NURSING

FACULTY NURSING AND HEALTH SCIENCES

UNIVERSITY MUHAMMADIYAH BANJARMASIN

ACADEMIC YEAR 2018


SHEET APPROVAL COACH

Name: M RIDHO HIDAYATULLAH

NPM : 1614401110052

Room / Hospital : NIFAS / RSUD Dr. H. MOCH ANSARI SALEH

Introduction Report : ABORTUS INCOMPLIT

Has completed all reports in the room.

Banjarmasin, Aug 2018

College student

M Ridho Hidayatullah

Approve

Clinical Advisors Academic Counselor

................................. Zaqqyah huzaifah, Ns., M.kep


Preliminary Report ABORTUS INCOMPLITES

ABORTUS INCOMPLITES

A. BASIC CONCEPT OF NURSING

1. Definition of

Abortion is the threat or expenditure of conception results at gestational age less than 20
weeks or fetal weight less than 500 grams, before the fetus is able to live outside the womb
(Nugroho, 2010).

Incomplete abortion is where most of the conception tissue is still left in the uterus where
bleeding is still occurring and the amount can be much or little depending on the remaining
tissue, which causes some placental site to remain open so that bleeding continues (Sujiyatini
et al, 2009)

Incomplete abortion is bleeding in young pregnancies where some of the conception results
have come out of the uterine cavity through the cervical canal which is left in the decidua or
placenta (Ai Yeyeh, 2010).

2. Etiology

The cause of miscarriage is largely unknown, but there are several factors as follows:

a. Growth Abnormalities Results of Conception

Abnormalities of growth resulting from conception can cause fetal death and subordinate
defects that cause the conception results to be removed. Impaired growth of conception results
can occur due to:

1) Chromosomal factors, disturbances occur from the beginning of chromosome meetings,


including sex chromosomes.

2) Endometrial environmental factors


a) Endometrium that is not ready to receive implantation from conception.

b) Maternal nutrition is lacking because anemia or pregnancy distance is too short.

3) External influences

a) Endometrial infection, endometrium is not ready to accept the results of conception

b) The results of conception affected by drugs and radiation cause the growth of the
conception results are disturbed.

b. Abnormalities of the placenta

1) Infection of the placenta for various reasons, so that the placenta cannot function.

2) Disorders of the placental blood vessels which include patients with diabetes mellitus

3) Hypertension causes circulatory disorders of the placenta causing miscarriage.

c. Maternal

Disease Sudden diseases such as pneumonia, abdominal typhus, malaria, syphilis, anemia
and maternal chronic diseases such as hypertension, kidney disease, liver disease, and diabetes
mellitus.

d. Abnormalities contained in the Uterus

Uterus is a place where fetal growth and development found abnormal conditions in the
form of uterine myoma, arch uterine uterus, uterine septus, uterine retro flexia, incompetent
cervix, surgery on the cervix (conization, amputation of the cervix), postpartum cervical tears
(Manuaba, 2010 )

3 . Pathophysiology

in early abortion, there is bleeding in the decidua basalis, followed nerloisi tissue that
causes the products of conception apart and considered a foreign object in the uterus. Thus
causing the uterus to remove foreign objects.
If the pregnancy is less than 8 weeks, the value of khorialis not penetrate the decidua and
deep so that the results of conception can come out entirely.If the pregnancy is 8-14 weeks
villi khori asli has penetrated too deeply until the placenta cannot be released completely
and causes a lot of bleeding from the placenta.If

the dead baby is not released in a short time, then he can be covered by him pisan blood
clot. In fetuses that have died and are not expelled can occur a process of modification of
the fetus dries and because the amionic fluid becomes less due to absorption. He became
rather flat. In a further level it becomes thin.

Another possibility for a dead fetus that is not quickly released is maceration, exfoliate
skin, softened skull, enlarged abdomen due to fluid and all reddish colored fetuses

(Ai Yeyeh, 2010).

PATHWAY
4. Signs and symptomps

a. Incomplete abortion is characterized by the partial release of conception results from the
uterus, so that the rest provide clinical symptoms as follows:

1) Menstruation or amenorrhea is delayed less than 20 weeks

2) Bleeding prolonged, until there is anemic state

3) Sudden bleeding causes a lot of distress

4) Infection occurs with high temperature marked

5) Malignant / choriocarcinoma degeneration (Manuaba, 2010) can occur.

b. Other symptoms of incomplete abortion include:

1) Ordinary bleeding is a little / a lot and there is usually a blood clot.

2) The feeling of mules (contraction) is added to greatness.

3) vaginal bleeding is or does not have conception tissue, there is a foul odor from the vulva

4) Open external uterine or cervical Ostium.

5) On vaginal examination, the tissue can be palpated in the uterine cavity or sometimes
protruding from the external or part of the tissue out.

6) Bleeding will not stop before the remaining fetus can cause shock (Maryunani, 2009).

5. Medical Management

a. General examination:

1) Assess quickly the general condition of the patient, including vital signs.

2) Check for signs of shock (pale, heavy sweating, fainting, systolic pressure less than 90
mmHg, pulse more than 112 times per minute).
3) If shock is suspected, immediately deal with shock. If there are no signs of shock, keep
that possibility in mind when the helper evaluates a woman's condition because her
condition can deteriorate quickly. If shock occurs, it is very important to start shock
treatment immediately.

4) If the patient is in shock, think the possibility of an ectopic pregnancy is impaired.

5) Install an infusion with a large infusion needle (16 G or more), give a physiological
saline solution or ringer lactate with 500 cc quick drops in the first 2 hours
(Syaifuddin, 2006).

b. Incomplete Abortion Treatment

1) Determine the size of the uterus, recognize and overcome any complications (severe
bleeding, shock and sepsis)

2) If there is a lot of bleeding or continues and <16 weeks of gestation, evacuation of the
remaining conception with:

a) Manual Vacuum Aspiration is a method selected evacuation. Evacuation with a


sharp curette should only be done if the AVM is not available.

b) If evacuation cannot be done immediately, give ergometrium 0.2 mg im (repeated


after 15 minutes if necessary) or misoprostol 400 mcg orally (can be repeated
after 4 hours if necessary).

3) If the pregnancy is> 16 weeks

a) Give an oxytocin infusion of 20 units in 500 ml of IV fluid (physiological salt or RL)


at a rate of 40 drops / minute until the conception expulsion occurs.

b) If necessary provide 200 mg of misoprostol per 4 hours until conception results


(maximum 80 mg)

c) Evacuation of the remaining conception left in the uterus


4) If there are no signs of infection give prophylactic antibiotics (sulbenisillin 2 grams / IM
or cefuroxime 1 gram orally).

5) If there is an infection give ampicillin 1 gram and Metrodidazole 500 mg every 8 hours.

6) If the patient looks anemic, give sulfasferosus 600 mg / day for 2 weeks (moderate
anemia) or blood transfusion (severe anemia).

7) Be sure to keep an eye on the mother's condition after handling (Syaifuddin, 2006).

c. Supporting Examination

1) Blood

Hb level, where normal Hb in pregnant women is ≥ 11 gr% (TM I and TM III 11 gr%

and TM II 10.5 gr%).

● Hb ≥ 11 gr%: no anemia

● Hb 9-10 gr%: mild anemia


● Hb 7-8 gr%: moderate anemia

● Hb ≤ 7 gr%: severe anemia

2) Urine

To check urine protein and urine glucose. For clients with pregnancy and Normal delivery
of protein and urine glucose is negative.

3) Ultrasound

To check whether the gestation pocket is still intact and amniotic fluid is still present.
B. CONCEPT OF NURSING CARE

1. Nursing Assessment

a. Client Identity

b. Main Complaints: Abdominal pain, bleeding, pain in suture wounds, fear of moving.

c. Health History, consisting of:

- Current health

- Past health

d. Surgical History

e. History of illness ever experienced

f. Family health history

g. Reproductive health history: Assess mennorhoe, menstrual cycle, duration, number,


nature of blood, odor, color and presence of dismenorhoe and assess when menopause
occurs, symptoms and the accompanying severity

h. History of pregnancy, childbirth, and postpartum: Assess how the condition of the
client's child starts from the womb until now, how is the condition of the child's health.

i Sexual history: Assess the client's sexual activity, the type of contraception used
and the accompanying complaints.

j. Drug use history: Assess history of oral contraceptive medications, digitalis drugs
and other types of drugs.

k. Pattern of daily activities: Assess nutrition, fluid and electrolytes, elimination


(bowel movements and BAK), sleep rest, hygiene, dependence, both before and during
illness.

l. Physical Examination
- Inspection

The things that are inspected include: observing the skin for color, discoloration,
lacerations, drainage lesions, respiratory pattern of depth and symmetry, body language,
movement and posture, limb use, physical limitations, and so on.

- Palpation

Touch: feel a swelling, record temperature, degree of moisture and skin texture or
determine the strength of uterine contractions.

- Pressure: determine the character of the pulse, evaluate edema, pay attention to the
position of the fetus or pinch the skin to observe turgor.

Examination in: determining the voltage / muscle tone or abnormal pain response

- Percussion

Using fingers: tap the knees and chest and listen to the sounds that indicate the presence or
absence of fluid, mass or consolidation.

Using a percussion hammer: tap your knees and observe whether there is reflex / movement
on the lower leg, check for abdominal skin reflexes or not abdominal wall contraction

- Auscultation

- listen in the antechubial room for blood pressure, chest for abdominal heart / lung sounds
for bowel sounds or The fetal heart rate. (Johnson & Taylor, 2005: 39)

M. Psychosocial examination

- Family response and perception

- Father's psychological status, family response to the baby

2. Nursing diagnosis

a. Acute pain is associated with uterine contractions


b. High risk of hemorarge shock associated with active bleeding

c. High risk of infection associated with bleeding and curettage process

d. Anxiety is related to lack of knowledge (lack of information / not knowing sources of


information) about curettage procedures

3. Nursing Care Plan

No. Purpose of intervention Rational

1 Client pain decreases in 3 × 1. Determine the nature of 1. Help in diagnosing and


24 hours of treatment with the location and duration of choosing appropriate
evaluation criteria pain and assess uterine nursing actions
contractions
- Pain scale 0 (none) 2. Discomfort associated
with spontaneous abortion
- Client does not complain
is usually due to uterine
of pain anymore 2. Assess psychological
contractions
stress of the client / partner
- Client's facial expression
and emotional response to 3. Can help in reducing the
does not cry anymore
the event . level of pain and anxiety
- TTV is within normal and increase coping that
3. Give a calm environment
limits can help relieve pain.
and instruct the client to / use
TD: the relaxation method 4. Initial discovery can

Systole <140 mHg 4. Measure TTV: TD, pulse, be used as an indicator for
respiration and temperature
Diastol < 90 mHg intervention
5. Give the right analgesic
N: 80 - 90x/ min further
medication
R: 16 - 24x/ minute 5. Reducing the client's
6. Prepare for curettage
focus on the range of pain
T: 36 - 37oC procedures
6. Action against basic
deviations will eliminate
pain

2. High risk of hemorarge 1. TTV observation 1. Knowing the general


shock associated with condition of the client
2. Assess daily fluid output
active bleeding can be
2. The amount of fluid is
prevented or does not occur 3. Give substitute daily fluid
determined by the number
after 3 × 24 hours of output.
of daily needs coupled with
treatment.
4. Position the mother the amount of fluid lost
with outcome criteria: properly (semi-fowler). pervagina

- Patients express not weak, 5. Perform bed rest and 3. Tranfusion may be
and no longer thirsty avoid the mother for valsalva needed in massive bleeding
maneuvers. conditions
- Moist lip mucosa
6. Report and record the 4. Ensure the availability of
- Normal skin turgor
number and nature of blood blood available to the
- Not sunken eyes loss brain, pelvic elevation
avoids venous
compression.

5. Bleeding can stop by


reducing activity

6. To find out the


approximate amount of
blood loss
3. Risk infection does not 1. Monitor the temperature 1. Increased temperature or
occur or decreases in 3 × 24 of the pulse and white blood pulse more normally can
hours of treatment with the cells (SDP) indicate infection
results criteria: protection of normall
2. Use aseptic surgery in the
leukocytes with SDP
- TTV within the normal preparation of equipment
25,000 / mm3can be
limit of
3. Encourage the client to do distinguished from SDP
TD: Systole <140 mmHg personal hygiene for increase in infection
example: change dressing
Diastol <90 mmHg 2. Reduces risk of
4. Encourage clients to eat contamination
N: 80 - 90x/ min
high protein foods
x
3. Prevents infection
R: 16 - 24 / minute
Collaboration:
4. Accelerates healing
T: 36 - 37oC
5. Give antibiotics as process
- Patients demonstrate the indicated
5. Helps prevent infection
ability to improve personal
health such as personal
hygiene

- There is no sign of
Inflammation:

- Rubor (redness)

- Tumor (swelling)

- Heat (heat)

- Dolor (pain)

- Function of laesa
(impaired function)
4. Anxiety decreases / 1. Assess the level of anxiety 1. Know how far the
disappears in 3 × 24 hours experienced by clients anxiety level can be
of treatment with Result overcome
2. Listen to client problems
criteria:
and listen actively 2. Increase the sense of
- Reporting a decrease in control over the situation
3. Measure TTV: TD, pulse,
anxiety until the stage can and provide opportunities
respiration and temperature
be resolved for client develops its own
4. Explain the curettage solutions
- Showing the condition of
procedure and the meaning
relaxation of clients 3. Severe anxiety situations
of symptoms and the
understanding of disease can be manifested from
prognosis of abortion
conditions and curettage TTV
procedures 5. Evaluation / validation of
4. Knowledge can help
the information provided
- TTV within normal limits reduce anxiety and increase
the

sense of control over the


situation

5. Knowing the

extent to which
information / methods can
be received by clients
REFERENCES

,Nursing Textbook Maternity. Renata Komalasari Ed.4. EGC. Jakarta. 2004

Mansjoer, Arif, et al. 2000.Kapita SelektaThird edition, volume I, Media Aesculapius Jakarta
2000.

MedisWiknjosastro Hanifa, et al, 2007, Midwifery Science, Edition III. Mold IX. YBP SP. Jakarta.

Wiknjosastro Hanifa, et al, 2008, Gynecology, Edition II. Prints VI. PT Bina Pustaka. Jakarta.

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