Yvonne, a 42-year-old married female, seek a consultation at OB OPD clinic with a complaint of heavy vaginal bleeding associated with abdominal cramps & dizziness. "I bled through my tampon and pad again, and my nightgown and bedding are soiled. I'm sick of this - I just want it to stop!" Yvonne tells the nurse that her periods have gradually gotten worse. They are now lasting 6-7 days instead of 3-4 and come every 30 days instead of every 26. The flow on her first few days has also gotten much heavier. She currently has heavy vaginal bleeding with abdominal cramps and dizziness. She has never missed a menstrual cycle. Her LMP was "about a month ago", she and her husband use condoms, and she has not been sexually active for a month. Yvonne arrives early as instructed to have a urine HCG completed prior to seeing you. The test is negative. The exam room is set up for a pelvic exam reveals that thickening of uterine wall is evident. You note that her medical history is remarkable only for severe reflux disease for which she takes daily Omeprazole. She smokes occasionally when out with friends. Vital signs: T36.7C HR 65bpm, RR 16cpm, BP 80/60mmHg; Height 5'3", Weight 210 lbs., BMI 37.2, pain 7/10. All of Yvonne's laboratory test results are normal except her hemoglobin level 7gms/dl. She reports missing I-2 days of work per month and she is avoiding social activities during the first three days of her period. She adamantly declines to consider combination hormonal contraception. This prompted her admission, and she was admitted to OB ward on Feb 18,2022 @ 7pm, with physician order of venoclysis of PNSS IL @ 30gtts per minute IVF bolus of 300cc then recheck BP after, give Tranexamic acid 500mg IVTT now, Tranexamic acid 500mg 1 tablet TID P.O, Mefenamic acid 500mg 1 capsule PRN for pain, FeS04 I capsule OD. Please repeat CBC in am and relay results, UTZ of whole abdomen, V/S q4hrs, I/O q shift. Watch out for any unusualities then refer accordingly. As a nurse on duty at 6-2am shift, you are assigned to patient Yvonne 42-year-old female admitted on Feb.18,2022 with a chief complaint vaginal bleeding with abdominal cramps, dizziness. Received an endorsement with ongoing IVF of PNSS IL @ 30gtts per minutes newly hooked, with a vital monitoring of every 4 hours to be plotted at the TPR sheet (8am-12nn, AM shift) (4PM-8PM, PM shift) (12-4AM Night shift) I/O q shift to be plotted at 6-2pm shift (AM shift). 2-10pm (PM shift), 10-6am (night shift) Administer Medication as ordered Tranexamic acid 500mg I tablet TID P.O (8am-Ipm-6pm) Mefenamic acid I capsule P.O PRN for pain, FeS04 1 capsule OD P.O (8am). As assigned nurse, you went back at the patient room by 8AM to take the vital signs with the following results BP 90/60mmHg, HR 86bpm, RR 18cpm, T 36.7C, 02 sat 96% and administered P.O. medication as ordered you offered a 1 glass of water about 200 ml. At around 9am significant others of the patient came to the station and informed you about the patient condition. So you went to the patient room to check and asked the patient about it then, patient complained of severe vaginal bleeding associated with abdominal pain, abdominal tenderness noted, dizziness as verbalized by the patient "Ma'am daghan pa japon ug kusog pa japon ang dugo nga gapanggawas ug sakit akong tiyan" ,upon checking the patient the diaper were soaked of blood about 200cc of bright red blood with clots noted and has changed her diaper twice with the same amount of blood soaked in a diaper and upon checking her vital signs BP reveal 80/60mmHg, HR 70pm, RR 18cpm, T36.5C 02 sat 96% and you placed you patient in a Trendelenburg position Then, you came back to the station and refer the patient to the attending physician based on the findings, then the doctor made an order to run 300 cc of IV bolus now and Tranexamic acid 500mg IVTT now, then rechecked the BP again and refer. By 9:30am, you came back again to reassess the condition of your assigned patient then vital signs reveal within normal. By 12nn, you came to get the vital signs with the following results BP 90/60mmHg, HR 85bpm, RR 20cpm, T 36.8C, 02 sat 97% Then, you went again to your patient room to ask her about her present condition and the patient said she's quite well and you give her medication that will be due at Ipm and give her another 1 glass of water about 150ml. After 30 minutes before your shift ends you went back to your patient to get the following information asking if how many time she voided and defecated and the patient claimed was she urinated 3x and defecated once and upon checking the IV fluids is about consumed and you followed it up with the same IV fluids as ordered. Then, endorsed it with same problem to be observed and same monitoring as ordered Do the following: 1)INTAKE & OUPUT MONITORING RECORD. (Use the I & O sheet provided) 2) VITALS SIGNS MONITORING RECORD. (Use the Vital Signs sheet provided) 3 PLEASE PRESENT HERE YOUR DRUG CALCULATION 4) NURSE'S NOTES. (Use the Nurses' Notes sheet provided) 5) DRUG STUDY DRUG STUDY (include IVF) GENERIC BRAND ROUTE FREQUENCY CLASSIFICATION &TIME SPECIFIC NURSING INDICATION CONSIDERATIONS 6) SHOW HERE YOUR IV COMPUTATION:

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