Jean Watson’s Theory Applied to a Female Patient

Subject:	Nursing
Pages:	8
Words:	1991
Reading time:	7 min
Study level:	Bachelor

Patient Information

Patient’s Initial:	Date of Care:
Age: 47 Wt: 59kg Ht: 61in	Admission Date:
Gender: F	Unit/Room:
Allergies: NKDA	Code Status: F/C
Ethnicity: Hispanic	Isolation status, if applicable: N/A

Chief Complaint

The patient has excessive per vaginal blood loss depicted by the blood clots expelled through the vagina, possibly as a result of uterine pathology. She has used more than six gynecological pads in the last 8 hours. Moreover, the patient has general body weakness characterized by getting tired easily secondary to fluid volume deficit from profuse uterine bleeding.

Diagnoses

The patient has a medical diagnosis of menorrhagia secondary to uterine fibroids. Additionally, the patient has symptomatic anemia secondary to uterine bleeding.

History of Present Illness

The patient reports having been doing laundry when she felt her underpants soaking eight hours prior to admission. On inspection, she noticed blood gushing from her vagina. The bleeding was continuous, profuse with blood clots, and not accompanied by lower abdominal pain. Additionally, the patient reports no aggravating or relieving factors, having used over eight six gynecological pads in the last eight hours before admission.

Moreover, the patient describes feeling general body weakness four hours after the onset of vaginal blood loss, aggravated by moving around the house and standing, and relieved by resting in the supine position.

Furthermore, the patient has had multiple admissions for dysfunctional uterine bleeding since 2013. Therefore, the patient was treated for dysfunctional uterine bleeding due to hormonal changes secondary to contraceptive use and transition to menopause. However, on reaching menopause, the patient should have had radiological studies such as ultrasound and MRI due to the increased likelihood of having uterine fibroids (Whitaker & Critchley, 2016).

Patient Education

This patient is alert and oriented to self, time, place, and the other person. Therefore, she is able to cooperate and comply with her care.

Educate the patient that the clinical team, including nurses and the physician, will give their best to address the health problem. Therefore, the reassurance will relieve anxiety in the patient.
Instruct the patient to use sterile gynecological pads that will be provided to avert the introduction of micro-organisms from the use of other sanitary pads that may cause infection.
Instruct the patient to preserve the gynecological pads used to enable the clinical team to estimate the blood loss to guide therapeutic interventions.

Past Medical History

The patient had gestational diabetes mellitus during the second pregnancy 15 years prior to admission. However, the hyperglycemia resolved after delivery. Additionally, the patient has been on treatment for hypertension since five years ago. The blood pressure is well controlled with oral Nifedipine 20mg twice daily and oral hydrochlorothiazide 25mg twice daily.

Surgical History

The patient had foot surgery for hemangioma when she was nine years old. Additionally, she has had two cesarean sections for the birth of her two children at age 27 and 32 years.

Social History

The patient has a sister but does not reside with her. The patient is meeting with a case manager and social worker; she may require placement in a short-term care facility to bridge the transition to an apartment. She is a single mother of two children, both female. The first borne is a college student, while the second-borne daughter is in high school.

Labs

Lab Test	Lab Components	Current Lab Value	Normal Range	The most recent Date of Lab Result	Clinical Significance, if indicated
CBC	RBC	2.79L	3.61-5.11	3/18/21	Anemia. The low RBC count denotes anemia secondary to blood loss.
	WBC	7.6	4.5-11.1	3/18/21	Infection and elevated red blood cell count indicate an infection. However, WBC with differential would pinpoint the duration of infection, whether acute or chronic and the responsible pathogens.
	Hgb	6.3L	11.7-15.5g/dL	3/18/21	Anemia is caused by blood loss.
	Hct	20.8%	36-48%	3/18/21	Anemia since the ratio of the volume of red blood cells to the volume of blood is low.
	PLT	230	140-400	3/18/21	Coagulation test to rule out the existence of clotting disorders as the cause of bleeding. However, a prothrombin time test would help further to rule out the presence of clotting disorders.
	MCV	75L	78-102	3/18/21	Iron-deficiency. The low level means corpuscular volume denotes microcytic red blood cells indicative of iron deficiency anemia.

Pathophysiology

The patient presents to the accident and emergency department with the chief complaint of excessive vaginal bleeding and general body weakness. On examination, the patient appears pale. The presenting clinical manifestations with her age of 47 years are consistent with the diagnosis of menorrhagia secondary to uterine fibroids with symptomatic anemia since uterine fibroids are common among postmenopausal women with dysfunctional uterine bleeding (Whitaker & Critchley, 2016).

The interaction of genetic predisposition with estrogen, progesterone, and growth factors such as epidermal growth factor in the uterus promotes the growth of uterine fibroid in women (Stewart et al., 2016). Consequently, the uterine fibroid increases the endometrial surface area. The increased surface area in the endometrium promotes the development of many blood vessels with subsequently increased blood flow with platelet deficiency (Whitaker & Critchley, 2016). Therefore, the increased blood flow into the perimyoma environment with platelet deficiency leads to uterine bleeding manifesting as menorrhagia. Uterine blood loss results in anemia manifesting as tiredness and pallor on the palmar surface of hands and the conjunctiva of the eye.

Jean Watson’s Theory of Human Caring in Patient’s Care

Jean Watson’s Theory of Human caring highlights the usual nursing practice of displaying empathy and care (Watson & Woodward, 2020). Moreover, the theory inspires an open and deep interaction with the patient in nursing practice. Consequently, the theory encourages nurses to be genuine and establish a spiritual connection with patients and their families to refine the healthcare environment experience for nurses, patients, and their families. For this reason, I would practice active listening when interacting with the patient to show attention and compassion. Additionally, it is necessary to authentically attend to the patient’s basic needs, including spiritual and physical necessities, which creates a healing environment for the patient.

Vital Signs and Systems

Body system	Findings
Vital Sign	BP: 89/55mmHg P: 110bpm T: 38.1 degrees celsius R: 26breaths/ minute Pain: O2 sat: 87%
Neurological	The patient is alert and oriented to self, time, place, and the other person.
Cardiovascular	The patient has a tachycardia of 110bpm. No heart murmurs. S1 and S2 heart sounds are audible.
Respiratory	The patient has regular respirations with normal depth and rhythm. However, she has tachypnea of 26 breaths per minute. Vesicular breath sounds are heard.
Nutrition/Hydration	The patient appears moderately frail. The mucous membrane is pale and dry.
Gastrointestinal	The patient reports feeling fullness and a history of frequent constipation.
Genitourinary	The patient has per vaginal bleeding. No vaginal polyps on speculum examination. Urine output is low and concentrated.
Rest/Exercise	The patient appears weak to effectively perform activities of daily living. She has difficulty with steady walking.
Integumentary	Skin pinch goes back very slowly, more than two seconds. The patient has evidence of hair loss with brittle spoon-shaped nails. No skin lesions.
Endocrine	The patient has decreased muscle mass. However, she has an upright posture.
Psychosocial Needs	The patient came to the health facility unaccompanied by significant others. She lives alone when her children are schooling. She is anxious and concerned about her children as she is unwell.
Misc	The patient reports no joint stiffness, pain, or inflammation. She has no bone deformities.

Nursing Diagnosis #1

Deficient fluid volume related uterine bleeding secondary to uterine fibroids as evidenced by per vaginal blood loss, blood pressure of 89/55mmHg, and pulse rate of 110bpm.

Goal #1

To ensure the patient has sufficient fluid volume within 6 hours as evidenced by blood pressure of above 100/60mmHg, a pulse rate of below 90bpm.

Nursing Interventions

Insert intravenous cannula.
Administer intravenous fluids such as Hartman’s solution at a rate of
Monitor and document vital signs periodically, emphasizing blood pressure, pulse rate, and urine output.

Rationale

To facilitate the administration of intravenous fluids and blood products for the correction of deficient blood volume.
To raise the blood volume for effective tissue perfusion
Deficient fluid volume leads to hypotension. Consequently, pulse rate will increase as a compensatory mechanism to maintain tissue perfusion. Therefore, monitoring of blood pressure and heart rate indicates treatment effectiveness.

Evaluation #1

After six hours, the patient’s blood pressure had increased to 101/58mmHg. Heart rate was 91bpm. Additionally, the patient’s rate of urine output was 30ml/hr. Therefore, the goal was fully met.

Nursing Diagnosis #2

Ineffective tissue perfusion is related to uterine bleeding as evidenced by oxygen saturation of 87%, general body weakness, excessive bleeding, and pallor of mucous membrane with the palmar surfaces of the hands.

Goal #2

The patient will have effective tissue perfusion within 12 hours as characterized by oxygen saturation above 95%, absence of weakness, and pallor.

Nursing Interventions

Administer blood products such as packed red blood cells as prescribed.
Administer oxygen via mask at a rate of 6 Liters per minute
Monitor, the blood oxygen saturation, using a pulse oximeter and respiratory rate.

Rationale

To increase the oxygen-carrying capacity of blood for effective tissue perfusion.
To improve the blood oxygen saturation for sufficient tissue perfusion.
To indicate the effectiveness of oxygen therapy.

Evaluation #2

Within 12 hours, the patient had a respiratory rate of 19 breaths per minute. Moreover, the patient had an oxygen saturation of 92%. However, the patient still had a moderate pallor of the mucous membranes after the administration of two pints of blood. Therefore, the goal was achieved partially.

Risk/Potential Nursing Diagnosis #1

Risk for infection related to per vaginal blood loss leading to diminished immunity.

Risk for Nursing Interventions

Instruct the patient to use sterile gynecological pads for the per vaginal blood loss.
Administer antibiotic medications as prescribed.
Practice aseptic techniques when attending to the patient, including speculum examination.

Rationale

To minimize the chances of introducing pathogens to the patient with a compromised immune system secondary to blood loss.
The antibiotics are prophylaxis to protect the patient against infection.
To avert introducing pathogenic micro-organisms, including bacteria, into the patient.

Evaluation #3

The patient was free from actions that would predispose her to get a hospital-acquired infection during the first 12 hours of their hospital stay. For this reason, the goal was fully met.

Medication List

Drug Name Generic Brand	1. Classification 2. Mechanism of Action	Rights Dose Route Frequency	Indication for THIS Patient	Nursing Responsibility (What you need to know or do before and after administering)	Major Side Effects/Nursing Implication
Leuprolide Lupron	Gonadotropin releasing agonist. It is a synthetic analog of gonadotropin-releasing hormone, which initially stimulates the release of luteinizing hormone and subsequent elevation of serum estradiol. Therapeutically, the drug decreases the fibroid tumor size and decreases blood loss(De La Cruz & Buchanan, 2017)	Intramuscular 3.75mg once a month.	To decrease blood loss and shrink tumor size prior to surgical removal of the uterine fibroids.	To assess the patient’s presenting symptoms to include excessive vaginal bleeding and increased pelvic pressure. The nurse will continuously monitor the presenting clinical features to evaluate treatment effectiveness.	Headache, blurred vision, stomach discomfort, and increased risk for stroke. Therefore, the nurse should continuously monitor the patient for signs of cerebrovascular events.
Tranexamic acid Lysteda	Antifibrinolytic agent The drug blocks the activation of plasminogen and subsequent conversion to plasmin. Consequently, it leads to decreased bleeding.	Intravenous 500mg three times daily for five days.	Decreases uterine blood loss as a result of fibroids.	The nurse should monitor vaginal blood loss before and during treatment.	Increased risk for seizures and thromboembolism. Therefore, the nurse should periodically monitor the patient for seizure occurrence.
Naproxen Aleve	Non-steroidal anti-inflammatory drugs The drug reversible inhibits the enzyme cyclo-oxygenase, which catalyzes prostaglandin synthesis. Therefore, the decreased prostaglandin synthesis reduces pain and uterine blood loss.	Oral route 500mg twice daily.	Relieves pain. Decreases uterine blood loss (De La Cruz & Buchanan, 2017).	The nurse should assess the patient for pain and vaginal blood loss before and during treatment to monitor drug effectiveness.	It can cause sodium retention in the kidney. Since the patient has been on treatment for hypertension, the nurse should continuously monitor the patient’s blood pressure.

Reference

De La Cruz, M. S., & Buchanan, E. M. (2017). Uterine fibroids: Diagnosis and treatment. American Family Physician, 95(2), 100–107. Web.

Stewart, E. A., Laughlin-Tommaso, S. K., Catherino, W. H., Lalitkumar, S., Gupta, D., & Vollenhoven, B. (2016). Uterine fibroids. Nature Reviews Disease Primers, 2, 16043. Web.

Watson, J., & Woodward, T. K. (2020). Jean Watson’s theory of human caring. Sage Publications.

Whitaker, L., & Critchley, H. O. D. (2016). Abnormal uterine bleeding. Best Practice & Research Clinical Obstetrics & Gynaecology, 34, 54–65. Web.