Saint Louis University

School of Nursing

SHEEHAN’S SYNDROME:
A CASE STUDY

SUBMITTED BY:
BSN IV-B1
RAGUINDIN, Leonell Gabriel
VENTURA, Neil Floyd
VITAMOG, Art Jericho
ARFAPO, Yvonne
BERNARDEZ, Keziah Charisse
BITENG, Effie Cloe Marie
DISPO, Claire Joyce
JACOBA, Danica Joy
REYES, Daphne Gwyn
SERANILLA, Maybelline
SERONG, Lara
TUSCANO, Angelina Corinne
 I. DEMOGRAPHIC PROFILE
A. BIOGRAPHICAL INFORMATION
Name: Sabrina Claudio OCCUPATION: Businesswoman, Saudi RN
Sex: F RELIGION: Roman Catholic
AGE: 27 CIVIL STATUS: Married
BIRTHDATE: June 1992 EDUCATIONAL STATUS: College
NATIONALITY: Filipino

B. HEALTH HISTORY
1. CHIEF COMPLAINT
 Change in mood/behavior
 Decreased sensorium
2. HISTORY OF PRESENT ILLNESS
 Previous admission: November 2019; G1P1 (1001) Pregnancy, uterine, term,
cephalic, delivered spontaneously to live baby boy with birth weight of 3.08kg, 51
cm. APGAR 9 and 9 at 1 and 5 minutes. Ballard’s: 37-38 weeks. Delivered
November 7, 2019 1:50am. With right mediolateral episiotomy with repair.
 Early severe postpartum hemorrhage was evident secondary to uterine atony
hence Total Abdominal Hysterectomy under general anesthesia was done on the
same day, with repair of the vaginal wall.
 Anemia secondary to blood loss hence blood transfusion done.
Hours PTA
17° She was well, able to consume meals, ambulatory and conversant.
The family decided to retain her admission for one more night in
order for the baby and mother to be discharged and go home at the
same time since the baby was still completing his antibiotic doses.
She was then monitored and observed.
16° Her relatives noticed a change in behavior; easily angered for no
apparent reason.
15° Husband was supposed to go out to buy more supplies, but then she
didn’t want to be alone and wanted to be held by the husband.
Husband also noticed text messages she sent to a relative saying
she felt sad and was depressed since she won’t be able to conceive
anymore. They planned on having 3 children.
10° She had decreases appetite, consuming one spoon of rice and 2
bites of banana. She also complained of lockjaw and mild nape
pain.
She also called her father in La Union to visit him. The time he
visited her, she hugged her father and held his hand tightly. The
father reported that she doesn’t usually do these.
She also started to neglect her baby by not feeding him.
5° She went to sleep. Responsive to verbal and tactile stimulation.
4° She mumbled incomprehensive sounds, did not open her eyes on
command and was loudly snoring. The father reported that she
never snores during sleep.
She also became dyspneic and restless, fingers were stiffening in
extended position, flexed elbows and inverted feet.
 Persistence of symptoms urged the relatives to seek consultation at the emergency
room. She was hen readmitted, intubated and was brought to ICU immediately.
This is her 4th admission in this institution
 Menstrual History
o She had her menarche at the age of 11 lasting for 4 days accompanied by
dysmenorrhea consuming 3-4 pads daily. Her menstrual cycle is regular
with a 28-30-day interval.
o There is no pap smear done.
o In 2014, she had one dose of HPV vaccine. She was not compliant with
the second dose.
 Sexual History
 o Experienced coitarche at the age of 25 with minimal bleeding and discomfort.
Subsequent sexual contacts were comfortable with occasional bleeding. No
dyspareunia noted.
o No family planning.
o She only has 1 sexual partner; husband.
 She has no food preference. Hence, she eats a balanced diet of meat, fish, fruits
and vegetables. She has a BMI of 25.1 which is classified as Obese I using the
Asia-Pacific Guidelines. But it must be taken into consideration that she is
postpartum. She does not exercise but considers walking around town as so. She
does not smoke, and has no history of use of recreational drugs. She occasionally
drinks consuming 1 bottle only. There is no reported partner abuse.

3. OBSTETRIC HISTORY
 November 7, 2019 G1P1 (1001) pregnancy, uterine, term, cephalic, delivered
spontaneously to a live baby boy.
 No history of miscarriages.

4. PAST MEDICAL HISTORY

 At 9 years old, she was diagnosed of Rheumatic Heart Disease via 2D echo. She
took Penicillin G with unrecalled dose for 5 years.
 She had a recurrence of RHD at 23 years old. She was prescribed Penicillin G
(Sumapen) and Atenolol with unrecalled dose for 2 years
 No history of hypertension, Diabetes Mellitus, Cancer, Pulmonary Tuberculosis
and Cardiovascular Diseases
# Dates Cause of Admission
1 August 31-September 2, 2019 Threatened preterm labor
(+) vulvovaginal candidiasis
UTI
2 September 16-Septeber 18. Threatened preterm labor
2019 Resolving vulvovaginal candidiasis
3 November 6-November 12, Normal Spontaneous Vaginal Delivery
2019 (Nov. 7)
Total Abdominal Hysterectomy (Nov. 7)
 She has no history of allergies as of the moment.
5. HEREDOFAMILIAL HISTORY
 Both parents are still alive and well. Her father has hypertension and
hyperthyroidism. Her mother on the other hand has hypertension as well. On the
paternal side, there is a history of hyperthyroidism and breast cancer and a history
of hypertension on the both sides. She has no history of tuberculosis, heart disease
and cancer on both sides as well as congenital anomalies.
6. ENVIRONMENT
 SANITATION
o She lives along a non-congested neighborhood, trash is segregated and
collected weekly. They own 4 dogs, 1 cat and 2 lovebirds.

II. PATHOPHYSIOLOGY
III. PRIORITIZATION
RANKING NURSING DIAGNOSES JUSTIFICATION
1st  Ineffective airway This is the first problem because according to
Airway clearance Virginia Henderson’s theory of need, breathing
 Ineffective breathing normally is a prioritized problem it is also
 Impaired gas exchange manifested to our patient who is intubated, and
 Risk for aspiration upon admission, patient complains of difficulty
 Impaired spontaneous of breathing and was diagnosed with
ventilation pneumonia. (add journal)
2nd  Ineffective tissue This is the second problem because according
Tissue perfusion: Peripheral, to Virginia Henderson’s theory of need,
perfusion Cerebral and Renal
3rd  Risk for electrolyte This is the third problem because according to
Fluid imbalance Virginia Henderson’s theory of need,
 Risk for imbalanced fluid
volume
 Risk for dry mouth
 Impaired oral mucous
membrane integrity
4th  Imbalanced nutrition less This is the fourth problem because according
Nutrition than body requirements to Virginia Henderson’s theory of need,
 Impaired swallowing
 Risk for unstable blood
glucose

7th  Impaired urinary This is the seventh problem because according

Excretion elimination to Virginia Henderson’s theory of need,
 Dysfunctional
gastrointestinal motility
5th  Activity Intolerance This is the fifth problem because according to
Activity  Impaired bed mobility Virginia Henderson’s theory of need,
 Impaired physical
mobility
 Impaired walking
 Impaired standing
 Risk for fall
 Risk for physical injury
 Disuse syndrome
9th  Impaired comfort This is the ninth problem because according to
Comfort  Acute pain Virginia Henderson’s theory of need,
 Fatigue
6th  Hyperthermia This is the sixth problem because according to
Temperature  Hypothermia Virginia Henderson’s theory of need,
10th  Ineffective health This is the tenth problem because according to
Self-care maintenance/management Virginia Henderson’s theory of need,
 Ineffective protection
 Self-care deficit


8 th
 Impaired skin Integrity This is the eighth problem because according
Skin Integrity  Risk for pressure ulcer to Virginia Henderson’s theory of need,
 Impaired tissue integrity
11th  Interrupted breastfeeding This is the eleventh problem because according
Role  Impaired parenting to Virginia Henderson’s theory of need,
Relationship  Risk for Impaired
attachment
 Dysfunction Family
Process
 Ineffective role
 performance
12th
 Ineffective child bearing This is the twelfth problem because according
Sexuality to Virginia Henderson’s theory of need,
13th  Situational low self This is the thirteenth problem because
Self-perception esteem according to Virginia Henderson’s theory of
 Disturbed body image need,
14 th
 Impaired memory This is the fourteenth problem because
Cognition Impaired verbal according to Virginia Henderson’s theory of
communication need,
15th  Powerlessness This is the fifteenth problem because according
Coping  Hopelessness to Virginia Henderson’s theory of need,
 Ineffective coping
 Risk for suicide
16th  Anxiety This is the sixteenth problem because
Grieving  Grieving according to Virginia Henderson’s theory of
need,
17th  Impaired religiosity This is the seventeenth problem because
Life Principles  Spiritual distress according to Virginia Henderson’s theory of
need,
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