Nursing Care Plan (NCP) for Abortion, Spontaneous Abortion, Miscarriage
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Outline
Lesson Objective for Nursing Care of Abortion (Spontaneous/Miscarriage)
- Understanding the Types of Abortion:
- Define and differentiate between spontaneous abortion (miscarriage) and induced abortion. Understand the physiological and emotional implications of each type.
- Recognizing Signs and Symptoms:
- Identify the signs and symptoms of spontaneous abortion, including vaginal bleeding, abdominal pain, and passage of tissue. Recognize the potential emotional distress experienced by the patient.
- Providing Emotional Support:
- Develop skills to provide empathetic and compassionate care to individuals experiencing a miscarriage. Address the emotional impact, grief, and psychological aspects associated with pregnancy loss.
- Ensuring Physical Well-being:
- Focus on monitoring the physical health of the patient, including assessing vital signs, managing bleeding, and identifying signs of complications. Collaborate with the healthcare team to ensure appropriate medical interventions.
- Facilitating Grief Support and Coping:
- Equip nurses with tools to support patients and their families in coping with grief after a spontaneous abortion. Provide resources for grief counseling and support groups.
Pathophysiology of Spontaneous Abortion (Miscarriage)
- Chromosomal Abnormalities:
- The most common cause of spontaneous abortion is chromosomal abnormalities in the developing fetus. These abnormalities may lead to developmental issues incompatible with life, resulting in natural termination.
- Maternal Health Conditions:
- Certain maternal health conditions, such as diabetes, thyroid disorders, autoimmune diseases, and infections, can contribute to an increased risk of spontaneous abortion by affecting fetal development or the maternal-fetal interface.
- Uterine Abnormalities:
- Structural abnormalities of the uterus, such as fibroids or congenital malformations, may interfere with the implantation of the embryo or provide an inhospitable environment for fetal development, leading to miscarriage.
- Hormonal Imbalances:
- Hormonal imbalances, particularly disruptions in the production of progesterone, which is crucial for maintaining pregnancy, can contribute to the inability to sustain a viable pregnancy, resulting in spontaneous abortion.
- Infections and Environmental Factors:
- Infections, exposure to environmental toxins, or certain medications during pregnancy can adversely affect fetal development and increase the risk of miscarriage. Infections such as rubella or cytomegalovirus are examples.
Etiology of Spontaneous Abortion (Miscarriage)
- Genetic Factors:
- Genetic abnormalities in the developing fetus, often arising from errors during cell division, are a primary cause of spontaneous abortion. These abnormalities may prevent normal fetal development.
- Advanced Maternal Age:
- The risk of miscarriage increases with maternal age, particularly in women over the age of 35. Advanced maternal age is associated with a higher incidence of chromosomal abnormalities in the ova, leading to spontaneous abortion.
- Trauma or Injury:
- Trauma or injury to the abdomen, such as from accidents or falls, can result in spontaneous abortion. Physical trauma may disrupt the developing embryo or fetus, leading to termination.
- Infections:
- Certain infections, including intrauterine infections, sexually transmitted infections, and systemic infections, can pose a risk to the developing fetus and contribute to miscarriage.
- Hormonal Factors:
- Imbalances in hormones critical for maintaining pregnancy, such as progesterone, can lead to a hostile uterine environment or the inability to support the ongoing pregnancy, resulting in spontaneous abortion.
Desired Outcome for Abortion (Spontaneous Abortion/Miscarriage)
- Physical Recovery and Stability:
- The primary goal is to support the woman’s physical recovery following a spontaneous abortion. This includes monitoring vital signs, managing pain, and addressing any complications to ensure the restoration of physiological stability.
- Emotional and Psychological Support:
- Provide emotional support to help the woman cope with the grief and emotional distress associated with a spontaneous abortion. Encourage open communication, offer counseling services, and involve mental health professionals as needed to assist in the healing process.
- Prevention of Complications:
- Focus on preventing and promptly managing any potential complications that may arise during or after the abortion. This involves close monitoring for signs of infection, excessive bleeding, or other complications, and taking appropriate interventions to mitigate risks.
- Education on Future Reproductive Health:
- Offer education and information regarding future reproductive health, including family planning options, contraception methods, and strategies to optimize the chances of a healthy pregnancy in the future. Empower the woman with knowledge to make informed decisions about her reproductive well-being.
- Follow-up Care and Monitoring:
- Establish a plan for follow-up care to monitor the woman’s physical and emotional well-being. Schedule regular check-ups to assess recovery progress, address any ongoing concerns, and provide additional support as needed. This ongoing care is crucial for promoting overall health and preventing potential complications.
Subjective Data:
- Pain in lower back
- Abdominal cramping
Objective Data:
- Vaginal bleeding or spotting
- Fluid or tissue passing through the vagina
Nursing Assessment for Abortion (Spontaneous Abortion/Miscarriage)
- Physical Assessment:
- Conduct a thorough physical assessment to evaluate the woman’s overall health, including vital signs, general appearance, and any signs of distress or discomfort. Monitor for symptoms of excessive bleeding, infection, or other complications.
- Gynecological Examination:
- Perform a gynecological examination to assess the condition of the uterus and cervix. Evaluate for any retained products of conception, signs of infection, or abnormalities that may require intervention.
- Pain Assessment:
- Assess the woman’s pain level and location. Use a pain scale to quantify pain intensity and identify any factors contributing to discomfort. Tailor pain management strategies accordingly.
- Emotional and Psychological Assessment:
- Conduct a sensitive and empathetic assessment of the woman’s emotional and psychological well-being. Inquire about her feelings, concerns, and coping mechanisms. Identify any signs of grief, anxiety, or depression that may require additional support.
- Bleeding Assessment:
- Monitor and quantify vaginal bleeding, assessing the color, amount, and consistency. Document any changes in bleeding patterns and intervene promptly if there are signs of excessive bleeding.
- Infection Risk Assessment:
- Evaluate for signs of infection, including fever, chills, foul-smelling discharge, or abdominal tenderness. Promptly address any indications of infection to prevent complications.
- Social Support and Resources:
- Assess the woman’s social support system and identify available resources. Determine the level of support from family, friends, or partners and offer additional resources such as counseling services or support groups.
- Educational Needs Assessment:
- Identify the woman’s educational needs regarding the abortion process, potential complications, and post-abortion care. Provide clear and comprehensive information about recovery, contraception options, and when to seek further medical attention.
Implementation for Abortion (Spontaneous Abortion/Miscarriage)
- Physical Comfort Measures:
- Provide pain relief measures, such as analgesics, as prescribed, to alleviate discomfort. Implement non-pharmacological interventions, such as heat therapy or relaxation techniques, to enhance physical comfort.
- Emotional Support:
- Offer empathetic and compassionate emotional support. Create a safe space for the woman to express her emotions, and provide information about the grieving process. Refer to counseling services if needed.
- Monitoring and Documentation:
- Continuously monitor vital signs, bleeding patterns, and emotional well-being. Document all assessments, interventions, and the woman’s response to treatment. Regularly update healthcare providers on changes in the woman’s condition.
- Educational Guidance:
- Provide clear and concise education about post-abortion care, including instructions on monitoring bleeding, signs of infection, and when to seek medical attention. Discuss contraceptive options and family planning based on the woman’s preferences and health status.
- Collaborative Care:
- Collaborate with a multidisciplinary team, including physicians, counselors, and social workers, to ensure comprehensive care. Facilitate referrals to appropriate services, such as mental health support or community resources, as needed.
Nursing Interventions and Rationales
| Nursing Intervention (ADPIE) | Rationale |
| Obtain information about pregnancy from patient including estimated due date | Note any chronic health conditions, previous miscarriages or events and risk factors that may have led up to the onset of symptoms.
Note: due date to determine gestational age and viability of fetus. |
| Assess patient for bleeding, amniotic fluid and passage of pregnancy tissue | Weigh or count number of saturated pads each hour
Note amniotic fluid or tissue being expelled from the vagina that indicates spontaneous abortion |
| Perform assessment of fundal height; note if abdomen is firm or rigid | Note any contractions that may indicate impending expulsion of fetus
Rigidity of the uterus may be a sign of infection |
| Assess for fetal heart rate | Determine if there is a viable fetus; determines course of treatment |
| Assist with ultrasound or amniocentesis | Helps to determine fetal maturity and viability in the presence of fetal heart rate |
| Initiate IV fluids and administer blood products as appropriate | Replacement of fluid and blood loss |
| Assess and manage pain | Contractions, low back pain and cramping are symptoms that require management.
Assist with non-pharmacological interventions as necessary. |
| Place patient in lateral position on strict bed rest | This position helps relieve pressure on the vena cava and helps reduce bleeding
Bed rest is required to limit blood loss and help with pain management |
| Monitor vital signs | Excessive blood loss can result in hypovolemia, especially in the case of placenta abruption.
Monitor for hyper/hypotension, tachycardia and shortness of breath. Note if fever is present which may indicate infection. |
| Assess patient’s psychological status and offer support and resources | Unexpected loss of pregnancy may cause emotional distress.
Offer emotional support and provide resources for counseling, religious contacts and support groups to help develop coping techniques. |
Evaluation for Abortion (Spontaneous Abortion/Miscarriage)
- Physical Recovery:
- Assess the woman’s physical recovery by monitoring vital signs, reviewing laboratory results, and evaluating any signs of complications, such as infection or excessive bleeding. Ensure that her physical health is stabilizing.
- Emotional Well-being:
- Evaluate the woman’s emotional well-being by assessing her coping mechanisms, mood, and overall mental health. Monitor for signs of grief, anxiety, or depression. Assess the effectiveness of emotional support interventions provided.
- Understanding and Adherence:
- Evaluate the woman’s understanding of post-abortion care instructions and her adherence to prescribed medications and follow-up appointments. Address any misconceptions or concerns to enhance her compliance with the recommended care plan.
- Contraceptive Planning:
- Assess the woman’s readiness for future family planning and contraceptive use. Ensure that she has received appropriate education about contraceptive options and has made informed decisions based on her preferences and health considerations.
- Feedback and Adjustment:
- Seek feedback from the woman regarding her satisfaction with the care received. Use this feedback to make any necessary adjustments to the care plan or interventions. Continuous communication ensures that the woman’s evolving needs are addressed.
References
- https://my.clevelandclinic.org/health/diseases/9688-miscarriage
- https://www.plannedparenthood.org/learn/pregnancy/miscarriage
- https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/signs-of-miscarriage/
- https://kidshealth.org/en/parents/miscarriage.html
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Transcript
Hey everyone, today, we’re going to be creating a nursing care plan for abortion, spontaneous abortion, and miscarriage. So, let’s get started. First, we’re going to be going over the pathophysiology. So, this is the termination of a pregnancy before the fetus is able to live outside the womb. Typically, it’s prior to 20 to 24 weeks, they may be spontaneous miscarriage in which there is no outside intervention or induced either electively or therapeutic reasons. Nursing considerations: you want to assess vital signs, pregnancy history, assess for bleeding, monitor fetal heart rate, initiate IV fluids, or blood, manage pain, and offer patient support Desired outcome: the patient will experience minimal blood loss and be free from infection. The Patient will develop coping skills to effectively manage emotional loss of pregnancy.
So, we’re going to go ahead and write out our care plan. We’re going to be having some subjective data and some objective data. So, we’re going to see what, what is it that we’re going to see in the patient? Subjective. They’ll have some pain in the lower back and they may also have some abdominal cramping Objective data that you’ll see. They’ll have some vaginal bleeding or spotting. And they also have fluid tissue that is passing through the vagina.
So, interventions we’re going to be doing, we’re going to want to monitor their vital signs. Excessive blood loss can result in hypovolemia, especially in the case of placenta abruption. You want to monitor for hyper or hypotension, tachycardia, and some shortness of breath. Note, though, if there’s a fever present, it may indicate an infection. Okay, next intervention. We’re going to obtain information about pregnancy from the patient, including an estimated due date. So, we want to note any sort of chronic health conditions, any previous miscarriages, or events and risk factors that may have led up to the onset of symptoms. We also want to make sure the due date to determine gestational age and viability of the fetus. So, we’re going to be checking out the patient history. The next intervention we want to assess is for bleeding, amniotic fluid, and passage of pregnancy tissue. We want to weigh or count the number of saturated pads each hour to note the amount of blood loss. Note that amniotic fluid or tissue being expelled from the vagina indicates a spontaneous abortion. We want to assess the fetal heart rate. We want to determine if there is a viable fetus and determine that course of treatment. You want to assess and manage pain. The contractions, the low back pain and the cramping are symptoms that require management for the patient. We can assist with some non-pharmacological interventions as necessary or by giving oral medication. We also want to make sure that we’re going to initiate any sort of IV fluids and administer blood products as appropriate. We want to make sure we’re replacing that fluid and blood loss, and we want to make sure that we’re assessing a patient’s psychological status and offering support and resources. Unfortunately, unexpected loss of a pregnancy may cause emotional distress; offer emotional support and provide resources for counseling, religious contacts, and some support groups for the patient.
Okay. Now we’re going to move on to the key points. So, pathophysiology of abortion is the termination of a pregnancy before the fetus is able to live outside the wound it’s caused by a genetic complication or unintentional. Some subjective and objective data. They’re going to have some pain in the lower back, abdominal cramping, vaginal bleeding, or even spotting fluid or tissue passing through the vagina. We’re going to monitor vital signs, obtain pregnancy history, assess for bleeding, make sure we’re going to monitor the fetal heart rate, initiate any IV fluids or possible blood, manage the patient’s pain, and offer any sort of support through resources or counseling or even support groups. And that’s the end of the care plan you guys did amazing.
We love you guys. Go out and be your best self today and as always happy nursing.
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