Nursing Care Plan (NCP) for Abortion, Spontaneous Abortion, Miscarriage

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Outline

Pathophysiology

Abortion is the termination of a pregnancy before the fetus is able to live outside the womb, usually prior to 20 – 24 weeks. They may be spontaneous (miscarriage), in which there is no outside intervention that results in the loss of pregnancy, or induced, either electively or for therapeutic reasons. Early abortions occur prior to 12 weeks’ gestation, while late abortions are between 12 and 20 weeks. Complete abortion is when all tissues are completely passed. When an incomplete abortion occurs, some tissue remains in the uterus and can be parts of the fetus, placenta or other pregnancy tissue.

Etiology

In elective abortion, the pregnancy is intentionally terminated through medical intervention. In cases of spontaneous abortion, the fetus often has genetic complications that are usually not related to the mother.

Desired Outcome

Patient will experience minimal blood loss and be free from infection; patient will develop coping skills to effectively manage emotional loss of pregnancy.

Subjective Data:

  • Pain in lower back
  • Abdominal cramping

Objective Data:

  • Vaginal bleeding or spotting
  • Fluid or tissue passing through the vagina

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.

Writing a Nursing Care Plan (NCP) for Abortion, Spontaneous Abortion, Miscarriage

A Nursing Care Plan (NCP) for Abortion, Spontaneous Abortion, Miscarriage starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


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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