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NURSING CARE of the CLIENT who is having an Abortion

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Presentation on theme: "NURSING CARE of the CLIENT who is having an Abortion"— Presentation transcript:

1 NURSING CARE of the CLIENT who is having an Abortion
Counseling about the procedures and alternatives Provide nonjudgmental care Allow the client to express her feelings Preparation for the procedures: Surgery-D&C or hysterotomy (rarely used) Medications: “Morning –after pill” –RU-482 Oxytocin Prostaglandins-ProstinE2 Misoprotol (Cytotec) Post –procedure care Administer RhoGam if the client is Rh-negative Discharge Instructions

2 Incompetent Cervix INCOMPETENT CERVIX is where there is painless effacement and dilation of the cervical os that is not associated with contractions It often occurs in the second trimester Risk Factor: Congenital uterine anomalies Diethylstilbestrol (DES) exposure Cervical operations Cervical Trauma Cervical Inflammation


4 Incompetent Cervix Clinical manifestations: Lower abdominal pain
Urinary frequency in the second trimester Effacement and Dilation of the cervix Protrusion of membranes through the cervix Rupture of the membranes in second trimester

5 Incompetent Cervix Treatment:
Bedrest- Position client so there is pressure off cervix Initially the Trendelenburg position may be used until after surgery Serial cervical ultrasound assessment No vaginal exams Administer tocolytic agents Surgical intervention- Cerclage is a band of nonabsorbable suture placed around the cervix. Monitor for uterine contractions, fetal well being, and vital signs


7 Incompetent Cervix Discharge planning:
Teach the client the clinical manifestations of preterm labor , rupture of membranes, and infection. And to report them to health care provider immediately. Teach the client to return(to hospital) if uterine contraction begin , because the suture will need to be removed to prevent damage to cervix and allow birth Keep follow up visits with the health care provider Do Fetal Movement Counts

8 Placenta Previa PLACENTA PREVIA is the improper implantation of the placenta in the lower uterine segment. It is classified according to the degree to which the placenta covers the cervical os.: Low-laying Marginal Partial Complete or Total


10 Placenta Previa Risk factors: Endometrial scarring
Impede Endometrial vasculation related to: Hypertension Diabetes mellitus Uterine tumor Drug abuse Smoking Increase placenta mass Closely spaced pregnancies Multiple gestation Multiparity

11 Placenta Previa Clinical Manifestations:
Episodic painless vaginal bleeding after 20 weeks gestation Bright Red Bleeding without uterine contractions Ultrasound: Reveals the malpositioned placenta Complications of placenta previa: Preterm delivery Hypovolemia Altered tissue perfusion Deterioration in fetal status


13 Placenta Previa NURSING CARE:
Perform a complete assessment on any pregnant client that presents with painless bright red vaginal bleeding except: NO VAGINAL EXAMS Insert large bore catheter(18 or greater) and maintain IV infusion Monitor: Vital signs Continuous Fetal monitoring I&O-pad count/weight them Notify: Physician, charge nurse, ICN, and anesthesia personnel

14 Placentia Previa Nurse Care: Obtain laboratory specimens:
CBC, Type & Rh, Type & Crossmatch Be prepared to deliver client: Vaginally for the low-lying placenta-have Double set up in the Delivery room Cesarean section for partial and complete placenta previa- have Hysterectomy tray in the delivery room Provide emotional support Strict Bedrest- Position client so pressure is not on the placenta If client is stable and has diet order make sure it is well balance Prenatal vitamins and iron will be continue

15 Abruptio Placenta ABRUPTIO PLACENTA is a premature separation, either partial or total of a normally implanted placenta from the decidual lining of the uterus after 20 weeks’ gestation. Classifications of Abruptio Placenta: Types: See next slide Marginal-A Central/Concealed/Covert-B Complete-C Degrees of placental separation: Grades-0-3


Chronic Hypertension Multiparty Abdominal Trauma Uterine Anomalies Smoking Cocaine Abuse Premature Rupture Of Membranes-PROM


19 ABRUPTIO PLACENTA Complications of Abruptio Placenta:
Risk of depleting clotting factors DIC Hypovolemia Multiorgan failure Maternal Death Uterine Placenta insuffiency Fetal Hypoxia Fetal Death

20 Abruptio Placenta Clinical manifestations:
Sudden Dark Red Vaginal Bleeding Unremitting pain Firm-to boardlike uterine Shock greater than blood loss Ultrasound will show abruption EFM: Uterine irritability Nonreassuring Fetal Heart pattern- Loss of variability and late decelerations

Amount of Vaginal Bleeding Vital Signs I&O Measure abdominal girth Uterine characteristics and activity EFM-Continuously For development of coagulation problems Review lab values: CBC, Coagulation studies, PT,PTT

Insert large IV Catheter(18-gauge or bigger) and maintain IV infusion Provide at 8-12L/min Anticipate Transfusion Therapy: RBC’s FFP PLT’s Crypopreciate Albumin

23 ABRUPTIO PLACENTA Nursing Care: Anticipate Expedited Delivery:
Vaginally Cesarean section Have Hysterectomy Tray in room Provide emotional support Instruct client and family on disease process and procedures and possible surgery Contact-Physician, Charge nurse, Anesthesia personnel, ICN unit

24 Disseminated Intravascular Coagulation
DISSEMINATED INTRAVASCULAR COAGULATION (DIC) is a complex coagulopathy condition which occurs secondary to another underlying disease process Risk Factor: Preeclampsia/Eclampsia Sepsis Abruptio Placenta Prolonged IUFD Excessive Blood Uterine inversion or rupture Amniotic Fluid embolism (AFE)


26 DIC Complications: Hypovolemia Alt. Tissue Perfusion
Multiorgan failure Maternal death Fetal death

27 DIC Clinical Manifestations: Shocklike state
Overwhelming and diffuse hemorrhage: Petechia, ecchymosis, hematomas Oozing of blood from puncture sites, IV sites, and /or surgery incisions. Bleeding gums. Blood in urine Laboratory valves: Decreased Hg and Hct Prolonged PTT and PT Decreased fibrinogen Decrease PLT’s D-Dimer

28 DIC NURSING CARE: Care for this client is for the critically ill client. Identify Risk factors predisposing to DIC. Early detection is extremely important Maintain IV site- Central line maybe placed. Anticipated Transfusion therapy: Fresh Whole Blood Fresh Frozen plasma Cryoprecipate Monitor VS, I&O, perfusion status*,bleeding, cardiopulmonary status

29 DIC Nursing Care: Educate the client and family concerning disease process, procedures. Provide support to the client and family. No Heparin is given to the client who has DIC and who is pregnant or has been delivered

30 Hyperemesis Gravidarum
HYPEREMESIS GRAVIDARUM is a disorder with intractable vomiting associated with pregnancy with significant electrolyte imbalance and fluid deficit and possible starvation. Etiology is unknown/PREGNANCY Risk Factors: High levels of hCG Gestational Trophoblastic Disease Multigestation Psychopathologic and emotional factors Stress Other pathophysiology

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