Wednesday, May 3, 2017

Special considerations in Patients with Abortion/Miscarriage

Before an abortion, perform the following:

Thoroughly explain all procedures to the patient.
After the patient uses the bedpan, inspect the contents carefully for intrauterine material. (The patient shouldn’t have bathroom privileges because she may inadvertently expel uterine contents.)

After spontaneous or elective abortion, perform the following:
  • Note the amount, color, and odor of vaginal bleeding. Save all the pads the patient uses, for evaluation, and provide perineal care.
  • Administer oxytocin and an analgesic as ordered.
  • Obtain vital signs every 15 minutes for 1 hour, every 30 minutes for 2 hours, every hour for 2 hours, then every 4 hours for 24 hours.
  • Monitor urine output.
  • Caring for a patient who has had a spontaneous abortion includes emotional support and counseling during the grieving process. Encourage the patient and her partner to express their feelings. Some couples may want to talk to a member of the clergy or, depending on their religion, may wish to have the fetus baptized.
  • The patient who has had a therapeutic abortion also benefits from support. Encourage her to verbalize her feelings. Remember, she may feel ambivalent about the procedure; intellectual and emotional acceptance of abortion aren’t the same. Refer her for counseling, if necessary.
  • Before the patient is discharged, perform the following:
  • Tell the patient to expect vaginal bleeding or spotting and to immediately report excessive bright-red blood or bleeding that lasts more than 10 days.
  • Advise the patient to watch for signs of infection, such as a temperature higher than 100.5° F (38° C) and foul-smelling vaginal discharge.
  • Encourage the patient to gradually increase her daily activities to include whatever tasks she feels comfortable doing, as long as these activities don’t increase vaginal bleeding or cause fatigue. Many patients return to work within 1 to 2 days.
  • Urge the patient to abstain from intercourse for 1 to 2 weeks, and encourage her to use a contraceptive when intercourse is resumed.
  • Instruct the patient to avoid using tampons for 1 to 2 weeks.
  • Inform the patient who desires an elective abortion of all available alternatives. She needs to know what the procedure involves, what the risks are, and what to expect during and after the procedure, both emotionally and physically. Ascertain whether the patient is comfortable with her decision to have an elective abortion. Encourage her to verbalize her thoughts both when the procedure is performed and at a follow-up visit, usually 2 weeks later. If you identify an inappropriate coping response, refer the patient for professional counseling.
  • Tell the patient to see her physician in 2 to 4 weeks for a follow-up examination.
  • Emphasize to the pregnant woman the importance of good nutrition and the need to avoid alcohol, cigarettes, and drugs. If the patient has a history of spontaneous abortions, suggest that she and her partner have thorough examinations. For the woman, this includes premenstrual endometrial biopsy, a hormone assessment (estrogen, progesterone, and thyroid, follicle-stimulating, and luteinizing hormones), and hysterosalpingography and laparoscopy to detect anatomic abnormalities. Genetic counseling may also be indicated.

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