What is the most appropriate initial nursing intervention for a patient diagnosed with a threatened abortion presenting with stable vital signs and mild discomfort?

B) Instruct the patient to rest and avoid strenuous activity

A) Encourage the patient to engage in light exercise

B) Instruct the patient to rest and avoid strenuous activity

C) Advise the patient to stop taking prenatal vitamins

D) Recommend the patient increase fluid intake to prevent dehydration

Which of the following actions should the nurse prioritize when caring for a patient diagnosed with a threatened abortion?

B) Advise the patient to rest and avoid strenuous activity

A) Encourage the patient to engage in daily physical exercise

B) Advise the patient to rest and avoid strenuous activity

C) Suggest the patient stop taking prenatal vitamins

D) Recommend the patient increase caffeine intake to maintain energy levels

What is the most appropriate nursing intervention for a patient experiencing a threatened abortion?

B) Advise the patient to maintain bed rest and avoid strenuous activities

A) Encourage the patient to engage in regular exercise to improve circulation

B) Advise the patient to maintain bed rest and avoid strenuous activities

C) Instruct the patient to take over-the-counter pain medication without consulting a healthcare provider

D) Recommend the patient increase fluid intake to prevent dehydration

What is the most appropriate nursing intervention for a patient experiencing a threatened abortion with stable vital signs and no significant bleeding?

C) Recommend the patient to avoid strenuous activities and monitor symptoms

A) Encourage complete bed rest without any movement

B) Advise the patient to continue normal daily activities

C) Recommend the patient to avoid strenuous activities and monitor symptoms

D) Suggest immediate hospitalization for continuous monitoring

Which of the following is the most appropriate nursing action for a patient who reports mild cramping during early pregnancy but has no bleeding or passage of tissue?

A) Reassure the patient that mild cramping can be normal in early pregnancy

B) Advise the patient to increase physical activity to alleviate cramping

C) Instruct the patient to immediately go to the emergency department

D) Recommend the patient take over-the-counter medications without consulting a physician

Which of the following findings in the patient's follow-up appointment is most indicative of a stable pregnancy?

D) No bleeding or passage of tissue

Which dietary recommendation is most appropriate for a patient experiencing mild iron deficiency anemia during pregnancy?

B) Increase intake of leafy green vegetables

A) Increase intake of citrus fruits

B) Increase intake of leafy green vegetables

C) Increase intake of dairy products

D) Increase intake of processed meats

A patient at a follow-up appointment reports increased fatigue and dizziness. Her lab results show a mild decrease in hemoglobin levels and a slight iron deficiency. What is the most appropriate nursing intervention to address these findings?

B) Suggest a diet high in vitamin C to enhance iron absorption

A) Increase her fluid intake to improve circulation

B) Suggest a diet high in vitamin C to enhance iron absorption

C) Recommend complete bed rest until symptoms improve

D) Advise her to avoid all physical activity to prevent fatigue

What is the primary purpose of iron supplementation in the management of mild anemia during pregnancy?

B) To improve oxygen transport by increasing hemoglobin levels

A) To increase the white blood cell count

B) To improve oxygen transport by increasing hemoglobin levels

A patient with mild anemia is showing slight improvement in hemoglobin levels and reports feeling more energetic after two weeks of dietary changes and iron supplementation. What is the most appropriate nursing action at this stage?

B) Encourage the patient to continue her current dietary and supplementation regimen

A) Discontinue iron supplementation since the patient feels better

B) Encourage the patient to continue her current dietary and supplementation regimen

C) Advise the patient to increase her iron supplementation dosage

D) Suggest reducing dietary iron intake to prevent overdose

Types of spontaneous abortion - Nursing Case Study

Pathophysiology

• Primary mechanism: Chromosomal abnormalities - Genetic defects in the embryo are the most common cause, leading to developmental problems and spontaneous abortion, as the body recognizes non-viability.

• Secondary mechanism: Hormonal imbalances - Insufficient progesterone production prevents proper uterine lining development, crucial for embryo implantation and growth, contributing to pregnancy loss.

• Key complication: Infection or inflammation within the uterus can disrupt the implantation environment or lead to tissue damage, further increasing miscarriage risk.

Patient Profile

Demographics:

28-year-old female, teacher

History:

• Key past medical history: No significant past medical history

• Current medications: Prenatal vitamins

• Allergies: None

Current Presentation:

• Chief complaint: Vaginal bleeding

• Key symptoms: Mild cramping, light spotting, no tissue passage

• Vital signs: Blood pressure 110/70 mmHg, heart rate 78 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F

Section 1

The initial assessment findings reveal that the patient's vital signs remain stable, with a blood pressure of 110/70 mmHg, heart rate of 78 bpm, respiratory rate of 16 breaths per minute, and temperature of 98.6°F. During the physical examination, there is light spotting noted on the perineum, but no active bleeding. A pelvic examination shows a closed cervical os, indicating that the cervix is not dilated, which is a reassuring sign in the context of a threatened abortion. The uterine size is consistent with the gestational age, and there are no signs of tenderness or significant uterine cramping. The patient reports mild discomfort but denies severe pain.

A transvaginal ultrasound is performed to assess the viability of the pregnancy. The ultrasound shows a gestational sac and a fetal pole consistent with the patient's reported gestational age, but the fetal heart rate is on the lower end of normal. There is no evidence of retained products of conception or significant subchorionic hemorrhage. Based on these findings, the healthcare team assesses the situation as a threatened abortion, meaning the pregnancy is at risk but not definitively lost at this stage.

With these findings, the patient is advised to rest, avoid strenuous activity, and continue taking prenatal vitamins. She is educated about the signs of worsening symptoms, such as increased bleeding, severe cramping, or passage of tissue, which would necessitate immediate medical attention. The patient is scheduled for a follow-up ultrasound and consultation with her obstetrician to monitor the pregnancy's progress. The focus remains on supportive care and monitoring, given the stable condition and the absence of severe complications at this time.

Section 2

A week after the initial assessment, the patient returns for her follow-up ultrasound and consultation with her obstetrician. She reports that she has been adhering to the recommended rest and avoiding strenuous activities. However, she has noticed an increase in the frequency of mild cramps, though they remain non-severe and she has not experienced any significant bleeding or passage of tissue. Her vital signs are reassessed and remain stable, with a blood pressure of 115/72 mmHg, heart rate of 80 bpm, respiratory rate of 18 breaths per minute, and temperature of 98.6°F.

The follow-up transvaginal ultrasound provides new diagnostic results. The ultrasound reveals a slight increase in the size of the gestational sac, and the fetal pole is more developed, consistent with the gestational age. The fetal heart rate, although still on the lower end of normal, has increased slightly since the last assessment. There is no evidence of a subchorionic hemorrhage, and the cervical os remains closed, which is reassuring. The absence of significant changes in the uterine environment or increased risk factors suggests that the pregnancy remains within the realm of a threatened abortion, but with a cautiously optimistic outlook.

In light of these findings, the healthcare team continues to emphasize supportive care, advising the patient to maintain her current regimen of rest and avoid activities that could exacerbate her symptoms. She is instructed to monitor for any signs of worsening symptoms and to keep a log of any changes in cramping or spotting. The patient is scheduled for another follow-up in two weeks, where her progress will be reassessed. The focus remains on vigilant monitoring and patient education, ensuring that the patient feels supported and informed throughout her journey.

Section 3

Two weeks later, the patient returns for her scheduled follow-up appointment. She reports that she has continued to follow her doctor's recommendations, maintaining a regimen of rest and avoiding any activities that might increase her risk of complications. Despite the precautions, she describes experiencing some episodes of mild cramping, though they remain sporadic and manageable. Importantly, she has not experienced any bleeding or passage of tissue. Her vital signs are checked once again, showing a stable blood pressure of 112/70 mmHg, a heart rate of 78 bpm, a respiratory rate of 16 breaths per minute, and a temperature of 98.4°F.

The follow-up transvaginal ultrasound reveals further reassuring developments. The gestational sac has increased appropriately in size, and the fetal pole shows continued growth. The fetal heart rate is now well within the normal range for the gestational age, providing additional reassurance. The cervical os remains closed, and there is still no evidence of a subchorionic hemorrhage or other concerning changes in the uterine environment. These findings suggest that the pregnancy is continuing to progress positively, and the risk of spontaneous abortion appears to be decreasing.

In light of these encouraging results, the healthcare team advises the patient to continue her current regimen of rest and activity modification. They emphasize the importance of ongoing monitoring and patient education, encouraging her to promptly report any new or worsening symptoms. The plan includes another follow-up appointment in two weeks to reassess her progress and ensure the pregnancy remains stable. The patient expresses gratitude for the support and guidance provided by her healthcare team, feeling more confident and reassured as she continues her pregnancy journey.

Section 4

Two weeks later, the patient returns for her follow-up appointment, expressing mild concern over new developments. She reports experiencing increased fatigue and occasional dizziness over the past few days. Her adherence to the recommended regimen of rest and activity modification remains commendable, but the new symptoms prompt a thorough reassessment by the healthcare team.

During the assessment, her vital signs show a slight drop in blood pressure to 108/68 mmHg, while her heart rate remains stable at 80 bpm. The respiratory rate is consistent at 16 breaths per minute, and her temperature is normal at 98.6°F. A complete blood count is ordered to evaluate her overall health status, revealing a mild decrease in hemoglobin levels, suggestive of anemia, likely contributing to her fatigue and dizziness. Her iron levels are also tested, showing a slight deficiency.

In response to these findings, the healthcare team discusses the importance of addressing her nutritional status. A dietary plan rich in iron is recommended, along with an iron supplement to help improve her hemoglobin levels. The patient is advised to monitor her symptoms and to continue reporting any changes. Another follow-up appointment is scheduled in two weeks to reassess her condition and ensure both her health and the pregnancy continue to progress positively. The patient's proactive involvement in her care and the healthcare team's supportive approach bolster her confidence as she navigates this phase of her pregnancy.

Section 5

Two weeks later, the patient attends her follow-up appointment, eager to discuss her progress since implementing the dietary changes and iron supplementation. She reports feeling slightly more energetic, with the dizziness occurring less frequently. Her adherence to dietary recommendations has been commendable, and she has been diligently taking her iron supplements as prescribed. The healthcare team conducts another thorough assessment to evaluate her response to the interventions.

During the assessment, the patient’s vital signs reveal a slight improvement in her blood pressure, now at 112/70 mmHg, indicating a positive trend towards stabilization. Her heart rate remains steady at 78 bpm, and her respiratory rate is a consistent 16 breaths per minute. Her temperature continues to be normal at 98.7°F. A repeat complete blood count shows a modest increase in her hemoglobin levels, now at 11.5 g/dL, suggesting that the interventions are effectively addressing her mild anemia. Her iron levels have also improved but remain slightly below the normal range, warranting continued supplementation and dietary focus.

Encouraged by these findings, the healthcare team commends the patient for her proactive engagement in her care plan. They emphasize the importance of maintaining her current regimen and remind her to monitor for any new symptoms. The team schedules another follow-up appointment in four weeks to ensure her condition remains stable and to address any new concerns promptly. This collaborative and supportive approach reassures the patient, contributing to her confidence in managing her health and the pregnancy journey ahead.