A 28-year-old female presents with signs of incomplete abortion and hemodynamic instability. Which nursing intervention is the highest priority for this patient?

D) Continue monitoring vital signs and administer additional IV fluids as prescribed

A) Administer pain medication to manage the patient's pain

B) Initiate blood transfusion based on the patient's hemoglobin level

C) Prepare the patient for an immediate dilation and curettage (D&C) procedure

D) Continue monitoring vital signs and administer additional IV fluids as prescribed

A 28-year-old female is experiencing an incomplete abortion with significant blood loss. Her vital signs exhibit tachycardia, hypotension, and an increased respiratory rate. Which nursing intervention should be prioritized to address her current hemodynamic status?

B) Continue administering IV fluids and prepare for a blood transfusion.

A) Administer prescribed analgesics to manage her pelvic pain.

B) Continue administering IV fluids and prepare for a blood transfusion.

C) Educate the patient about the D&C procedure to ease her anxiety.

D) Monitor her electrolyte levels closely for any imbalances.

A patient with ongoing pelvic pain and light-headedness after initial fluid resuscitation receives a blood transfusion and undergoes a dilation and curettage (D&C) procedure. Which nursing action is most critical to ensure the patient's continued stabilization post-procedure?

B) Monitoring vital signs for signs of hemodynamic instability.

A) Administering analgesics as prescribed to manage pelvic pain.

B) Monitoring vital signs for signs of hemodynamic instability.

C) Educating the patient about signs of infection and when to seek help.

D) Encouraging ambulation to prevent deep vein thrombosis.

A patient undergoing a dilation and curettage (D&C) procedure for retained products of conception is being monitored post-operatively. Which nursing intervention is most critical to ensure the patient's stability after the procedure?

C) Monitor vital signs and assess for signs of continued bleeding.

A) Encourage early ambulation to prevent deep vein thrombosis.

B) Administer prescribed analgesics to manage pelvic pain.

C) Monitor vital signs and assess for signs of continued bleeding.

D) Educate the patient about the importance of fluid intake post-procedure.

A patient who recently underwent a dilation and curettage procedure is now exhibiting a low-grade fever, intensified pelvic pain, and tachycardia. A repeat pelvic ultrasound reveals retained tissue, and the white blood cell count is elevated. Which nursing intervention is the most appropriate to implement first in managing this patient's condition?

A) Administer prescribed broad-spectrum antibiotics

B) Prepare the patient for a repeat dilation and curettage

C) Educate the patient on signs of worsening infection

D) Increase frequency of vital sign monitoring

A patient who underwent a dilation and curettage (D&C) procedure six hours ago is now experiencing a low-grade fever, increased pelvic pain, a slight tachycardia, and elevated white blood cell count. A repeat ultrasound shows retained tissue. Which nursing intervention should be prioritized to address the patient's current condition?

A) Administer broad-spectrum antibiotics as prescribed.

B) Increase fluid intake to ensure hydration.

C) Apply a warm compress to the lower abdomen to alleviate pain.

D) Encourage ambulation to promote uterine contraction and tissue expulsion.

A patient has been receiving broad-spectrum antibiotics for suspected pelvic infection following an incomplete evacuation of retained tissue. Despite treatment, her condition shows only marginal improvement, with a persistent fever and elevated white blood cell count. What is the nurse's priority action based on this situation?

B) Prepare the patient for a repeat dilation and curettage as discussed with the healthcare team.

A) Administer additional analgesics to manage the patient's pelvic pain.

B) Prepare the patient for a repeat dilation and curettage as discussed with the healthcare team.

C) Encourage the patient to increase fluid intake to aid in hydration.

D) Monitor the patient's vital signs and laboratory results for any further changes.

A patient has been on broad-spectrum antibiotics for 12 hours for a suspected infection post-evacuation. Her fever persists at 100.8°F (38.2°C), pelvic pain remains high at 7 out of 10, and her white blood cell count has increased to 16,500/mm³. A repeat pelvic ultrasound shows no significant change in retained tissue. What is the most appropriate nursing intervention at this time?

C) Prepare the patient for a possible repeat dilation and curettage procedure.

A) Increase the dosage of analgesics to manage the pelvic pain.

B) Continue monitoring vital signs and wait for further response to antibiotics.

C) Prepare the patient for a possible repeat dilation and curettage procedure.

D) Administer antipyretics to reduce the fever and reassess in 4 hours.

A patient presents with fever, increased white blood cell count, and abdominal tenderness following a recent surgical procedure. Her heart rate is elevated, and she exhibits mild metabolic acidosis. Blood cultures are pending. What is the priority nursing intervention at this time?

B) Initiate broad-spectrum antibiotics as ordered.

A) Administer antipyretics to reduce fever.

B) Initiate broad-spectrum antibiotics as ordered.

C) Increase IV fluid rate to manage blood pressure.

D) Apply warm blankets to manage chills.

A patient exhibits signs of infection with an elevated white blood cell count, fever, and increased heart rate. Given the need for urgent surgical intervention, which nursing intervention is most critical to implement immediately to stabilize the patient prior to the procedure?

B) Initiate intravenous fluid resuscitation

A) Administer prescribed broad-spectrum antibiotics

B) Initiate intravenous fluid resuscitation

C) Position the patient in Trendelenburg position

D) Provide oxygen therapy via nasal cannula

Ealry abortion - Nursing Case Study

Pathophysiology

• Primary mechanism: Chromosomal abnormalities are the leading cause of early abortion, accounting for approximately 50-70% of cases. These genetic defects often result in non-viable embryos, prompting the body to terminate the pregnancy naturally.

• Secondary mechanism: Hormonal imbalances, particularly involving progesterone, can disrupt the uterine environment. Insufficient levels of this hormone may prevent the endometrium from properly supporting embryo implantation and growth.

• Key complication: Impaired trophoblastic invasion can occur, where the developing placenta fails to adequately penetrate the uterine lining. This can compromise nutrient and oxygen supply, leading to pregnancy loss.

Patient Profile

Demographics:

28-year-old female, nurse

History:

• Key past medical history: History of irregular menstrual cycles, anemia

• Current medications: Iron supplements, oral contraceptive pill

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Vaginal bleeding and abdominal pain

• Key symptoms: Moderate pelvic pain, light-headedness, and intermittent nausea

• Vital signs: Blood pressure 90/60 mmHg, heart rate 110 bpm, respiratory rate 22 breaths per minute, temperature 98.6°F

Section 1

Initial Assessment Findings:

Upon further assessment, the 28-year-old female's condition reveals additional concerning details. The pelvic examination shows cervical dilation with the presence of blood clots and tissue fragments, indicating an incomplete abortion. The patient reports increased severity in her pelvic pain, now rated as 7 out of 10 on the pain scale. Her light-headedness worsens when she attempts to stand, suggesting significant blood loss. A complete blood count reveals a hemoglobin level of 9.5 g/dL, indicating worsening anemia, likely exacerbated by acute blood loss. Her electrolytes are within normal limits, but a serum beta-hCG test confirms a decrease compared to previous levels, aligning with the suspected pregnancy loss.

The patient's vital signs remain unstable, with a persistent tachycardia of 115 bpm and hypotension at 88/58 mmHg, despite efforts to manage her condition with IV fluids. Her respiratory rate remains elevated at 24 breaths per minute, which may suggest a compensatory mechanism for the low blood pressure. Given these findings, there is a concern for hemodynamic instability and the potential development of hypovolemic shock due to ongoing bleeding. The clinical team must prioritize stabilizing her hemodynamic status while planning for potential surgical intervention.

These findings compel the healthcare team to reassess their approach, considering the need for a dilation and curettage (D&C) procedure to manage the incomplete abortion and control the bleeding. The patient will require close monitoring of her vital signs and hemoglobin levels, as well as continued support for her anemia with blood transfusions if necessary. Additionally, the team will evaluate her response to administered fluids and pain management strategies, preparing for potential complications such as infection or further blood loss.

Section 2

Response to Interventions:

Following the initiation of IV fluid resuscitation, the clinical team observes some improvement in the patient's hemodynamic parameters, though her condition remains tenuous. Her heart rate decreases slightly to 105 bpm, and her blood pressure rises to 95/65 mmHg, indicating a partial response to fluid therapy. However, the patient continues to report significant pelvic pain, now rated as 6 out of 10, and her light-headedness persists, particularly upon standing. In light of these ongoing symptoms, the team decides to administer a unit of packed red blood cells to address the anemia and support improved oxygen delivery to tissues.

As the blood transfusion progresses, the patient's hemoglobin level is reassessed and shows a modest increase to 10.2 g/dL. While this is a positive sign, the team recognizes that the underlying cause of bleeding must be addressed to prevent further deterioration. The decision is made to proceed with a dilation and curettage (D&C) procedure to evacuate any retained products of conception and control the ongoing hemorrhage. The patient is prepared for the procedure, with continuous monitoring of her vitals to ensure stability during the intervention.

Post-procedure, the patient’s condition shows signs of improvement. Her blood pressure stabilizes at 100/70 mmHg, and her heart rate decreases to 98 bpm. She reports a reduction in pelvic pain to 4 out of 10, and her light-headedness diminishes significantly. These changes suggest a positive response to the intervention. However, the healthcare team remains vigilant, closely monitoring for signs of infection or additional blood loss, as well as ensuring that her pain management is adequate. The patient is scheduled for a follow-up complete blood count and reassessment of her vital signs to confirm sustained improvement and to guide further treatment decisions.

Section 3

New Complications:

Despite initial signs of stabilization post-procedure, the patient begins to exhibit new symptoms that raise concern for the healthcare team. Approximately six hours after the dilation and curettage, she develops a low-grade fever of 100.4°F (38°C), and her pelvic pain intensifies, now rated at 7 out of 10. These symptoms, along with a slight increase in heart rate to 102 bpm, prompt the team to consider the possibility of post-procedure infection or retained products that were not fully evacuated.

A repeat pelvic ultrasound is ordered, revealing a small amount of retained tissue that could be contributing to the patient's symptoms. Additionally, her white blood cell count has risen to 14,000/mm³, suggesting an inflammatory or infectious process. In response to these findings, the decision is made to start the patient on a broad-spectrum antibiotic regimen to address potential endometritis, a common complication following procedures like D&C.

The clinical team discusses the situation with the patient, emphasizing the importance of close monitoring over the next 24 to 48 hours. They explain the potential need for additional intervention if her condition does not improve or if further diagnostic imaging indicates continued retention of tissue. The patient is reassessed frequently, with plans for another complete blood count and ultrasound if her symptoms persist or worsen. The team remains focused on preventing progression to more severe complications such as sepsis or significant hemorrhage, ensuring that all members are prepared to respond swiftly to any changes in her status.

Section 4

Following the initiation of broad-spectrum antibiotics, the healthcare team closely monitors the patient for any changes in her condition. Over the next 12 hours, her fever persists, marginally increasing to 100.8°F (38.2°C). The patient's pelvic pain remains consistently high, rated at 7 out of 10, despite analgesics. Her heart rate stabilizes at 98 bpm, which is a slight improvement but still elevated compared to baseline. However, her blood pressure remains stable at 118/76 mmHg, and she is adequately hydrated with IV fluids.

A new set of laboratory results reveals a continued rise in her white blood cell count, now at 16,500/mm³, which suggests that the inflammatory or infectious process is still active. A repeat pelvic ultrasound shows no significant change in the retained tissue, raising concerns about the adequacy of the initial evacuation. The slight enlargement of the endometrial cavity is noted, which may be contributing to the patient's persistent symptoms.

Given these findings, the clinical team deliberates the possibility of a repeat dilation and curettage to fully evacuate the retained tissue. They weigh the risks and benefits, considering the potential for further infection versus the necessity of resolving the underlying cause of her symptoms. The decision is made to consult with the obstetrics and gynecology team for surgical intervention while continuing the antibiotic regimen. The patient is informed of the situation, including the rationale for a possible repeat procedure, allowing her to participate in the decision-making process. The team remains vigilant, prepared to act swiftly should her condition deteriorate, with the primary goal of preventing any progression to more severe complications.

Section 5

As the team prepares for the potential surgical intervention, the patient's condition begins to exhibit subtle yet significant changes, necessitating further clinical evaluation. Over the next few hours, her fever climbs to 101.5°F (38.6°C), indicating a possible escalation in the infectious process. The patient's pelvic pain remains at a distressing 7 out of 10, and she reports new onset of chills and increased abdominal tenderness upon palpation. Her heart rate climbs again to 104 bpm, reflective of her body's ongoing stress response, while her blood pressure shows a slight drop to 112/72 mmHg, warranting closer hemodynamic monitoring.

The healthcare team orders additional diagnostic tests to further assess the patient's condition. A repeat complete blood count reveals a marked increase in her white blood cell count to 18,200/mm³, suggesting a heightened inflammatory response. Blood cultures are obtained to identify any potential bacteremia, given the systemic signs of infection. Meanwhile, a comprehensive metabolic panel indicates a mild metabolic acidosis, with a bicarbonate level of 20 mEq/L, possibly secondary to her persistent fever and increased respiratory rate.

In light of these findings, the clinical team escalates their response by broadening the antibiotic coverage and expediting the consultation with the obstetrics and gynecology team for immediate surgical intervention. The decision for an urgent repeat dilation and curettage is made, aiming to address the retained tissue and mitigate the risk of sepsis. The patient's consent is reaffirmed, and she is prepared for the procedure with a focus on stabilizing her vital signs and managing her pain effectively. The team remains vigilant, ready to adjust the treatment plan as needed, to ensure a favorable outcome and prevent further complications.