Which initial nursing action is most appropriate for confirming the gestational age of the pregnancy in this patient?

B) Obtain a urine pregnancy test

D) Conduct a pelvic examination

A 25-year-old female patient presents with a confirmed pregnancy and expresses the decision to terminate it. Which initial nursing intervention is most appropriate to ensure her immediate physical well-being?

C) Conduct a complete blood count and Rh factor determination.

A) Perform an ultrasound to confirm gestational age.

B) Discuss emotional support resources available.

C) Conduct a complete blood count and Rh factor determination.

D) Educate the patient on the procedure for pregnancy termination.

When a patient with an Rh-negative blood type is undergoing a medical abortion, which of the following is a necessary nursing intervention to prevent future Rh sensitization?

A) Administer Rh immunoglobulin

B) Provide counseling on contraception

C) Schedule a follow-up ultrasound

D) Educate on dietary supplements

A patient with a confirmed intrauterine pregnancy at seven weeks gestation and an Rh-negative blood type is scheduled for a medical abortion. What is the primary purpose of administering Rh immunoglobulin to this patient?

C) To reduce the risk of infection

D) To manage cramping and bleeding post-procedure

What is the primary reason for administering Rh immunoglobulin to a patient undergoing a medical abortion?

D) To promote uterine contraction

Which of the following instructions should the nurse emphasize to the patient regarding signs to report after a medical abortion?

B) Heavy bleeding exceeding a menstrual flow

C) Bright red blood with occasional small clots

D) Use of over-the-counter analgesics

A patient recovering from a recent procedure reports increased bleeding and mild dizziness. Her hemoglobin has dropped from 13.0 g/dL to 11.5 g/dL. Which nursing intervention is most appropriate to address her mild anemia?

B) Encourage increased intake of iron-rich foods.

A) Administer a blood transfusion.

B) Encourage increased intake of iron-rich foods.

C) Restrict fluid intake to manage dizziness.

D) Advise complete bed rest until symptoms resolve.

Which dietary recommendation should the nurse make to help the patient manage her mild anemia post-procedure?

A) Increase intake of iron-rich foods such as spinach and red meat

B) Avoid all dairy products to improve iron absorption

C) Limit fluid intake to prevent further bleeding

D) Increase vitamin C intake to enhance immune function

During the follow-up appointment, which of the following actions is most important for the nurse to reinforce to the patient?

B) Continuing to monitor and log symptoms

A) Increasing daily physical activity

B) Continuing to monitor and log symptoms

What is the priority nursing intervention for a patient experiencing mild fatigue and stabilized hemoglobin levels after a recent episode of blood loss?

B) Advise the patient to continue rest and hydration

A) Encourage increased physical activity

B) Advise the patient to continue rest and hydration

C) Suggest reducing dietary iron intake

D) Recommend immediate hospitalization

abortion - Nursing Case Study

Pathophysiology

• Primary mechanism: Hormonal imbalance, particularly a decrease in progesterone, disrupts the uterine lining's ability to support an embryo, leading to pregnancy loss.

• Secondary mechanism: Abnormal placental development or poor attachment to the uterine wall can result in insufficient nutrient and oxygen delivery to the fetus, prompting termination.

• Key complication: Incomplete abortion can occur, where not all fetal tissue is expelled, potentially leading to infection or hemorrhage if not promptly addressed.

Patient Profile

Demographics:

25-year-old female, retail worker

History:

• Key past medical history: No significant past medical history

• Current medications: Oral contraceptive pill

• Allergies: None

Current Presentation:

• Chief complaint: Request for termination of pregnancy

• Key symptoms: Mild cramping, no bleeding

• Vital signs: Blood pressure 118/76 mmHg, heart rate 72 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F

Section 1

Initial Assessment Findings

Upon initial assessment, the 25-year-old female presents as alert and oriented, with no signs of distress. She reports a last menstrual period approximately seven weeks ago and confirms a positive home pregnancy test. Physical examination reveals mild abdominal tenderness but no palpable masses or abnormal growths. Her vital signs remain stable, with a blood pressure of 118/76 mmHg, heart rate of 72 bpm, respiratory rate of 16 breaths per minute, and a temperature of 98.6°F. The patient denies any significant bleeding or spotting and mentions mild cramping that she describes as similar to menstrual cramps.

During the nursing assessment, the patient expresses a clear understanding of her decision to terminate the pregnancy and articulates the emotional and practical reasons behind her choice. She appears calm and composed, with adequate social support from her partner, who is present during the consultation. The nurse conducts a thorough review of systems, revealing no additional symptoms such as nausea, vomiting, or dizziness. The patient is educated on the potential for minor complications, such as incomplete abortion, and is advised on the importance of follow-up care to ensure complete uterine evacuation and prevent infection.

The nursing team plans to perform an ultrasound to confirm the gestational age and ensure there are no anomalies, such as ectopic pregnancy, that could complicate the procedure. Blood work, including a complete blood count and Rh factor determination, is also ordered to establish a baseline and anticipate any needs for Rh immunoglobulin administration if required. The nursing staff prepares to provide emotional support and additional resources, such as counseling services, to assist the patient throughout her care journey.

Section 2

New Diagnostic Results

Following the initial assessment, the ultrasound is performed and confirms an intrauterine pregnancy consistent with a gestational age of approximately seven weeks. There are no signs of ectopic pregnancy or other anomalies, providing reassurance for the planned medical management of the abortion. The ultrasound findings align with the patient's last menstrual period, supporting her readiness to proceed with the termination as planned.

Blood work results are reviewed, showing a complete blood count within normal limits, indicating no current signs of infection or anemia. The patient's Rh factor is determined to be negative. Given this, the nursing team discusses the need for Rh immunoglobulin administration to prevent Rh sensitization in future pregnancies. This preventative measure is explained to the patient, who expresses understanding and agrees to receive the injection as part of her care plan.

With diagnostic results confirming the absence of complications such as an ectopic pregnancy and the necessary preparations made for Rh immunoglobulin administration, the nursing team coordinates with the healthcare provider to schedule the medical abortion procedure. The patient is educated on what to expect during and after the procedure, including possible side effects like cramping and bleeding. She is provided with a follow-up appointment to monitor her recovery and ensure complete uterine evacuation. The nursing staff reaffirms the availability of support services and encourages the patient to reach out if she has any concerns or questions during her recovery.

Section 3

Response to Interventions

Following the administration of Rh immunoglobulin and the initiation of the medical abortion regimen, the patient is monitored closely for her response to the interventions. Over the subsequent hours, she reports experiencing mild to moderate cramping, which is consistent with expected side effects of the medication. Her vital signs are stable, with a blood pressure of 118/76 mmHg, heart rate of 78 beats per minute, respiratory rate of 16 breaths per minute, and an oxygen saturation of 98% on room air. The patient is encouraged to rest and use a heating pad to alleviate discomfort, alongside taking over-the-counter analgesics as needed.

The patient is instructed to monitor her bleeding, which should not exceed heavy menstrual flow. After several hours, her bleeding is noted to be within normal limits, characterized by bright red blood with occasional small clots. The nursing team reassures the patient about these findings, emphasizing the importance of reporting any excessive bleeding or signs of infection, such as foul-smelling discharge or fever. She is also reminded of the importance of hydration and nutrition during her recovery period.

The patient expresses relief with how the procedure is progressing and feels supported by the ongoing care. She is reminded of her follow-up appointment in one week to confirm complete uterine evacuation and discuss any ongoing concerns. The nursing staff reiterates the availability of emotional support services, should she feel the need, and provides contact information for a 24-hour helpline. As she prepares to discharge, the patient verbalizes understanding of her post-procedure instructions and demonstrates confidence in managing her recovery at home.

Section 4

New Complications

As the patient continues her recovery at home, she begins to notice a slight increase in bleeding and mild dizziness on the second day post-procedure. Concerned, she contacts the healthcare facility to report her symptoms. The nursing team advises her to come in for an assessment to ensure her safety and rule out any complications. Upon arrival at the clinic, her vital signs are re-evaluated: blood pressure is slightly lower than before at 110/70 mmHg, heart rate is 82 beats per minute, respiratory rate remains stable at 16 breaths per minute, and oxygen saturation is 98% on room air.

A physical examination reveals that her bleeding is now moderate, with continued bright red blood and slightly larger clots than previously noted. Although the patient remains hemodynamically stable, a hemoglobin and hematocrit test is ordered to assess for potential anemia due to increased blood loss. The laboratory results indicate a mild drop in hemoglobin to 11.5 g/dL from her baseline of 13.0 g/dL, suggesting a need for closer monitoring, but not an immediate intervention.

The nursing staff reassures the patient that these findings, while different from before, are still manageable. They emphasize the importance of continued hydration and rest, and recommend she increase her intake of iron-rich foods to help manage the mild anemia. The patient is advised to keep a detailed record of her bleeding and any other symptoms, and to report any further changes promptly. With a plan for close follow-up and additional support, the patient feels more at ease and agrees to return in two days for another assessment to ensure she remains on a safe recovery trajectory.

Section 5

Two days later, the patient returns to the clinic for her follow-up appointment as planned. During the initial assessment, the nursing team notes that her vital signs remain stable: blood pressure is 112/72 mmHg, heart rate is slightly elevated at 88 beats per minute, respiratory rate is 18 breaths per minute, and oxygen saturation is 97% on room air. The patient reports feeling slightly fatigued but has not experienced any dizziness since her last visit. She mentions that the bleeding has decreased to a lighter flow with fewer clots, indicating some improvement.

A repeat hemoglobin and hematocrit test is conducted to monitor her recovery progress. The laboratory results reveal that her hemoglobin has stabilized at 11.6 g/dL, suggesting that her body is slowly compensating for the earlier blood loss. The nursing team discusses these findings with the patient, reinforcing the importance of continuing her current regimen of rest, hydration, and consumption of iron-rich foods. They also encourage her to maintain a log of her symptoms, ensuring any new or worsening symptoms are communicated promptly.

Based on her current status and the improvement in her symptoms, the nursing staff and the patient agree on a follow-up plan that includes another check-in by phone in two days and a clinic appointment in a week. This plan will allow the healthcare team to ensure her continued recovery and address any potential issues early. The patient leaves the clinic feeling reassured and supported, equipped with clear instructions and knowing that she can reach out to her healthcare providers if needed.