Chapter 19
Miscarriage Case Study Answers
- Priority nursing assessments:
- Assess the amount and nature of vaginal bleeding.
- Evaluate vital signs to monitor for hemodynamic stability.
- Perform a pain assessment to determine the severity and nature of cramping.
- Assess Maria’s emotional state and coping mechanisms.
- Review her medical history, including any previous pregnancy complications.
- Management options for a missed miscarriage:
- Expectant management: Allowing the miscarriage to resolve naturally over time.
- Medical management: Administration of medications like misoprostol to assist with the expulsion of pregnancy tissue.
- Surgical management: Dilation and curettage (D&C) to remove retained products of conception.
- Providing emotional support:
- Offer active listening and validate Maria’s feelings of loss.
- Provide privacy and a safe space for Maria to express her emotions.
- Involve family members or support persons, if desired by Maria.
- Offer referrals to counseling services or grief support groups.
- Patient education:
- Educate Maria to seek immediate medical attention if she experiences heavy bleeding (soaking more than one pad per hour), severe abdominal pain, fever, or foul-smelling vaginal discharge.
- Explain the importance of follow-up appointments to ensure complete resolution of the miscarriage and to monitor for complications.
- Impact of hypothyroidism:
- Hypothyroidism can increase the risk of miscarriage, preterm birth, and developmental issues in the fetus.
- Nursing interventions include ensuring Maria’s thyroid levels are monitored regularly and that she adheres to her prescribed levothyroxine regimen.
- Community resources:
- Suggest support groups for pregnancy loss, such as those offered by local hospitals or organizations like Share Pregnancy and Infant Loss Support.
- Provide information about online resources or hotlines for emotional support.
- Refer Maria to a social worker or counselor specializing in perinatal loss if needed.
