Chapter 19

Miscarriage Case Study

Answers

1. The priority nursing assessments for Maria include assessing the amount and nature of vaginal bleeding; evaluating vital signs to monitor for hemodynamic stability; performing a pain assessment to determine the severity and nature of cramping; assessing Maria’s emotional state and coping mechanisms; and reviewing her medical history, including any previous pregnancy complications.
2. Expectant management options for a missed miscarriage is allowing the miscarriage to resolve naturally over time. A medical management option for a missed miscarriage would include administration of medications like misoprostol to assist with the expulsion of pregnancy tissue. A surgical management option for a missed miscarriage is a dilation and curettage (D&C) to remove retained products of conception.
3. The nurse can provide emotional support by engaging in active listening and validating Maria’s feelings of loss; providing privacy and a safe space for Maria to express her emotions; involving family members or support persons, if desired by Maria; and offering referrals to counseling services or grief support groups.
4. Patient education should include the following: 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; and explain the importance of follow-up appointments to ensure complete resolution of the miscarriage and to monitor for complications.
5. 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.
6. Community resources that the nurse could recommend to Maria include the following:

• 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.

2. Please find answers to the Learning Activity interactive elements within the element.