A client who has undergone a dilation and curettage for early ...

[ts19998]

A client who has undergone a dilation and curettage for early pregnancy loss is likely to be discharged the same day.
 
  The nurse must ensure that vital signs are stable, bleeding has been controlled, and the woman has adequately recovered from the administration of anesthesia. To promote an optimal recovery, discharge teaching should include (Select all that apply):
  a. Iron supplementation.
  b. Resumption of intercourse at 6 weeks following the procedure.
  c. Referral to a support group if necessary.
  d. Expectation of heavy bleeding for at least 2 weeks.
  e. Emphasizing the need for rest.

Question 2

The reported incidence of ectopic pregnancy in the United States has risen steadily over the past 2 decades. Causes include the increase in STDs accompanied by tubal infection and damage.
 
  The popularity of contraceptive devices such as the IUD has also increased the risk for ectopic pregnancy. The nurse who suspects that a patient has early signs of ectopic pregnancy should be observing her for symptoms such as (Select all that apply):
  a. Pelvic pain
  b. Abdominal pain
  c. Unanticipated heavy bleeding
  d. Vaginal spotting or light bleeding
  e. Missed period

[bigsis44]

Answer to Question 1

ANS: A, C, E
The woman should be advised to consume a diet high in iron and protein. For many women iron supplementation also is necessary. Acknowledge that the client has experienced a loss, albeit early. She can be taught to expect mood swings and possibly depression. Referral to a support group, clergy, or professional counseling may be necessary. Discharge teaching should emphasize the need for rest. Nothing should be placed in the vagina for 2 weeks after the procedure. This includes tampons and vaginal intercourse. The purpose of this recommendation is to prevent infection. Should infection occur, antibiotics may be prescribed. The client should expect a scant, dark discharge for 1 to 2 weeks. Should heavy, profuse, or bright bleeding occur, she should be instructed to contact her provider.

Answer to Question 2

ANS: A, B, D, E
A missed period or spotting can easily be mistaken by the patient as early signs of pregnancy. More subtle signs depend on exactly where the implantation occurs. The nurse must be thorough in her assessment because pain is not a normal symptom of early pregnancy. As the fallopian tube tears open and the embryo is expelled, the patient often exhibits severe pain accompanied by intraabdominal hemorrhage. This may progress to hypovolemic shock with minimal or even no external bleeding. In about half of women, shoulder and neck pain results from irritation of the diaphragm from the hemorrhage.