6 Elective Termination Nursing Care Plans

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6 Elective Termination Nursing Care Plans

Elective Termination: Therapeutic abortion may be done to safeguard the woman’s health, or a voluntary abortion may be a woman’s reproductive decision.

Nursing Care Plans

The nursing plan of care of clients for elective termination includes assessing biopsychosocial status, giving appropriate instruction/information, promoting coping strategies and emotional support, and preventing postprocedural complications.

Here are six (6) nursing care plans and nursing diagnosis for elective termination or therapeutic abortion: 

Anxiety

Anxiety: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response.

May be related to

  • Stress
  • Situational/maturational crises.
  • Unmet needs.
  • Unconscious conflict about essential values/beliefs

Possibly evidenced by

  • Apprehension.
  • Fear of unspecified consequences.
  • Focus on self.
  • Impaired attention.
  • Increased tension.
  • Preoccupation
  • Sympathetic stimulation

Desired Outcomes

  • Patient will recognize the presence of anxiety.
  • Patient will identify the cause of anxiety.
  • Patient will begin to use positive coping strategies to adjust to the situation.
  • Patient will use resources/support systems effectively.
  • Patient will report anxiety reduced to a manageable level.
Nursing InterventionsRationale
Recognize the client’s anxiety and encourage to express her feelings.To assist the client in identifying feelings and begin to deal with problems.
Establish a therapeutic relationship, conveying empathy and unconditional positive regard.To provide a positive attitude towards the client.
Provide comfort measures such as breathing and relaxation techniques.This can influence physiological responses (BP, pulse, and respiration). Tense muscles may interfere with
the procedure.
Explain procedures before they are performed, and stay with the client to provide concurrent feedback.A physical presence is reassuring and can increase cooperation and promote a sense of security.
Provide a support person/family member to stay with the client particularly if she is undergoing a the second-trimester procedure requiring
induction of labor.
The presence of a familiar person can help reduce client anxiety and promote relaxation and coping.

Acute Pain

Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe with anticipated or predictable end and a duration of <6 months.

May be related to

  • After effects of procedure/drug effect.

Possibly evidenced by

  • Autonomic responses/change in vital signs.
  • Report of discomfort.
  • Changes in muscle tone.
  • Distraction behaviors.

Desired Outcomes

  • Patient will identify/use methods that provide relief.
  • Patient will state that discomfort is minimized and/or controlled.
Nursing InterventionsRationale
Determine the extent/severity and location of discomfort.Although some discomfort is expected, severe cramping and abdominal tenderness may indicate
complications.
Explain to the client the nature of discomfort expected.Knowledge helps the client to cope with reality.
Cramping pain during, and for one wk after, a first-trimester termination is expected. Clients treated with prostaglandins may experience nausea, vomiting, and diarrhea.
Provide comfort measures such as relaxation and breathing techniques.To enhance coping skills and decrease feelings of fear, tension, and pain.
Provide information about the use of prescription or nonprescription analgesics.To increase knowledge and awareness of the safe administration, dosage, and side effects.
Administer narcotic/nonnarcotic analgesics, sedatives, and antiemetics, as prescribed.These drugs promote relaxation, decrease pain, and control side effects of treatment (drug
therapy).

Deficient Knowledge

Deficient Knowledge: Absence or deficiency of cognitive information related to a specific topic.

May be related to

  • Lack of exposure/recall or misinterpretation of information.
  • Unfamiliarity with information resources.

Possibly evidenced by

  • Request for information.
  • Statement of misconception.
  • Inaccurate follow-through of instructions.
  • Development of preventable events/complications

Desired Outcomes

  • Patient will participate in the learning process.
  • Patient will verbalize accurate information about the reproductive system.
  • Patient will explain the proper use of desired contraceptive methods.
  • Patient will demonstrate appropriate follow-through with treatment and aftercare.
  • Patient will receive Rho(D) immune globulin within 72 hr of termination, if appropriate.
  • Patient will verbalize the implications of the Rh factor for planning future pregnancies or for receiving blood transfusions.
Nursing InterventionsRationale
Assess level of client knowledge, and provide information about reproduction. Use charts and diagrams.Knowledge is essential to prevent future unplanned pregnancies. Written and visual materials are more clear, concrete and can be easily understood.
Discuss alternative methods of contraception.To provide the client the ability to choose the best contraception for her. Ovulation may occur
before menses resume, so contraception needs to be
considered at this time.
Give specific written instructions about the contraceptive chosen.Client may have a method of contraception prescribed before discharge. Because of the anxiety
and stress associated with the termination, verbal
information may not be retained.
Reinforce postabortion instructions concerning the use of tampons and resumption of sexual activity, exercise, and prescribed antibiotics,if applicable. Provide written instructions.The stress/anxiety caused by the procedure can decrease the client’s ability to process and retain information. Written instructions can be reviewed when necessary.
Identify signs/symptoms to be reported to the healthcare provider.Prompt evaluation/intervention may prevent or limit complications.
Provide information about the implications of Rho (D)-negative blood and the need for Rh IgG administration.The client may not be aware of her blood type or the implications for future pregnancies if she is Rho(D)-negative. Understanding may promote positive self-care, enhance cooperation, and help prepare the client for future pregnancies.
Verify Rh-negative status and administer RhIgG. Give 50 mg for early abortion; otherwise, dosage is the same as for delivery or fetal hemorrhage in the nonsensitized client.For the Rho(D)-negative client, RhIgG prevents anti-Rh-positive antibody formation, so that negative effects on future pregnancies are avoided. Microdoses are given for early abortions, and this dose is sufficient up to 12 weeks’ gestation. Fetal RBCs may be noted as early as 38 days after conception.

Risk for Spiritual Distress

Risk for Spiritual Distress: At risk for an impaired ability to experience and integrate meaning and purpose in life through a person’s connectedness with self, other persons, art, music, literature, nature, and a power greater than oneself.

Risk factors

  • Perception of moral/ethical implications of therapy.

Possibly evidenced by

  • [not applicable].

Desired Outcomes

  • Patient will discuss beliefs/values about spiritual issues.
  • Patient will verbalize acceptance of self/decision.
  • Patient will identify and use resources appropriately.
Nursing InterventionsRationale
Assist with problem-solving within the client’s ethical and religious beliefsThe ability to project the consequences of a decision or to explore alternatives may be hinder by anxiety and emotion.
Support the client’s decision.Client may have few if any, support systems available at this time and may need a nonjudgmental resource.
Note comments indicating feelings of guilt, negative self-concept/self-esteem, and ethical or religious value conflicts.There may be a conflict with family/significant other(s) regarding the morality of the client’s decision, which can create confusion for the client.
Discuss alternatives to abortion with the client and significant other(s), if present. Maintain nonjudgmental attitude.A decision based on a rational choice is less likely to result in conflict.
Explain the grief response that may occur.The client may not expect to feel the loss.
Stress the importance of follow-up visits.There may be delayed psychological reactions, which can be assessed at the follow-up visit along with the
physical status.
Refer to clergy/spiritual advisor, or professional counseling.Some clients may need additional counseling before and after abortion to help them resolve feelings of conflict or guilt.

Risk For Decisional Conflict

Risk for Decisional Conflict: At risk for uncertainty about the course of action to be taken when choice among competing actions involves risk, loss, or challenge to personal life values.

Risk factors

  • Unclear personal values/beliefs.
  • Lack of experience or interference with decision making.
  • Lack of relevant sources of information or information from multiple or divergent sources.
  • Support system deficit.

Possibly evidenced by

  • [not applicable]

Desired Outcomes

  • Patient will acknowledge feelings of anxiety/distress related to making difficult decision.
  • Patient will verbalize confidence in the decision to terminate the pregnancy.
  • Patient will meet psychological needs as evidenced by appropriate expression of feelings, identification of options, and use of resources.
  • Patient will display relaxed manner and/or calm demeanor, free of physical signs of distress.
Nursing InterventionsRationale
Ascertain circumstances of conception and response of family/significant other. Encourage client to talk about the issues and process used to problem-solve and make decisions regarding termination.Allows the nurse to determine whether the client/couple has explored alternatives. The decision to terminate a pregnancy may have been based on an inability to problem-solve or a lack of support and resources.
Evaluate the influence of family and significant other(s) on the client.Conflict can arise within the client herself as well as within the family. Allows the nurse to encourage positive forces or provide support where it is lacking.
Provide explanations about the procedure desired by the client, pre-procedural and post-procedural tests, examinations, and follow-up.Lack of knowledge about the procedures, reproduction, or self-care may contribute to the client’s/family’s inability to cope positively with this event, which may be behaviorally manifested by the client canceling appointments or verbalizing ambivalence. By eliminating fear of the unknown and by reinforcing reasons for and appropriateness of
The decision, ongoing verbalization can foster positive decision making.
Note expressions of indecision and dependence on others.May indicate ambivalence about decision and need for further information and discussion.
Assist client to look at alternatives and use a problem-solving process to validate the decision. Involve significant others as appropriate.Helps client to reinforce reasons for decision and to be comfortable that this is the course she wants
Act as a liaison and lend support to significant other(s).Helps reduce stress and encourages significant other(s) to be supportive of the client.
Provide positive feedback for efforts and progress noted.To promote continuation of efforts.
Remain with the client during examinations and the procedure. Provide both physical and emotional support.Physical presence of nurse can help client feel accepted and reduce stress.
Obtain/review informed consent.Depends on agency guidelines. No procedure should be performed unless the client freely consents to it.
Review safe options available based on gestation.Assists client in making an informed decision.
Refer for additional counseling or resources, if needed.Some clients may be more affected by the decision and may require additional support and/or education or genetic counseling.

Risk For Maternal Injury

Risk for Injury: Vulnerable for injury as a result of environmental conditions interacting with the individual’s adaptive and defensive resources, which may compromise health.

Risk factors

Possibly evidenced by

  • [not applicable].

Desired Outcomes

  • Patient will recognize and report signs/symptoms of complications.
  • Patient will institute appropriate corrective measures.
Nursing InterventionsRationale
Monitor vital signs, noting increased pulse rate, severe headache, or flushed face.Changes in vital signs such as (decrease blood pressure, increase heart rate, increase respiratory rate) indicate a late sign of hypovolemic shock from blood loss.
Note dyspnea, wheezing, or agitation.Prostaglandins may cause vasoconstriction or bronchial constriction.
Evaluate the level of discomfort.Abdominal pain, tenderness, and severe cramping may indicate retained tissue or uterine perforation.
Monitor and assess blood loss. Count and weigh or estimate peri pads.Bleeding is normally like a heavy menstrual period. Excessive loss (more than 1 large pad per hour for 4 hr) may indicate retained tissue or uterine
perforation
Instruct client to report symptoms indicating complications (e.g., temperature 100.4° F (40.0°C) or greater, chills, malaise, abdominal pain or tenderness, severe bleeding, heavy flow with clots, foul-smelling and/or greenish vaginal discharge).Clients are in the healthcare facility for a short time. Complications, including bleeding and infection, may be manifested days or weeks after the procedure.
Stress importance of returning for a follow-up examination.Follow-up is necessary to assess healing. A repeat pregnancy test is sometimes done after early first- trimester procedures to assure procedure was complete.
Provide a contact person in case of emergency.Providing a contact reduces the feelings of fear and anxiety.
Determine cervical status before the procedure. Assist as needed with the insertion of Laminaria tent or prostaglandin (lamicel) gel.These are inserted 24–48 hr before procedure in order soften the cervix;
Assist with/review results of ultrasonography before the procedure as indicated.Helps in confirming gestational age and the size of products of conception.
Assist with any additional treatment or procedures necessary to control complications.IV therapy may need to be instituted, with or without the administration of oxytocin. Additional surgery (D & C or
hysterectomy) may be needed to control bleeding as indicated.

See Also

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