Primary Nursing Diagnosis

Anticipatory grieving related to fetal loss OUTCOMES. Grief resolution

INTERVENTIONS. Grief work facilitation: Perinatal death; Active listening; Presence; Truth telling; Support group

H PLANNING AND IMPLEMENTATION Collaborative

The treatment involves inducing labor to deliver the fetus. The timing of the delivery varies. A 48-hour wait is recommended to give the patient time to gather support from her family and to fathom the reality of the situation. Other patients may prefer to let the labor start on its own, but this could take weeks. The danger with this conservative treatment is that the necrotic fetus can lead to either DIC or infection, or both, in the mother. A cesarean section is rarely done, unless the maternal condition necessitates an immediate delivery.

Induction of labor is often a 2-day process. Insertion of a Laminaria tent into the endocervi-cal canal dilates the cervix. If necessary, the Laminaria can be held in place by a tampon. The risk of infection in the presence of a dead fetus needs to be considered. Prostaglandin E2 gel or 20-mg suppositories are alternatives to Laminaria. By the second day, the cervix is usually ripe and an oxytocic induction of labor can begin. When infusing oxytocin, assess often for resting tone, as uterine rupture caused by hyperstimulation can occur. Labor contractions are very uncomfortable for the patient. Liberal dosages of analgesia or anesthesia may be given if the patient desires because their effects on the fetus do not need to be considered. Intravenous narcotics, an epidural, and sedatives may be ordered for relief of pain and anxiety.

If the patient has an epidural, turn her from side to side hourly to ensure an adequate distribution of anesthesia. Patients have limited mobility and require assistance in turning and positioning comfortably. Use pillows to support the back and abdomen and between the knees to maintain alignment. Check the blood pressure and pulse every 30 minutes. Most patients are unable to void and require a straight catheterization every 2 to 3 hours to keep the bladder empty. Maintain the infusion of intravenous fluids to prevent hypotension, which can result from regional anesthesia. Monitor the patient's pain relief and notify the nurse anesthetist or physician if the patient is uncomfortable.

Dealing With Sorrow

Dealing With Sorrow

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