Premature Dilation of the Cervix

Premature Dilation of the Cervix -...

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Premature Dilation of the Cervix  (Incompetent/Dysfunctional Cervix) Premature dilation of the cervix often occurs in the 4th or 5th mo and is associated with repeated second-trimester  spontaneous abortions accounting for 15%–20% of second-trimester pregnancy losses. CLIENT ASSESSMENT DATA BASE Ego Integrity Feelings of failure at a life event; expressions of shame/guilt Expressions/manifestations of anxiety and/or fear Elimination Urinary frequency/urgency Pain/Discomfort Absence of pain, although lower abdominal pressure may be noted Safety May present with premature rupture of membranes (PROM) during second trimester Sexuality History of repeated, relatively painless, bloodless, second-trimester fetal loss (habitual spontaneous aborter). Premature shortening, effacement, and dilation of cervix during current pregnancy. elective), or cervical lacerations. Sterile vaginal examination reveals dilation, cervical effacement. Membranes may be felt or seen protruding though cervical os. Social Interaction Concern about response of others; report of conflicted relationship with mother (e.g., especially if she used  diethylstilbestrol [DES]). Teaching/Learning Reported previous occurrence of spontaneous abortion Family history of DES use by mother DIAGNOSTIC STUDIES Diagnosis is usually made on basis of history of repeated second-trimester abortions. Serial Ultrasonography:  Beginning at 6–8 weeks’ gestation can detect cervical shortening and premature dilation and  aid in diagnosis, especially in women without clear-cut history of cervical dysfunction. Nitrazine and/or Fern Test:  Detects presence of amniotic fluid, indicating ruptured membranes. NURSING PRIORITIES 1. Evaluate client/fetal status. 2. Assist with efforts to maintain the pregnancy, if possible. 3. Provide emotional support. 4. Provide appropriate instruction/information.
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DISCHARGE GOALS 1. Client/fetal condition stable following procedure 2. Uterine contractions absent 3. Therapeutic needs and concerns understood NURSING DIAGNOSIS: Anxiety [specify level] May Be Related To: Situational crisis, threat of death/fetal loss Possibly Evidenced By: Increased tension, apprehension, feelings of inadequacy, sympathetic  stimulation, and repetitive questioning DESIRED OUTCOMES/EVALUATION  Verbalize fears and concerns. CRITERIA—CLIENT/COUPLE WILL: Report anxiety is reduced to a manageable level. Use  individually appropriate coping mechanisms  to deal with the short- and long-term outcomes of the situation.
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