Exemplar 27.4 Perinatal Loss
A client of Native American descent comes to the hospital in early labor at 23 weeks' gestation. The client's parents, sisters, and brothers are with her as well as her husband. The client's family insists on remaining with her during labor. Hospital policy, however, limits visitors to two. Which action is most appropriate for the nurse to take in this situation? A) Ask the parents of the baby what their needs are regarding the family request. B) Call security to escort the family out of the hospital. C) Speak with the nurse manager about supporting the family's wishes. D) Show the family to the waiting room.
A) The mother and the baby's father may be acculturated to contemporary American life enough that they might not want the extended family in attendance even though they know this is traditional. Before confronting the family by asking them to leave or calling security, the parents of the baby are consulted first. If the parents agree to the extra visitors, then seeking the assistance of the manager is inappropriate.
A client with severe right-sided abdominal pain is experiencing a miscarriage. Which nursing diagnosis is most appropriate for this client? A) Anxiety B) Grieving C) Interrupted Family Processes D) Ineffective Coping
B) A pregnant mother, no matter how early, sees the fetus as a baby and can be expected to grieve the loss. Because the mother has already lost the fetus, Anxiety is not the primary diagnosis. Until the nurse is able to assess the mother's grief process, Ineffective Coping and Interrupted Family Processes are not the priority diagnoses.
The antepartum nurse is caring for parents who have lost their baby at 20 weeks' gestation. Which intervention is most appropriate for the nurse to implement with this family? A) Calling social services to help with burial plans B) Explaining the causative factor of the fetal loss C) Telling the parents they can have another baby D) Obtaining an order for counseling for the parents
B) Explaining the causative factor for the fetal loss assists families in progressing through the grieving process. Counseling would be appropriate if the parents are in complicated grieving. Offering to help with burial plans is not the immediate need, but will be appreciated at a later time. Telling the parents they can have another baby is demonstrating that the nurse does not understand the nature of the loss.
A nurse is caring for a client who just found out she has had a miscarriage. The nurse understands that the client will likely grieve over the loss. What is true regarding perinatal loss grieving? A) The grief experienced by fathers after perinatal loss appears similarly to the grief experienced by mothers after perinatal loss. B) Postpartum depression may occur in women who have experienced perinatal loss. C) Grief is typically less severe when the perinatal loss occurs before 20 weeks' gestation. D) Perinatal loss refers only to emotional changes that occur after perinatal loss.
B) Postpartum depression may occur in women who have experienced perinatal loss. The grief experienced by fathers after perinatal loss appears differently than the grief experienced by mothers after perinatal loss. Grief can be mild to severe after perinatal loss, regardless of when the loss occurs. Perinatal loss refers to the physical and emotional changes that occur after perinatal loss.
The nurse is caring for a 40-year-old client who just had amniocentesis and was told that the fetus has Down syndrome. What is an appropriate outcome goal for this client? A) To complete the work of grieving during the hospital stay B) To begin the process of grieving the loss of a normal baby C) To accept the upcoming birth of a baby with special needs D) To consider the possibility of a therapeutic abortion
B) When it is known that the fetus is not as expected, the mother and family will grieve the loss of the perfect baby that they imagined in order to come to accept what is the reality. The work of grief for the loss of the normal infant encompasses the same process as grieving for a death and cannot be accomplished in a few days. The family, hopefully, will accept the upcoming child upon completion of the grieving process. The mother could opt for a therapeutic abortion, but the priority goal is beginning the work of grief.
A primigravida is hospitalized at 32 weeks' gestation after a second hemorrhage from a complete placenta previa. The client delivers a stillborn infant 1 week later. Which intervention should the nurse perform to help this family in the grieving process? A) Remove all baby supplies from the mother's room. B) Refrain from talking about the baby. C) Facilitate and support the family viewing and holding the infant. D) Ask to have the mother moved off the postpartum floor.
C) Advocates of seeing the stillborn believe that viewing assists in dispelling denial and allows the couple to take the next step in the grieving process. If the baby was normally formed, it assists the mother to feel less of a failure. The mother should be consulted before moving her off the postpartum unit. Removing baby supplies might assist in the denial process, as will not talking about the baby.
An obstetric nurse is reviewing risk factors for prenatal loss with a group of clients. Which clients are at a high risk for prenatal loss? Select all that apply. A) The woman who drinks one cup of coffee every morning B) The woman recovering from a gastrointestinal virus C) The unmarried 14-year-old woman living in the city D) The woman who lives in a rural area E) The woman who had a healthy baby 6 months ago resulting from a healthy pregnancy
C, D, E) The woman who delivered a baby only 6 months ago is at higher risk because her body has not had time to fully recover from the previous birth. Adolescents under age 15 are at higher risk, and those living in rural areas where there may be limited access to healthcare providers also face greater challenges. A gastrointestinal virus will not negatively impact the pregnancy, and those in urban areas have better access to healthcare. One cup of coffee is not excessive intake of caffeine.
The nurse is caring for an adolescent client who has just learned she is pregnant. In order to decrease the risk of perinatal loss with this client, the nurse wants to assess the client for specific risk factors. What information will the nurse want to question specifically for the adolescent who was just informed she is pregnant? A) "Please tell me about your dietary habits." B) "When was your last menstrual period?" C) "Is this your first pregnancy?" D) "Do you use any substances such as drugs, alcohol, or tobacco products?"
D) Although all pregnant women will be questioned about substance abuse, the nurse will be especially interested in asking an adolescent client about it. Adolescents have a higher rate of substance abuse, and the use of drugs, alcohol, and tobacco can have a negative impact on the outcome of the fetus. All pregnant women will be asked about last menstrual period, diet, and reproductive history. Last menstrual period is of less importance with the young adolescent, whose periods tend to be irregular and cannot be counted on to indicate due date.
The nurse is caring for a premature baby who was born at 28 weeks' gestation. The baby's parents tell a visiting family member, "we'll be ready to bring the baby home in a few weeks." Which is the most therapeutic response by the nurse in this situation? A) "A therapist could help you resolve your feelings of denial." B) "I'm glad he's doing so well." C) "Do you have the nursery ready yet?" D) "Although your baby is doing quite well, he probably won't be ready to come home for a few months."
D) Families are often in the stage of denial with the birth of a premature newborn. It is important for nurses to gently encourage the parents to be realistic. By agreeing with the parent's statement, the nurse is prolonging the state of denial and making it more difficult for the parents to see the situation realistically. Some parents do benefit from professional counseling, but nurses still need to provide support when working with families. It is not important if the nursery is ready yet, and asking this question distracts from the real issues this family is facing at this time.
A nurse working in labor and delivery is planning care for a client who is arriving to the unit from a local obstetrician's office with a suspected perinatal loss. What nursing implementation is best for this client and the client's family? A) Place the client in a room closest to the nurse's station to closely observe the client. B) Call the hospital chaplain to ensure the chaplain can be in the client's room when the client arrives. C) Call the local funeral home and notify them of the client's situation. D) Place the client in the room furthest from the other clients.
D) When planning care for a client with a suspected perinatal loss, the nurse should place the client in the room furthest from the clients to provide for privacy. The other options are inappropriate and are not sensitive to the client's emotions.