Perinatal loss

a,c,d (Rationale A private room allows the parents privacy to grieve.​ However, a room too close to crying babies may increase the distress or anxiety of the family going through the loss. Encourage the couple to ask questions and give them time to discuss the options. The family should be given some time to process their grief before interventions or asking the mother about birthing preferences. Birthing preferences may include lighting and music. Assisting with access to support systems will support the family through the grieving process of their loss.)

A client and her husband are preparing for the delivery of their son. The client was diagnosed with an intrauterine fetal demise earlier in the day and was admitted for induction of labor and delivery. Which interventions would be appropriate for this​ couple? ​(Select all that​ apply.) a Provide access to support systems within the hospital to help them manage their grief. b Immediately start the interventions for the induction of labor. c Encourage the couple to ask questions. d Ask the mother what sort of music and lighting she wants. e Secure a private room near the nursery so the couple will not be so sad with other babies around.

b,c,d,e (Rationale The symptoms of​ spotting, cramping, no fetal movement or change in fetal​ activity, and/or severe back pain may indicate a situation that may lead to serious complications​ and/or fetal death. A headache is a symptom to​ monitor, but unless it is​ severe, suggesting​ preeclampsia, it alone is not a symptom to be extremely concerned about)

A client that is 28 weeks pregnant calls the office with some concerns. The OB nurse takes the call and asks what symptoms she is having. What symptoms would indicate that the client requires an examination by the healthcare​ professional? ​(Select all that​ apply.) a Headache b No fetal movement c Severe back pain d Spotting e Cramping

a,b,e (Rationale ​Diabetes, thyroid​ disease, and infection are medical conditions that may contribute to perinatal loss. Anemia is a common condition in pregnancy and is not related to perinatal loss. Rh negative blood type is not a factor in perinatal loss by itself.)

A nurse educator is conducting a review session with nursing students taking a​ maternal-newborn course. The educator asks the class to discuss the risk factors associated with fetal demise and perinatal loss. Which responses by the students indicate appropriate understanding of this​ topic? ​(Select all that​ apply.) a Thyroid disease b Infection c Anemia d Rh negative e Diabetes

d (The client is sharing her feelings of guilt. After a perinatal​ loss, mothers feel that an action that they have​ done, or something their body​ did, was the cause of their​ infant's death.​ Anger, denial, and betrayal may be other emotions that are experienced during the grieving process.)

A nurse is caring for​ 32-year-old client,​ Clara, and her​ husband, following the loss of her​ 35-week fetus. Clara is​ crying, and says​ "I should not have gone out in the boat while I was pregnant. That is why my baby​ died." Which emotion is Clara​ sharing? a Denial b Betrayal c Anger d Guilt

a (Rationale A​ two-vessel cord is considered an umbilical cord abnormality and increases the risk for a perinatal loss. A placental abruption is a condition where the placenta separates from the uterus. This is a condition of the placenta. A congenital anomaly involves a malformation that develops on the​ fetus, not the cord. A​ two-vessel cord is not a result from a trauma. Traumas include falls or accidents.)

A nurse is reviewing the report from a client who just received her​ 20-week ultrasound. The ultrasound report noted a​ two-vessel cord and recommended​ follow-up ultrasounds to follow the fetal growth every 4 weeks until delivery. Based on these​ results, which condition is this client at risk for that may increase the risk of fetal demise and perinatal​ loss? a Umbilical cord abnormality b Trauma c Placental abruption d Congenital malformation

b (Rationale: Risk factors for perinatal loss include age, health conditions, and previous instances of perinatal loss. Increased age at the time of conception, particularly for women 40 or older, can increase the risk for complications during pregnancy. Past instances of multiple complications in gestations put a woman at higher risk. Conditions such as gestational diabetes increase the risk for fetal loss. The use of drugs, alcohol, or tobacco increases the risk for complications during pregnancy and significantly increases the risk for fetal loss.)

A nurse is teaching a class to expecting parents. The nurse discusses the risk factors associated with perinatal loss, including all except: a Previous multiple complications of gestation. b Maternal age over 35. c Gestational diabetes d The use of drugs, alcohol, or tobacco.

a,b,e (Rationale: Once the premature infant has died, the parents should be placed in a room with a rocking chair so they can hold the baby. Many hospitals provide a "memory" box for the family that has a lock of hair, footprints, and so on. Giving the family the number of a local support group provides them with contact with others facing the same issues. Relatives should not be encouraged to visit until the parents are ready and have had their own private time with the baby. The nurse would answer all questions about the infant's appearance because the infant belongs to the parents, not the hospital. )

A premature infant has died. What interventions performed by the nurse aides in assisting the parents in dealing with their loss? (Select all that apply.) a Ask if they would like a lock of the infant's hair. b Provide a quiet, enclosed area to visit as long as necessary. c Ensure that all relatives are present to acknowledge the loss. d Decline questions about the infant's appearance. e Provide parents with the phone number of local support groups.

c (Rationale An intrauterine fetal death is usually diagnosed with ultrasound that shows the absence of fetal heart activity. The nurse would not anticipate an order for an emergency​ cesarean-section delivery if fetal death has not yet been diagnosed. Fetal death is not confirmed by CT scanning. Pregnancy testing is not used in the diagnosis of fetal death.)

The nurse is providing care for a client who may be experiencing a fetal demise. Which order does the nurse anticipate for this​ client? a CT scan b Pregnancy test c Ultrasound d Emergency cesarean section

c (Perinatal loss can occur for a variety of reasons including​ infection, preeclampsia,​ diabetes, thyroid​ disorders, placenta​ previa, placental​ abruption, trauma, congenital​ malformations, alloimmunizations, and asphyxia. The cause may also be unknown. Previous use of oral​ contraceptives, postterm​ pregnancy, and age of 25 are not risk factors for perinatal loss.)

You are caring for Mrs.​ Johnson, a​ 25-year-old client who just delivered a stillborn infant. While reviewing her medical record and documenting your​ nurse's notes, you review that the client arrived to the hospital with a large amount of vaginal bleeding. Which risk factor in the​ client's history may have caused the event to​ occur? a Age of 25 b Previous use of oral contraceptives c Placental abruption d Postterm pregnancy

d (Rationale: Perinatal loss is the death of an infant or fetus at any time from the point of conception to 28 days after birth. In the past, some have proposed that perinatal loss results in less intense grief because the parents and family have not had time to form a close bond with the infant; this theory has since been proven incorrect. In fact, the grief associated with the loss of a child can be more intense than most other losses. If the fetus is lost during the first 20 weeks of gestation, it is referred to as a miscarriage or a spontaneous abortion. This is a significant loss for the mother and should not be discounted for any reason. )

The nurse is caring for a client experiencing perinatal loss whose baby was delivered stillborn. The nurse understands that perinatal loss is not: a Referred to as a miscarriage or a spontaneous abortion if it occurs prior to 20 weeks gestation. b A significant loss for the mother. c The death of an infant or fetus at any time from the point of conception to 28 days after birth. d Less intense grief because the parents and family have not had time to form a close bond with the infant.

a (Rationale Disenfranchised grief occurs when the person feels marginalized or forgotten by support persons or society. Perinatal loss is not usually recognized by society. Bittersweet grief occurs in response to memories that linger after the loss. The person may have processed the​ loss, but at certain times the feelings of grief may return. Anticipatory grieving occurs when there is foreknowledge of an impending loss. Dysfunctional grieving manifests as prolonged or exaggerated grief.)

The nurse is caring for a client who experienced a miscarriage at 17 weeks gestation. Which type of grief will the nurse assess this client for during the​ 2-week follow-up​ visit? a Disenfranchised b Anticipatory c Bittersweet d Dysfunctional

c (Rationale: Viewing and holding the baby has several benefits: It assists in dispelling denial so the family can progress with grieving; it allows the family to bond with the infant; and the parents can see that the baby did exist and obtain closure now that the infant has died. Many parents imagine the worst and seeing the infant can dispel fears about the child's appearance. The move to another unit should be at the family's discretion, remembering that the obstetrical staff is better prepared to meet the family's needs. Telling the parents they can have another baby is negating the baby that died. The family should not be left alone unless it is their request. )

The nurse is caring for a mother who has just delivered a stillborn infant. Which intervention would the nurse initiate for the family? a Move the mother to a medical-surgical floor. b Tell the family they can have another baby soon. c Encourage the family to view and hold the baby. d Leave the family alone to start the grieving process.

c (Rationale: The nurse would inquire about the client's support systems and refer the client as needed, as a strong support system is extremely important in helping a client through the grieving process. Social isolation will intensify grief because the client cannot talk about feelings. Triggers of grief are everywhere and will abate as the grieving is resolved. A client who is grieving has acknowledged the loss. )

The nurse is caring for a mother whose premature infant died. Which factor would the nurse inquire about when planning care for the mother's grief? a Social isolation b Triggers of grief c Support systems d Loss acknowledgment

d (Rationale: The mother who does not understand why the fetus died may be in denial and is also feeling like the baby's death was out of her control. The nurse makes certain that all the relevant information is given to the parents as to why the baby died. The goal is to help the family gain back some control of the situation. Denial is normal but is not related to powerlessness. A sense of powerlessness may cause some mothers to blame the doctor. The mother who asks for spiritual guidance is not demonstrating powerlessness. )

The nurse is caring for a woman who had a miscarriage. The nurse selects powerlessness as a nursing diagnosis based on what manifestation? a The mother denies that she is no longer pregnant. b The mother does not blame the doctor. c The mother asks to talk to her spiritual advisor. d The mother is having trouble understanding what happened.

c (Rationale Telling the grieving parents that the chaplain will not bless the baby because it would have been unable to survive outside of the womb is an inaccurate statement. The hospital chaplain is trained to provide comfort to the parents during the grieving process and will bless the baby if asked to do so. All the other statements reflect appropriate understanding regarding perinatal loss and bereavement.)

The nurse is caring for a​ 42-year-old client and her husband who experienced a intrauterine fetal demise at 21 weeks​' gestation. They are holding the​ baby, wrapped in a baby​ blanket, and the husband states that they would like to have the baby blessed. What response indicates that the nurse requires further education in perinatal​ loss? a "If it is okay with​ you, I would like to take some photos of the blessing for the memory book of your ​child? " b "We have holy water in our perinatal loss bereavement​ kit, would that be something you would want to be used in the ​blessing? " c "Our chaplain will not bless a baby unless it could have survived outside of the womb when born. " d "Let me get the operator to call hospital chaplain for this request. "

a (Rationale Perinatal loss can occur for a variety of reasons. These​ include, but are not limited​ to, infection,​ preeclampsia, diabetes, thyroid​ disorders, placenta​ previa, placental​ abruption, trauma, and congenital malformations. A maternal age of less than 15 is a risk factor for perinatal loss.​ However, maternal age of less than 20 is not. African American women are more likely to have a stillbirth than Caucasian women. Anteversion or retroversion of the uterus is not a risk factor that increases the occurrence of perinatal loss.)

The nurse is conducting a seminar on perinatal loss for healthcare providers on​ maternal-newborn unit. Which risk factor is appropriate for the nurse to include in the educational​ session? a Placental abruption b Retroverted uterus c Pregnancy age of less than 20 d Caucasian race

b (Rationale The nurse should prepare the parents of a stillborn infant for the way the baby may appear. This includes maceration and discoloration of the skin. The nurse does not place a time limitation on the visit. The viewing of the infant is not videotaped. The newborn​'s hands are not taped together prior to viewing by the parents.)

The nurse is preparing a stillborn infant for the parents​' viewing. Prior to this​ viewing, what should the nurse discuss with the​ parents? a The need for taping the hands together b Appearance of the newborn c Need to videotape the visit d Time limitations for visit

d (Rationale Many hospitals have bereavement protocols when providing care to parents who have experienced a perinatal loss. It is important for the nurse to ask the parents what they would like included in their bereavement package and whether they would like to have it at discharge or they would like the hospital to keep it until they are ready to receive the package. The nurse would not contact the hospital chaplain without asking the parents first. The nurse should not discourage the parents from holding their infant after the delivery based on their documented religious affiliation. The nurse would ask the parents what they would like to do first. It is not appropriate to refer the parents to the healthcare provider to determine their needs. This is a nursing responsibility.)

The nurse is providing care for a couple who experienced a fetal demise of their baby at 31 weeks​' gestation. Which action by the nurse is most appropriate when providing culturally competent care to this​ family? a Contacting the hospital chaplain to talk with the parents b Discouraging the parents from holding their infant due to their noted religious affiliation c Referring the parents to the healthcare provider to determine their needs d Asking the parents what they would like to include in the bereavement package

b (Rationale The nurse would recommend that the client attend a group therapy session. Group therapy can allow the parents to discuss feelings with other families who have experienced the same loss. Massage therapy is not an appropriate recommendation for a client who has experienced a perinatal loss. Antidepressant and hormone therapy may be used to treat postpartum depression that can occur after a perinatal loss.)

The nurse is providing care to a client who experienced a perinatal loss 4 weeks ago. The client is tearful and still grieving the loss of her child. Which nonpharmacologic therapy can the nurse recommend to this​ client? a Antidepressant therapy b Group therapy c Massage therapy d Hormone therapy

b (Rationale The history of a single miscarriage does not impact future pregnancies. The client has carried one pregnancy to​ term, and is not considered to be at a higher risk or lower risk for future pregnancies. This client is not at risk for infection with no other risk factors in her medical history.)

The nurse is reviewing the medical history of a​ 34-year-old client who is coming to the office for the first prenatal visit at 8 weeks. The nurse notes that this is the client​'s third pregnancy with 1 term birth at 39 weeks and a miscarriage at 8 weeks. Which conclusion does the nurse formulate after reviewing the medical history for this​ client? a Has an increased risk for infection b Has no impact on future pregnancies c Decreased risk for a miscarriage d Increased risk for a miscarriage

b (Rationale: The nurse recognizes that the parents will grieve the loss of one infant, but will encourage bonding with the surviving infant. The parents are facing an unusual situation and the priority of nursing is to help them bond with the survivor. The parents need to grieve the loss of the baby in order to bond with the live baby. If the parents state that they have one infant without suggestion of a grieving process, they are probably in denial. The expectation is that the parents will visit the living baby daily. )

The nurse is working with a family who had premature twins, one of whom has died. Which outcome of care will the nurse set as a goal for this family? a The parents will not grieve for the dead infant. b The parents will bond with the remaining infant. c The parents will visit the surviving infant once a week. d The parents will state that they have one live child.

b (Rationale: The nurse teaches mothers to eat foods rich in folic acid as low folic acid levels are associated with fetal neural tube defects, which can cause perinatal loss. Second pregnancy, blood compatibility, and delivery at 38 weeks are not associated with perinatal loss. )

The nurse who is preparing a class to assist expectant parents in having a healthy baby should include which of the following as a risk factor associated with perinatal loss? a Second pregnancy b Neural tube defects c Blood compatibility of mother and baby d Delivery at 38 weeks

d (An intrauterine fetal demise is usually diagnosed with ultrasound that shows the absence of fetal heart activity.​ However, the woman may initially report with complaints of absent fetal movement. Once the diagnosis has been​ made, the woman will be scheduled for an induction of labor. The nurse would not anticipate the need for​ oxygen, a surgical​ consult, or a beta hCG test.)

You are caring for​ Susan, a​ 40-year-old client who is 38 weeks pregnant. Susan reported to the hospital with complaints of decreased fetal movement. After an​ ultrasound, it is determined that Susan has experienced a fetal demise. Which order is anticipated for​ Susan's continued​ care? a Oxygen b Surgical consult c Beta hCG test d Induction of labor

a

Which assessment is a priority for a client who suffers a perinatal loss who is diagnosed with postpartum​ depression? a Suicidal thoughts b Anxiety c Fatigue d Change in appetite

b,c,e (A woman experiencing fetal demise is at risk for developing serious complications. These include disseminated intravascular​ coagulation, infection or sepsis. The nurse does not anticipate​ complications, such as uterine rupture or​ glycosuria, as a result of fetal demise.)

Which maternal complications may result from intrauterine fetal demise ​(Select all that​ apply.) a Glycosuria b Infection c Sepsis d Uterine rupture e Disseminated intravascular coagulation

a,b,d,e (Rh​ incompatibility, diabetes, thyroid​ disease, or infectious disease processes may contribute to a perinatal loss and are detectable in maternal blood work. Cystic fibrosis is an autorecessive genetic disorder that can be tested for in​ pregnancy, but does not contribute to perinatal loss.)

Which maternal disease processes detected by blood tests can contribute to a perinatal​ loss? ​(Select all that​ apply.) a Rh incompatibility b Diabetes c Cystic fibrosis d Thyroid disease e Infectious disease

a (Antidepressants and hormone therapy are the two choices of pharmacologic therapy used for postpartum depression that can occur after a perinatal loss. Antibiotics would be used for a client that had an infection. IV therapy and a blood transfusion are not appropriate treatment methods for postpartum depression related to perinatal loss.)

Which pharmacologic therapy may be indicated for a client diagnosed with postpartum depression following a perinatal​ loss? a Hormone therapy b Antibiotics c Blood transfusion d IV fluids

a,c,d (A pregnant client may experience severe back​ pain, vaginal​ spotting, and/or a change in fetal movement if she is going through a perinatal loss. Chest pain and dysuria​ (pain with​ urination) are not symptoms associated with perinatal loss.)

Which physical clinical manifestations may occur for the client who experiences a fetal​ demise? ​(Select all that​ apply.) a Change in fetal movement b Chest pain c Severe back pain d Vaginal spotting e Dysuria

c (A loss of a fetus prior to 20 weeks​' gestation is referred to as a spontaneous abortion or a miscarriage. A stillbirth or fetal demise is the loss of an infant after 20 weeks. A therapeutic abortion refers to an abortion necessary for medical indications.)

Which term reflects the loss of a fetus during the first 20 weeks of​ gestation? a Stillbirth b Therapeutic abortion c Spontaneous abortion d Fetal demise