Unit 4 Infertility and Spontaneous Abortion

imminent/inevitable miscarriage

mod-->heavy bleeding + cramping open cervix

hysterosalpingography

x-ray imaging of the uterus and fallopian tubes after injection of contrast material -assesses flow thru uterus and tubes -shows size and shape of uterus

The nurse is caring for a 26-yr-old patient who is being discharged after an induced abortion. Which statement should the nurse include in discharge teaching? 1. "Avoid sexual intercourse for 2 weeks." 2. "Heavy bleeding is expected for 24 hours." 3. "A temperature of 101oF (38.9oC) is normal" 4. "Birth control pills should not be taken for 30 days."

1 After an abortion, teach the patient to avoid intercourse for 2 weeks. Contraception can be started the day of the procedure. Symptoms of possible complications include a fever and abnormal vaginal bleeding. These symptoms should be reported immediately.

The nurse is reviewing the record of a pregnant client seen in the health care clinic for the first prenatal visit. Which data, if noted on the client's record, should alert the nurse that the client is at risk for a spontaneous abortion? 1.Age 35 years 2.History of syphilis 3.History of genital herpes 4.History of diabetes mellitus

2 Maternal infections such as syphilis, toxoplasmosis, and rubella are causes of spontaneous abortion. There is no evidence that genital herpes is a causative agent in abortion, although the presence of active lesions at the time of birth presents concerns. Maternal age greater than 40 years and diabetes mellitus are considered high-risk factors in a pregnancy but are related to an increased risk of congenital malformations, not abortions.

A woman inquires about herbal alternative methods for improving fertility. Which statement by the nurse is the most appropriate when instructing the woman in which herbal preparations to avoid while trying to conceive? 1. "You should avoid nettle leaf, dong quai, and vitamin E while you are trying to get pregnant." 2. "You may want to avoid licorice root, lavender, fennel, sage, and thyme while you are trying to conceive." 3. "You should not take anything with vitamin E, calcium, or magnesium. They will make you infertile." 4."Herbs have no bearing on fertility."

2 Nettle leaf, dong quai, and vitamin E promote fertility. Herbs that a woman should avoid while trying to conceive include: licorice root, yarrow, wormwood, ephedra, fennel, goldenseal, lavender, juniper, flaxseed, pennyroyal, passionflower, wild cherry, cascara, sage, thyme, and periwinkle. Vitamin E, calcium, and magnesium may promote fertility and conception. Although most herbal remedies have not been proven clinically to promote fertility, women should avoid the following herbs while trying to conceive: licorice root, yarrow, wormwood, ephedra, fennel, goldenseal, lavender, juniper, flaxseed, pennyroyal, passionflower, wild cherry, cascara, sage, thyme, and periwinkle.

A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs the client regarding management of care. Which statement made by the client indicates a need for further instruction? 1."I will watch to see if I pass any tissue." 2."I will maintain strict bed rest throughout the remainder of the pregnancy." 3."I will count the number of perineal pads used on a daily basis and note the amount and color of blood on the pad." 4."I will avoid sexual intercourse until the bleeding has stopped and for 2 weeks following the last episode of bleeding."

2 Strict bed rest throughout the remainder of the pregnancy is not required for a threatened abortion. The client should watch for the evidence of the passage of tissue. The client is instructed to count the number of perineal pads used daily and to note the quantity and color of blood on the pad. The client is advised to curtail sexual activities until bleeding has ceased and for 2 weeks after the last evidence of bleeding or as recommended by the health care provider.

Semen analysis is a common diagnostic procedure related to infertility. In instructing a male patient regarding this test, the nurse would tell him to: 1. ejaculate into a sterile container 2. obtain the specimen after a period of abstinence from ejaculation of 2 to 5 days 3. transport specimen with container packed in ice 4. ensure that the specimen arrives at the laboratory within 30 minutes of ejaculation

2 The male must ejaculate into a clean container or a plastic sheath that does not contain a spermicide. An ejaculated sample should be obtained after a period of abstinence to get the best results. He should avoid exposing the specimen to extremes of temperature, either heat or cold. The specimen should be taken to the laboratory within 2 hours of ejaculation.

The nurse is preparing to discharge a 30-year-old woman who has experienced a miscarriage at 10 weeks of gestation. Which statement by the woman would indicate a correct understanding of the discharge instructions? 1. I will not experience mood swings since I was only at 10 weeks of gestation." 2. "I will avoid sexual intercourse for 6 weeks and pregnancy for 6 months." 3. I should eat foods that are high in iron and protein to help my body heal." 4. "I should expect the bleeding to be heavy and bright red for at least 1 week."

3 After a miscarriage a woman may experience mood swings and depression from the reduction of hormones and the grieving process. Sexual intercourse should be avoided for 2 weeks or until the bleeding has stopped and should avoid pregnancy for 2 months. A woman who has experienced a miscarriage should be advised to eat foods that are high in iron and protein to help replenish her body after the loss. The woman should not experience bright red, heavy, profuse bleeding; this should be reported to the health care provider.

The nurse provides medication instruction for a 30-yr-old woman who is prescribed clomiphene (Clomid). Which patient statement is most important for the nurse to clarify? 1. "Hormone production and release will be increased." 2."This drug is like estrogen and is used to treat infertility." 3."I should avoid intercourse while taking this medication." 4. "This medication will stimulate my ovaries to produce eggs."

3 Clomiphene is an oral medication administered for infertility. The medication is a selective estrogen-stimulation modulator that stimulates ovulation, making pregnancy after intercourse or artificial insemination more likely. The drug increases gonadotropin-releasing hormone production. In addition, the release of the follicle-stimulating hormone and luteinizing hormone is increased.

Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. What is an appropriate management approach for this type of abortion? 1. prepare the woman for a dilation and curettage (D&C). 2. Place the woman on bed rest for at least 1 week and reevaluate 3. Prepare the woman for an ultrasound and blood work 4. Comfort the woman by telling her that if she loses this baby, she may attempt to get pregnant again in 1 month

3 Dilation and curretage (D&C) is not considered until signs of the progress to an inevitable abortion are noted or the contents are expelled and incomplete. Bed rest is recommended for 48 hours initially. Repetitive transvaginal ultrasounds and measurement of human chorionic gonadotropin (hCG) and progesterone levels may be performed to determine if the fetus is alive and within the uterus. If the pregnancy is lost, the woman should be guided through the grieving process. Telling the client that she can get pregnant again soon is not a therapeutic response because it discounts the importance of this pregnancy.

An infertile woman is about to begin pharmacologic treatment. As part of the regimen, she will take purified follicle-stimulating hormone (FSH) (urofollitropin [Metrodin]). The nurse instructs her that this medication is administered in the form of a/an: 1. intranasal spray 2. vaginal suppository 3. IM injection 4. tablet

3 Intranasal spray is not the appropriate route for urofollitropin. Vaginal suppository is not the correct route for urofollitropin. Urofollitropin is given by IM injection; the dosage may vary. Urofollitropin cannot be given by tablet; it is given only by IM injection

primary infertility

inability to conceive after 1 yr of unprotected sex

secondary infertility

inability to conceive after a previous pregnancy

A client arrives at the health care clinic and tells the nurse that her last menstrual period was 9 weeks ago. The client tells the nurse that a home pregnancy test was positive but that she began to have mild cramps and is now having moderate vaginal bleeding. On physical examination of the client, it is noted that she has a dilated cervix. Which statement, if made by the client, indicates that the client is interpreting the situation correctly? 1."I will need to remain on bed rest for 2 weeks." 2."I will need to take a full course of antibiotic treatment." 3."I will need to take tocolytic medication to halt the labor process." 4."I will need to prepare myself and my family for the loss of this pregnancy."

4 The client is experiencing a spontaneous abortion (miscarriage), which cannot be prevented and will terminate her pregnancy. Bed rest will not reverse this process.

Complete miscarriage

all fetal tissue expelled and cervix closed

causes of miscarriage

chromosomal abnorm teratogens IDDM thyroid disorders uterine abnorm hormonal disorders maternal infection

scrotal ultrasound

examine for varicocele + abnormalities in scrotum and spermatic cord

incomplete miscarriage

expulsion of fetus, retention of placenta and/or membranes in the uterus

threatened miscarriage

mild spotting, cramping w/closed cervix