A look into septic abortion nursing care plan, ultra-sound, causative organisms and complications
Nursing care plan for septic abortion
A nursing care plan usually outlines the nursing care that is supposed to be provided to a patient. It is a set of actions that the nurse will have to implement so as to resolve nursing problems which are identified by assessment.
The creation of the plan is an intermediate stage of nursing process. It guides in ongoing provision of the nursing care and also assists in evaluation of the care.
Characteristics of a quality nursing care plan:
- It largely focuses on actions that are designed to minimize the existing problem.
- It is also a product of a deliberate systematic process.
- It relates mostly to the future.
- It is also based upon several identifiable health and nursing problems.
Elements of the nursing care plan:
- NANDA nursing diagnosis having related factors as well as diagnostic criteria
- Nursing outcome classifications that has specified outcomes that are supposed to be achieved including deadlines
- Nursing intervention classifications that has specified interventions.
In nursing care plan for an abortion definitions for Abortion is: Spontaneous abortion, miscarriage, or even induced abortions, where the products of conception are expelled from uterus before fetal viability as well as gestation of less than 20 weeks is fully achieved.
Causes for Septic Abortion
It can be due to fetal, placental, or even the maternal factors:
- Fetal factors can include defective embryologic development emanating from abnormal chromosome division (which is the most common cause of fetal death), faulty implantation of a fertilized ovum, as well as failure of endometrium to accept fertilized ovum, usually leads to such abortions between 9 and 12 weeks of the gestation period.
- Placental factors include premature separation of normally implanted placenta, abnormal placental implantation, as well as abnormal platelet function. Usually lead to abortion around the 13th week of the gestation.
- Maternal factors might also include maternal infection, malnutrition, as well as abnormalities of reproductive organs, this can lead to abortion between 11 and 19 weeks of the gestation
Other maternal factors that are found after septic abortion include endocrine problems, like the thyroid gland dysfunction or even the lowered estriol secretion, which includes any type of surgery that necessitates the manipulation of pelvic organs, blood group incompatibility and also the Rh isoimmunization, recreational drug use and the environmental toxins.
Therapeutic septic abortion is normally performed so as to preserve the mother’s mental or physical health in the cases of any unplanned pregnancy, or even the medical conditions, like cardiac dysfunction or fetal abnormality.
Complications which can occur in Nursing Care Plan for Abortion
- Infections in case of products of conception aren’t fully expelled
- Coagulation defects like disseminated intravascular coagulation
Assessment Nursing Care Plan for Abortion
- Pink discharge for many days or a scant brown discharge for weeks
- Cramps and also increased vaginal bleeding
- If any contents remain, cramps and also the bleeding continue.
Assess the patient’s emotional status, and also that of the baby’s father and other family members. Often this hospital admission is the first one for the patient, and it might lead to some amount of anxiety and fear
Diagnostic tests Nursing Care Plan for Septic Abortion
- HCG in blood or the urine confirms
- Decreased HCG level
- Laboratory test results reflect a decreased hemoglobin level
- Ultrasound examination; absence of the fetal heart sounds
Primary Nursing Diagnosis found in Nursing Care Plan for Abortion are the
Anticipatory grieving related to an unexpected pregnancy outcome
Common nursing diagnosis found in Nursing Care Plan for Abortion are;
- Disabled family coping
- Dysfunctional grieving
- Risk for infection
Nursing outcomes, Interventions, and also the patient teaching nursing care plan for the septic abortion.
Septic abortion ultrasound
Incomplete miscarriage is a term that is given to miscarriage where there are retained products of conception that is still within the uterus.
Ultrasound appearance is normally variable, usually ranges from visible fetal parts to a mass of the mixed echogenicity. The presence of a prominent vascular supply as well as feeding vessel assists to make the diagnosis. In chronic cases the retained products might be avascular.
Treatment and prognosis
These might be managed medically (e.g. misoprostol treatment) or even surgically (e.g. dilatation and also curettage).
- septic abortion shock
- diffuse intravascular coagulopathy
An abortion or even a miscarriage becomes septic after the entry of bacteria into uterus. The infection first involves inner lining of uterus and the retained products of conception (placenta as well as the fetus). This particular infection then spreads to outer linings of uterus.
In advanced cases, then the bacteria gain access to the abdominal cavity as well as the bloodstream (a state known as bacteremia) and finally spread to the body organs, leading to the signs and symptoms of sepsis.
Factors which can put a woman at risk for sustaining a septic abortion are:
- The period of rupture of fetal membranes that are surrounding the unborn child being unnoticed
- Medical or even surgical induction of abortion by use of unsafe or even contaminated products such as soaps, scissors etc.
- Self-induced abortion by use of the non-sterile methods
- Presence of a sexually transmitted infection like chlamydia
- As a complication of pregnancy with the intrauterine device
A septic abortion is more likely if a pregnant woman develops a fever with some amount of chills, abdominal pain, as well as vaginal bleeding with or even without the passage of the products of pregnancy (i.e. placenta and the fetal parts).
It is a life-threatening condition if it is not treated promptly as the woman might go into a state of shock because of the widespread infection and also the organ dysfunction. Septic shock results in mental confusion, very low blood pressures, low body temperatures or even an experience of spiking fevers, and also some people can have reduced urine output.
Kidney failure, fatal bleeding, as well as formation of scar tissue in intestinal and pelvic organs causing intestinal blockage and some infertility are some of potential consequences of the untreated septic abortion.
To evaluate a suspected case of septic abortion, the doctor usually performs an ultrasound, which might as well help reveal the presence of pregnancy materials in uterus.
Vigorous hydration and also antibiotics are normally used to treat women who have septic abortion. If an ultrasound indicates the presence of residual products of conception in uterus, the doctor will perform a dilatation and curettage to get rid of them.
Septic abortion causative organisms
Septic abortions usually emanates from induced abortions that is done by untrained practitioners by use of nonsterile techniques; they are more common when the induced abortion is found to be illegal. Infection is less after spontaneous abortion.
Typical causative organisms are Escherichia coli, Enterobacter aerogenes, Proteus vulgaris, hemolytic streptococci, and anaerobic organisms (Clostridium perfringens). One or more organisms might be involved.
Symptoms and signs usually appear within a period of 48 hours after abortion and are similar to those of the pelvic inflammatory disease (chills, vaginal discharge, often peritonitis) and those of threatened or even incomplete abortion (vaginal bleeding, cervical dilation, passage of the products of conception). Perforation of uterus during the procedure usually leads to severe abdominal pain.
Septic shock may result, leading to hypothermia, oliguria, and also respiratory distress. Sepsis because of the C. perfringens might lead to thrombocytopenia and findings of intravascular hemolysis (anuria, jaundice, hemoglobinuria, hemosiderinuria).
Septic abortion is obvious clinically, usually based on finding severe infection in the women who are pregnant. Ultrasonography should be done so as to check for the retained products of conception as a possible cause.
Uterine perforation is obvious during this particular procedure; it is to be suspected when women have a lot of unexplained severe abdominal pain as well as peritonitis. Ultrasonography is very much insensitive for perforation.
When septic abortion is suspected, aerobic as well as anaerobic cultures of blood are usually performed so as to assist in direct antibiotic therapy. Laboratory tests are supposed to include CBC with differential, liver function tests, glucose, and creatinine. PT and PTT are then done if liver function test results are abnormal or if the women have experienced excessive bleeding.
Septic abortion complications
Complications of the spontaneous miscarriages as well as therapeutic abortions are the following:
- Complications of anesthesia
- Postabortion triad (bleeding, low-grade fever)
- Retained products of conception
- Uterine perforation
- Bowel injury
- Failed abortion
- Septic abortion
- Cervical laceration
- Disseminated intravascular coagulation
The term “septic abortion” usually refers to a spontaneous miscarriage or therapeutic abortion complicated by a pelvic infection.
Postabortion complications can develop due to 3 major mechanisms as follows: incomplete evacuation of uterus and also the uterine atony, which causes hemorrhagic complications; infection; and also the injury because of the instruments that are used during the procedure.
In septic abortion, infection normally starts as endometritis and also involves the endometrium and retained products of conception. If it is not treated, the infection might spread further into myometrium and parametrium.
Parametritis can then progress into peritonitis. The patient can develop bacteremia and also sepsis at any stage of the septic abortion. Pelvic inflammatory disease is the most common complication of the septic abortion.
- Incomplete miscarriage: https://radiopaedia.org/articles/incomplete-miscarriage
- Septic Abortion: https://www.fertilitysmarts.com/definition/880/septic-abortion-fertility
- Septic Abortion: https://www.merckmanuals.com/professional/gynecology-and-obstetrics/abnormalities-of-pregnancy/septic-abortion
- Abortion Complications: https://emedicine.medscape.com/article/795001-overview#a5
- Pathophysiology: https://nurseslabs.com/abortion/
- nursing care plan: http://nursingcrib.com/nursing-care-plan/