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Anticipatory grieving related to pregnancy loss ncp

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Anticipatory grieving related to pregnancy loss ncp

  1. 1. Nursing interventions 1) I: Assess emotional state. Note cultural beliefs, expectations. R: Anxiety and depression are common reactions to losses associated with abortion or pregnancy loss. Personal expectations may affect response to change. 2) I: Determined as to what stage is the client in grieving. R: To provide appropriate care.
  2. 2. 3) I: Review past life experiences/ previous loss, role changes and coping skills, noting strengths/ success. R: Useful in dealing with current situation and problem solving existing needs. 4) I: Make time to listen to client. Encourage free expression of hopeless feelings and the desire to die. R: It is more helpful to allow these feelings to be expressed and dealt with than to deny or ignore them. 5) I: Assess suicidal potential. R: Some mothers may not be able to accept the loss and attempt suicide in order to stop the feeling of guilt and hurt. Studies indicate women are three times as likely to attempt suicide; however, men are three times as likely to succeed.
  3. 3. 6) I: Provide therapeutic touch as individually accepted. R: Conveys sense of concern/closeness to reduce feelings of isolation and enhance sense of self-worth. 7) I: Identify spiritual concerns. Discuss available resources and encourage participation in religious activities as appropriate. R: Search for meaning is common to those facing changes in life. Participation in religious/spiritual activities can provide sense of direction and peace of mind. 8) I: Be honest in answering questions, providing information. R: Enhances sense of trust and nurse-client relationship
  4. 4. 9) I: Provide an open, nonjudgmental environment. Used therapeutic communication skills of active listening acknowledgment. R: Promotes and encourages realistic dialogue about feeling and concerns. 10) I: Encourage verbalization of thought/concerns R: Client may feel supported in expression for feelings by the understanding that deep and often conflicting emotions are normal and experienced by others in this difficult situation. 11) I: Recognize that each client is unique and will progress at own pace. R: Time frames vary widely. Cultural, religious, ethnic, individual differences impact on manner of grieving.
  5. 5. 12) I: Establish rapport with client and significant others. Listen and encourage pt significant others to verbalize feelings. R: This open lines of communication and facilitate successful resolution of grief. 13)I: Accepted need to deny loss as part of normal grief process. R: Realization occurs weeks to months after loss. Reality continues to be over whelming sadness, anger, guilt, hostility may be seen. 14)I: Refer patient to appropriate support group. R: So that patient will be able to get support and information from women or couples who have gone through the same situation. Thus, will not feel alone and helphlettsps.: //thromboangiitis.blogspot.com/2010/0 9/nursing-care-plan-grieving-anticipatory. html
  6. 6. Risk for Complicated Grieving Death is a major stressful event for children and families. Traumatic event can bring serious psychological and social distress.
  7. 7. Expected outcomes The patient will  Express feelings of loss, guilt, fear, anger or sadness  Maintain healthy patterns of sleep, activity and eating  List personal strengths  Use healthy coping mechanisms and social support system  Seek fulfillment through preferred spiritual practices  Begin planning for future  Appropriate move through stages of grieving
  8. 8. Interventions  Identify the hope in patient’s life to help decrease anger and feeling of frustration.  Promotes sleep such as giving snack, pillows, backrub, or shower to enhance rest  Teach patient relaxation techniques such as meditation, deep breathing exercise, diversional therapy or progressive muscle relaxation to promote feelings of comfort  Encourage patient to express grief and feelings of anger, guilt and sadness. Inability to express these feelings may result in maladaptive behaviors.  Encourage patient to express feelings in ways he or she is most comfortable with, eg, crying, talking, writing and drawing.
  9. 9. Intervention cont  Provide suitable counseling if necessary  Seek for social support for the emotional support  Avoid letting patient be alone in the room to prevent he or she has any unwanted action such as suicide.
  10. 10. Ineffective coping  Monitor reaction of client and evaluate risk of harming self or others. R: Client with ineffective coping has a higher risk of suicidal thoughts.  Encourage client to express feeling about the loss of baby, including the effect and relationship with significant others. R: To identify number of support from family and significant others. Monitor reaction of client and evaluate risk of harming self or others. R: Client with ineffective coping has a higher risk of suicidal thoughts.  Encourage client to express feeling about the loss of baby, including the effect and relationship with significant others. R: To identify number of support from family and significant others.
  11. 11.  Use verbal and nonverbal therapeutic communication approaches including active listening, empathy, and acceptance. R: To encourage the client to express negative emotions and verbalize grieve and concerns.  Offer alternative coping strategies including using physical activity as a distraction, and deep breathing exercises for relaxation.
  12. 12.  Refer client for professional psychological counselling as client continues to have difficulty coping . R: To further assist client and significant others in adjusting and coping with the effect of pregnancy loss.
  13. 13. Interrupted family process related to grief over fetal death Nursing Interventions:  Allow the support from a significant person during the experience and have sensitive caregivers  Being given time to grieve  Being allowed choices (decision making)  Giving short and simple explanations, allowing parents to be together (if the woman has come alone, she should be asked about her preferences for someone to be with her)  Provide a quiet place for grieving  Provide privacy
  14. 14.  Giving information about emotions and reactions that they may experience  Identify their own values to facilitate respect for the wide ranging emotions, customs and provide culturally sensitive care  Acknowledge the client’s physical and emotional pain  Immediate support for the mother and discouraged her from focusing on self-blame  Encourage fathers to discuss their feelings with their partners, in individual counseling, or in support groups  Each person should be encouraged to assist the other to grieve at an individual pace and to use referrals as necessary
  15. 15. Risk for haemorrhage: excessive vaginal bleeding  Monitor vital signs especially blood pressure and pulse  Monitor for evidence of haemorrhage such as abdominal pain, uterine status and vaginal bleeding.  Frequent assess on vaginal discharge and its characteristics  IV infusion and fluid replacement  Strictly monitor intake and output.  Administer oxytocin as prescribed to keeps uterus contract.
  16. 16. Risk for development DIC  Observe for bleeding from unexpected sites.  Sites for IV insertion or taking blood, nosebleeds, or spontaneous bruising may be early  Monitor Laboratory studies on coagulation-- Fibrinogen and platelets usually are decreased, prothrombin time (PT)and activated partial thromboplastin time (aPTT) may be prolonged and fibrin degradation products are increased.  Monitor and strictly intake and output. (output must be maintained at 30ml/hr.
  17. 17. Risk of infection  Monitor vital signs especially temperature  Use aseptic technique in cleaning the perineal area  Assess vaginal discharge for foul odour  Monitor laboratory test especially White Blood Cell  Teach the importance of perineal care-maintain the hygiene  Aminister of prophylatic antibiotics as prescribed to prevent infection.

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