NUR 1025C Exam 3

NUR 1025C Exam 31. Induced abortion is the purposeful interruption of a pregnancy before 20 weeks of gestation. (Spontaneous abortion or miscarriage is discussed in Chapter 12.) If the abortion is performed at the woman's request, the term elective abortion is usually used; if performed for reasons of maternal or fetal health or disease, the term therapeutic abortion applies. Many factors contribute to a woman's decision to have an abortion. Indications include (1) preservation of the life or health of the mother, (2) genetic disorders of the fetus, (3) rape or incest, and (4) the pregnant woman's request. The control of birth, dealing as it does with human sexuality and the question of life and death, is one of the most emotional components of health care. It has been the most controversial social issue in the last half of the twentieth century and continues to be so today. Regulations exist to protect the mother from the complications of abortion. Second-Trimester Abortion Because the great majority of induced abortions in the United States occur in the first trimester, only about 10% are performed in the second trimester. Second-trimester abortion is associated with more complications and costs than first-trimester abortions. Dilation and evacuation (D&E) accounts for almost all procedures performed in the United States. In general medical administration of second-trimester abortions involves the same drugs (misoprostol and mifepristone) used in medical termination of pregnancy during the first trimester. The D&E procedure is generally preferred by patients because it is less expensive and better tolerated than medical abortion during the second trimester (Fritz and Speroff, 2011b). Dilation and Evacuation D&E can be performed at any point up to 20 weeks of gestation, although it is more often performed between 13 and 16 weeks (Paul and Stein, 2011). The cervix requires more dilation because the products of conception are larger. Often laminaria are inserted several hours or several days before the procedure, or misoprostol can be applied to the cervix to soften the tissue. The procedure is similar to that of vaginal aspiration, except that a larger cannula is used and other instruments may be needed to remove the fetus and placenta. Nursing care includes monitoring vital signs, providing emotional support, administering analgesics, and postoperative monitoring. Disadvantages of D&E include possible long-term harmful effects on the cervix. The woman who has an induced abortion should be given clear instructions to return immediately to the health care facility or emergency department for any of the following symptoms: • Fever greater than 38° C (100.4° F) • Chills • Bleeding greater than two saturated pads in 2 hours or heavy bleeding lasting a few days • Foul-smelling vaginal discharge • Severe abdominal pain, cramping, or backache • Abdominal tenderness (when pressure applied) A woman who is 10 weeks pregnant is being counseled by the nurse regarding her upcoming elective abortion. What information should the nurse provide? A. "A local anesthetic will be injected into your vagina." B. "The exact name of the procedure is dilation and extraction." C. "They may use a seaweed product to dilate your cervix." D. "You won't need to have any cervical dilation at all." Vacuum aspiration is the most common method for surgical abortion for pregnancies up to 12 weeks' gestation. After 7 weeks, cervical dilation is often accomplished with laminaria, a dried seaweed product. For a pregnancy that is 5-7 weeks' gestation, no dilation is needed. A local anesthetic is injected into the cervix in women who are between 8 and 12 weeks' gestation because of the need for mechanical dilation. A dilation and extraction is the term for abortions performed during the second trimester.