NCP

2. 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.

3. 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.

4. 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

5. 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.

6. 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

7. Risk for Complicated Grieving
Death is a major stressful event for
children and families. Traumatic event
can bring serious psychological and
social distress.

8. 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

9. 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.

10. 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.

11. 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.

12.  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.

13.  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.

14. 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

15.  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

16. 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.

17. 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.

18. 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.