nursing:miscarriage

ED nurse initiated Rx of the patient presenting with PV bleeding in early pregnancy

introduction

  • patients with bleeding in early pregnancy are at risk of miscarriage and thus they tend to be extremely concerned and benefit from early supportive care
  • they should have the expected process explained early and that although most will not actually have a miscarriage with mild PV bleeding, unfortunately miscarriage cannot be prevented if it is going to happen
  • if bleeding becomes very heavy, then care in an area such as Fast Track with added privacy can be of great benefit to the patient
  • their length of stay in ED could be reduced and their symptoms partly relieved by nurse initiated ED Rx, although it is recognised that these presentations can be complex and warrant timely medical assessment to properly exclude important red flags.
  • the following is a suggested framework for ED's who have nurses accredited to undertake ED nurse initiated treatment including the ordering of pathology tests.

specific history and examination

specific nurse initiated Rx for PV bleeding in early pregnancy

red flags to escalate medical referral

  • patients with very heavy PV bleeding who may have cervical shock and require vaginal examination by an ED doctor ASAP, may be better managed in the main gynae cubicles or even in the resus cubicles.

  • patients with severe lower abdominal pain or shoulder tip pain may have a ruptured ectopic pregnancy and require urgent assessment by an ED doctor ASAP, and may be better managed in the main gynae cubicles or even in the resus cubicles.

  • hypotension
  • pale lips
  • severe PV bleeding
  • severe pain
  • USS evidence to suggest possible ectopic pregnancy

initial Mx

  • most patients can be managed in Fast Track
  • iv access is usually not needed unless heavy bleeding or possible ectopic pregnancy
  • if less than 8 wks pregnant or no fetus seen on USS then baseline or serial serum HCG should be taken
  • if Rh group is negative or unknown, and no recent Anti-D has been given, blood should be collected for grouping and antibodies to ascertain whether the patient needs Anti-D administration
  • oral analgesics such as paracetamol +/- codeine
nursing/miscarriage.txt · Last modified: 2012/07/23 05:26 by gary1