Dilation And Curettage (D&C) Nursing Care Plan & Management

Notes

Definition
  • The gradual enlargement of the cervical os and the curetting (scraping) of endometrial or endocervical tissue for histologic study.
Discussion
  • The procedure is usually performed to:
    1. To diagnosed cervical or uterine malignancy.
    2. To control dysfunctional uterine bleeding.
    3. To complete an incomplete abortion.
    4. To aid in evaluating infertility.
    5. To relieve dysmenorrheal.
  • Fractional D&C procedures can assist in differentiating between endocervical and endometrial lesions.
PositioningDilation And Curettage (D&C)
  • Lithotomy; arms may be extended on armboards.
Packs/ Drapes
  • Gynecologic pack
Instrumentation
  • D&C tray
Supplies/ Equipment
  • Padded stirrups
  • Telfa
  • Perineal pad
  • Suction
  • Lubricant
Procedure Overview
  1. A weightened speculum is placed in the vaginal vault.
  2. The cervix is grasped with a tenaculum.
  3. A graduated sound is passed through the cervical canal into the uterine cavity to determine its depth and angulation.
  4. Using Hegar or Hank dilators, the surgeon begins to dilate the cervical opening, increasing the size of each dilator.
  5. A Telfa sponge is placed over the bill of the weighted speculum, and the uterus is gently curetted, allowing the tissue specimen to collect on the Telfa sponge.
  6. The small serrated curette is used to scrape the uterine walls again or when the D&C is performed to remove retained placental tissue, while the large, blunt curette and forceps are used to remove the tissue.
  7. If a fractional D&C is performed, endocervical curettings are obtained before the uterus is sounded, to avoid bringing endometrial cells into the cervical os.
  8. The weighted speculum is removed, and the perineum is dressed with a perineal pad.

Perioperative Nursing Considerations
  1. Stirrups should be padded, and a coccygeal support placed on the table to protect the lower sacral area.
  2. Raise and lower the legs together and slowly to prevent disturbances caused by rapid alterations in venous return and/ or injury to the rotator hip joint.
  3. Instruments are set up on the black table in order of usage, a scrub person may not be necessary during the procedure.
  4. If a fractional D&C is performed, multiple specimens may be obtained. They should be placed in separate containers, and labeled accordingly.

Exam

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Nursing Care Plan

Nursing Diagnosis

Potential for infection related to invasive procedure of dilation and curettage and tissue trauma during the procedure.

Planning

After a series of nursing intervention, the patient will be free from infection and will demonstrate knowledge on what to look for as signs of impending infection.

Nursing Intervention Rationale
Obtain preoperative vital signs of client. This will serve as the baseline data and a basis for comparison postoperatively.
Conduct health education before the operation on the following topics:

  • Signs and symptoms of infection like increasing body temperature, foul smelling discharges from the perineum, moderate to severe abdominal cramps
  • Advise that should any sign of infection occurs, it must be reported immediately to the nurse on duty for validation and evaluation
    1. Good perineal hygiene
    2. Use of tampons is contraindicated, use perineal pads instead
    3. No sexual intercourse until vaginal discharge stops
Instructing clients on the signs and symptoms of impending infection gives them the idea of what to look for so immediate action and intervention can be sought.

  1. Minimizes the entry of harmful microorganisms.
  2. Tampons increases risk for infection and delays tissue healing.
  3. To allow tissue healing.
Coordinate with the OR/DR team to ensure that aseptic technique will be maintained during the entire procedure of D & C. D & C is an invasive procedure and equipment and materials used during the operation may be a possible source of harmful microorganism, hence, everything should be sterile.
Monitor for signs and symptoms of infection inclusive of vital signs and post D & C CBC count. Prompt recognition and intervention of manifestations of infection prevents progression into a worse septic condition.
Nursing Evaluation

After a series of nursing intervention, the patient was free from infection and demonstrated understanding on the possible signs and symptoms of impending infection.

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