Notes
image credit: pregmed.org
Description
- Incompetent cervix is characterized by a painless dilation of the cervical os without contractions of the uterus.
- Incompetent cervix commonly occurs at about the 20th week of pregnancy.
Etiology
- History of traumatic birth
- Repeated dilation and curettage
- Client’s mother treated with diethylstilbestrol (DES) when pregnant with the client
- Congenitally short cervix
- Uterine anomalies
- Unknown etiology
Pathophysiology
- Connective tissue structure of the cervix is not strong enough to maintain closure of the cervical os during pregnancy.
Assessment findings
1. Associated findings
- History of cervical trauma
- History of repeated, spontaneous, second trimester terminations
- Possibly spontaneous rupture of the membranes
2. A common clinical manifestation is appreciable cervical dilation with prolapsed of the membranes through the cervix without contractions.
Nursing Management
1. Provide client and family teaching. Describe problems that must be reported immediately (ie,pink-tinged vaginal discharge, increased pelvic pressure, and rupture of the membranes).
2. Maintain an environment to preserve the integrity of the pregnancy.
- Prepare for cervical cerclage, if appropriate.
Maintain activity restrictions as prescribed.
c. Discuss the need for vaginal rest (ie, no intercourse or orgasm)
3. Prepare for the birth if membranes are ruptured.
4. Address emotional and psychosocial needs.
Exam
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Nursing Care Plan
Premature Dilation of the Cervix Nursing Care Plans
Risk for Disturbed Maternal-Fetal Dyad
Risk for Disturbed Maternal-Fetal Dyad: At risk for disruption of maternal-fetal dyad as a result of a comorbid or pregnancy-related conditions.
Related to:
- Complication of pregnancy (e.g. premature dilation of cervix)
- Physical or substance abuse
- Treatment-related side effects (e.g. medications)
Possibly evidenced by:
- Painless bleeding
- Rupture of membranes
- Uterine contractions
- Increased pelvic pressure
Risk factors:
- Increased maternal age
- Congenital structural defects
- Trauma to the cervix
Desired outcomes:
- Patient will verbalize understanding of individual risk factors or conditions that may impact pregnancy.
- Patient will engage in necessary alterations in lifestyle and daily activities to manage risks.
- Patient will identify signs and symptoms requiring medical intervention or evaluation.
- Patient will display fetal growth within normal limits and carry pregnancy to term.
| Nursing Interventions | Rationale |
|---|---|
| Review history of previous pregnancies. | To check for presence of complications. |
| Obtain history about prenatal screening and amount and timing of care. | Lack of prenatal care can place both mother and fetus at risk. |
| Note conditions potentiating the condition. | may directly affect uteroplacental circulation and gas exchange. |
| Note maternal age. | Maternal age above 35 years old is associated with increased risks. In pregnant adolescents, the most common high risk conditions include preterm delivery. |
| Investigate current home situation. | May have history of unstable relationship or inadequate/lack of housing that affects safety as well as general well being. |
| Provide information and assist in ultrasonography as indicated. | Detects presence of complications that may affect pregnancy. |
| Screen for abuse during pregnancy. | Prenatal abuse is correlated with preterm delivery and premature dilation of cervix. |
| Instruct client in reportable symptoms and monitor for unusual symptoms at each prenatal visit. | Provides opportunity for early intervention in event of developing complications. |
| Facilitate positive adaptation to situation through active listening, acceptance and problem solving. | Helps in successful accomplishment of the psychological tasks of pregnancy. |
| Review medication regimen. | Prepregnancy treatment for maternal conditions may require alteration for maternal and fetal safety. |
| Encourage modified or complete bed rest as indicated. | Activity level may need modification, depending on symptoms of uterine activity and cervical changes. |
| Emphasize normalcy of pregnancy, focus on pregnancy milestones, “countdown to birth”. | Promotes sense of hope that modifications or restrictions serve a worthwhile purpose. |
| Discuss implications of preexisting condition and possible impact on pregnancy. | Pregnancy may have no effect, or may reduce or exacerbate severity of symptoms of chronic conditions. |
Deficient Knowledge
May be related to
- Lack of exposure and/or recall
- Misinterpretation of information
Possibly evidenced by
- Questioning
- Request for information
- Statement of misconception
- Inappropriate or exaggerated behaviors
Desired Outcomes
- Verbalize understanding of her own circumstances and treatment
- Demonstrate self-care behavior to maintain pregnancy
| Nursing Interventions | Rationale |
|---|---|
| Determine level of client’s knowledge. | Provides opportunity to clarify what has been learned previously, to identify cultural myths, and to correct misconceptions. |
| Assess degree of anxiety. | Anxiety can interfere with learning process. |
| Involve significant others in the discussion. | Helps reinforce understanding of all individuals involved. |
| Provide information about future expectations. | Client may experience concern about whether difficulties may be encountered. |
| Identify signs and/or symptoms to be reported to the healthcare provider. | Prompt evaluation and intervention may prevent or limit complications. |
Anxiety
Anxiety: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response.
Related to:
- Premature cervix dilation
- Situational crisis
- Stress
- Threat of fetal death
- Threat to/change in health status
Possibly evidenced by:
- Expressed concerns due to change in life events
- Worried
- Awareness of physiological symptoms
- Difficulty concentrating
- Increase in vital signs
Desired outcomes:
- Patient will appear relaxed and report anxiety is reduced to manageable level.
- Patient will verbalize awareness of feelings of anxiety.
- Patient will identify healthy ways to deal with and express anxiety.
- Patient will demonstrate problem solving skills.
| Nursing Interventions | Rationale |
|---|---|
| Review physiological factors. | These factors can cause/exacerbate anxiety. |
| Provide primary nurse, if possible | Facilitates continuity of care and increases client’s confidence in care providers. |
| Determine current prescribed medications and recent drug history of prescribed or over-the-counter medications. | These medications can heighten feelings and sense of anxiety. |
| Monitor vital signs. | To identify physical responses associated with both medical and emotional conditions. |
| Observe patient’s behaviors. | Can point to the client’s level of anxiety. |
| Review obstetric history. | A history of fetal loss, the client’s understanding of the vents and proposed interventions may affect the client’s degree of anxiety. |
| Review results of diagnostic tests. | May point to physiological sources of anxiety. |
| Review coping skills used in the past. | To determine those that might be helpful in current circumstances. |
| Establish therapeutic relationship, conveying empathy and unconditional positive regard. | To avoid the contagious effect or transmission of anxiety. |
| Provide accurate information about the situation. | Helps client identify what is reality based. |
| Promote comfort measures. | To help put the client at ease. |
| Accept client as is. | The client may need to be where he or she is at this point in time. |
| Allow the behavior to belong to the client; do not respond personally. | The nurse may respond inappropriately, escalating the situation to a nontherapeutic interaction. |
| Assist the client to use anxiety for coping with the situation, if helpful. | Moderate anxiety heightens awareness and permits the client to focus on dealing with problems. |
| Encourage client to develop an activity program. | May serve to reduce level of anxiety by relieving tension. |
| Review medication regimen and possible interactions and discuss appropriate drug substitutions, changes in dosage, and time of dose. | To minimize side effects. |
| Identify client’s perception of the threat represented by this occurrence. | The ambiguity of the outcome and aggravate anxiety. |
| Determine availability of support systems and psychological response to the event. | Establishes the plan of care. Degree of negative response and lack of or inadequacy of support contributes to heightened levels of anxiety, possibly to the point of affecting overall outcome. |
| Assess psychological indicators of anxiety: BP, pulse, respiratory rate, diaphoresis, and so on. | Psychological changes in vital signs may have psychological origin. |
| Provide explanation on what is happening and what can be expected. Provide factual information about causes, implications, and treatment. | May reduce anxiety by increasing awareness of the situation. |
| Provide information on an ongoing basis. | Can help allay anxiety. |