A 32-year-old woman at 12 weeks gestation presents to the emergency department with severe cramping and heavy vaginal bleeding. The cervical os is open, and fetal tissue is visible. What is the priority nursing intervention?
1Prepare the client for immediate surgical intervention✓ 정답
2Administer pain medication to reduce cramping
3Encourage the client to ambulate to promote tissue passage
4Apply heat to the abdomen to reduce cramping
해설
In inevitable abortion with open cervical os and visible fetal tissue, immediate surgical intervention (e.g., D&C) is prioritized to prevent hemorrhage and infection. Other options (pain meds, ambulation, heat) delay critical care.
Clinical Judgment
This question assesses nursing priorities in the obstetric emergency of Inevitable Abortion. The key findings are an Open Cervical Os and Visible Fetal Tissue. These two signs mean the pregnancy can no longer continue, and if the uterine contents are not completely expelled, there is a risk of severe hemorrhage and infection. The patient's vital signs (BP 90/60, HR 110) already show early signs of Hypovolemic Shock. Therefore, the nurse's top clinical judgment is immediate notification of the medical team and preparation for surgical intervention. This is to control bleeding and remove retained tissue to protect the patient's life.
Memory Tip
The core of inevitable abortion is "Open and Out." Remember that when the cervical Os is Open and tissue is coming Out or visible, surgical management (D&C/D&E) is required.
KR vs US
In Korea, conservative treatment (medication, waiting for natural expulsion) may be more commonly attempted for inevitable abortion. However, in the US NGN/CJMM exam, if the patient shows signs of being Hemodynamically Unstable (hypotension, tachycardia) and the cervix is open, Immediate Surgical Intervention is emphasized as the standard of care and the top-priority nursing intervention. Comfort measures can be provided concurrently with surgical preparation but should not be prioritized over it.
임상 시나리오
Clinical Practice Guide
When managing a patient with suspected or confirmed inevitable abortion:
1. Notify HCP! immediately and continuously monitor vital signs.
2. Secure a large-bore IV and prepare fluid administration.
3. Count pads to quantify blood loss, and save any expelled tissue for pathology examination.
4. Obtain written consent for surgery (D&C or D&E) and assist with preparation.
5. Provide emotional support and clear information to the patient and partner.
Caution
This is a single-answer question, not SATA (Select All That Apply), but the trap is making you choose inefficient or dangerous conservative interventions in a clear emergency. "Pain relief," "encouraging ambulation," and "abdominal warm compresses" are all inappropriate first-line interventions when there is a risk of hemorrhage and shock. Pain management and emotional support are important, but only after addressing the life-threatening condition.
핵심 개념
Inevitable Abortion — Inevitable abortion. In early pregnancy (before 20 weeks), the cervix opens (Open Cervical Os), there is vaginal bleeding and cramping, and fetal tissue is visible or begins to be expelled, making continuation of the pregnancy impossible.
Dilation and Curettage (D&C) — Dilation and curettage. A surgical procedure in which the cervix is dilated and an instrument called a curette is used to scrape the endometrial tissue from the uterus. Used to remove retained tissue after an incomplete or inevitable miscarriage.
Hypovolemic Shock — Hypovolemic shock. A life-threatening condition caused by a sudden decrease in circulating blood volume, leading to inadequate tissue perfusion. In this case, massive vaginal bleeding is the cause.
Open Cervical Os — Open cervix. A condition in which the opening of the uterus, which should remain closed during a normal pregnancy, is open. One of the diagnostic signs of an inevitable miscarriage.
Hemodynamically Unstable — Hemodynamic instability. A state where key circulatory indicators such as blood pressure and pulse are outside the normal range, indicating instability. In this case, it is confirmed by hypotension (90/60 mmHg) and tachycardia (110 bpm).