AIIMS Nagpur NO- 2020
Obstetrics & Gynaecology
Medium
Nurse's main priority assessment while caring for the client having spontaneous abortion:
Appeared in: AIIMS Nagpur NO- 2020
Explanation
- Hemorrhage is the most immediate and life-threatening complication of spontaneous abortion (miscarriage).
- The primary mechanism of harm is excessive blood loss from the placental implantation site, which can rapidly lead to hypovolemic shock.
- Nursing assessment must prioritize monitoring for signs of shock, including tachycardia, hypotension, and changes in mental status, as well as quantifying blood loss (e.g., pad counts).
- The fundamental management principle for hemorrhagic shock is to stop the bleeding and replace the lost blood volume, making early detection critical (SRC_4255).
Why Other Options Were Wrong
- Option A: Dehydration is a potential problem, especially with associated nausea and vomiting, but it develops more slowly and is not as acutely life-threatening as massive hemorrhage.
- Option B: Hypertension is not a characteristic sign of spontaneous abortion. In fact, hypotension is the expected finding in the presence of significant hemorrhage.
- Option C: Subinvolution is the failure of the uterus to return to its normal size after delivery or abortion. It is a later complication, not an immediate priority during an active spontaneous abortion.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Prioritization of nursing care in obstetric emergencies, specifically spontaneous abortion to guide bedside assessment, documentation, and the next nursing action.
- A nurse's primary role in managing a spontaneous abortion is vigilant monitoring for hemorrhage and shock. This includes frequent vital sign checks, assessing the amount of vaginal bleeding by counting and weighing perineal pads, and checking uterine tone.
- The nurse must be prepared for emergency interventions, such as establishing large-bore IV access for fluid and blood product administration, preparing the client for a potential dilation and curettage (D&C) procedure, and providing emotional support.
- What if the patient's blood type is Rh-negative? The nurse must anticipate the need to administer Rho(D) immune globulin (RhoGAM) to prevent Rh sensitization, which could affect future pregnancies. This is a critical nursing responsibility in any case of bleeding during pregnancy for an Rh-negative woman.
How to Approach the Question
- This is a priority-setting question. The best approach is to use a framework like the ABCs (Airway, Breathing, Circulation) or Maslow's Hierarchy of Needs.
- Analyze the options in the context of a spontaneous abortion.
- Hemorrhage directly threatens 'Circulation' (the 'C' in ABCs) and is a physiological need for survival, making it the highest priority.
- Evaluate the other options: Dehydration is a fluid balance issue but is less acute than active bleeding. Hypertension is clinically opposite to what is expected with hemorrhage. Subinvolution is a later complication, not an immediate threat.
- Conclude that preventing or managing hemorrhage is the most critical, life-saving action.
Concept Tested & Keywords
- Concept Tested: Prioritization of nursing care in obstetric emergencies, specifically spontaneous abortion.
- Stem keywords: spontaneous abortion, priority assessment, caring for client
- Lead-in keywords: main priority
Question ID
Q5VRzKSWcQbqe4cqsko4Y6
Reference Book
E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 23-31
E6 Obstetrics Williams p. 48-69
Practise the full AIIMS Nagpur NO- 2020
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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