Nursing Care Plan for Premature Dilation of the Cervix (Incompetent/Dysfunctional Cervix)

Premature dilation of the cervix often occurs in the 4th or 5th mo and is associated with repeated second-trimester spontaneous abortions accounting for 15%–20% of second-trimester pregnancy losses.

NURSING PRIORITIES
1. Evaluate client/fetal status.
2. Assist with efforts to maintain the pregnancy, if possible.
3. Provide emotional support.
4. Provide appropriate instruction/information.

DISCHARGE GOALS
1. Client/fetal condition stable following procedure
2. Uterine contractions absent
3. Therapeutic needs and concerns understood

Nursing diagnosis of incompetent cervix: Anxiety may be related to situational crisis, threat of death/fetal loss possibly evidenced by increased tension, apprehension, feelings of inadequacy, sympathetic stimulation, and repetitive questioning.

Desired Outcomes
1. Verbalize fears and concerns.
2. Report anxiety is reduced to a manageable level. Use individually appropriate coping mechanisms to deal with the short- and long-term outcomes of the situation.

Nursing intervention with rationale:
1. Provide primary nurse, if possible.
Rationale: Facilitates continuity of care and increases client’s/couple’s confidence in care providers.

2. Review obstetric history.
Rationale: The degree of anxiety depends on the nature of the situation, the history of fetal loss, the client’s understanding of the events and proposed interventions, and the client’s coping behaviors, both past and present.

3. Identify client’s perception of the threat represented by this occurrence.
Rationale: The ambiguity of the outcome can aggravate anxiety.

4. Determine availability of support systems and psychological response to event.
Rationale: Establishes data base and plan of care. Degree of negative response and lack of/inadequate support contributes to heightened levels of anxiety, possibly to the point of affecting overall outcome.

5. Assess physiological indicators of anxiety: BP, pulse, respiratory rate, and diaphoresis.
Rationale: Physiological changes in vital signs may have psychological origin.

6. Remain with couple. Explain what is happening and what can be expected. Provide factual information about causes, implications, and proposed treatment.
Rationale: May reduce anxiety by increasing awareness of the circumstance.

7. Provide information on an ongoing basis.
Rationale: Can allay anxiety.

8. Refer to other sources for support or counseling if anxiety is excessive or support systems are inadequate.
Rationale: May aid in long-term adjustment to situation.