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Assessment Subjective: Hindi to nangyayare. Buntis ako. As verbalized by the patient. Bumili na kami ng mga gamit pangbata.

Meron na syang kwarto sa bahay namin. As verbalized by the clients husband. Objective: Detached from environment Disorganized in performing ADLs Crying Preoccupation with the thoughts of the event Decreased appetite Isolation of self Rumination

Diagnosis Anticipatory grieving related to expected loss of unborn child secondary to ectopic pregnancy.

Rationale Ectopic pregnancy is on in which implantation occurs outside the uterine cavity. There are no unusual symptoms at the time of implantation. The corpus luteum of the ovary continues to function as if the implantation were in the uterus. No menstrual flow occurs. The woman may experience nausea and vomiting of early pregnancy, and a pregnancy test for hCG will be positive giving the woman an assumption that she is having a normal pregnancy.

Planning After 8 hours of nursing intervention: 1. Client and significant other are able to express their grief in a culturally acceptable manner. 2. Client and family are able to share their grief with each other.

Intervention Independent: Assess the client and significant others response to the expected loss: denial, bargaining, depression, and so forth. Provide support without offering false hopes (specify for client: e.g., if in denial, dont force acceptance of loss; explain that denial is a normal coping mechanism). Ensure that all caregivers and auxiliary staff are aware of the clients loss.

Rationale Client and significant other may present to the hospital in any phase of the grief process. Client may move in and out of the stages. Coping mechanisms assist the client to gradually face the loss. Knowledge assists the client and family to move through their grief.

Evaluation GOAL MET: After 8 hours of nursing intervention: 1. Client and significant other were able to express their grief in a culturally acceptable manner. 2. Client and family were able to share their grief with each other. Alam na namin na wala na talaga yung bata. Masakit man pero kailangan naming tanggapin.

Intervention prevents anguish from wellintentioned comments about the loss. Grieving is an individual process influenced by cultural norms that may be very different from the nurses. Client and significant other may be distracted and have trouble

Support cultural grief behavior of client and family (e.g., screaming). Provide for privacy if needed and remain nonjudgmental. Provide clear explanations and instructions. May need to repeat

information.

concentrating on information. Encouragement provides permission to grieve together openly. The use of touch has cultural implications. Intervention promotes family support for client and significant other while protecting them from unwanted guests. Information assists the client to understand feelings that may be overwhelming at times. Discussion facilitates open communication between parents to prevent anger or guilty feelings about differences in grieving.

Encourage parents to talk about their feelings about the loss. Use touch as culturally appropriate. Allow visitors as client and significant other desire.

Provide information about the normal grief process (written and verbal).

Discuss gender differences in grieving (e.g., the mother has a longer attachment to pregnancy than the father).

Collaborative: Refer client and significant other to a grief support group.

Support groups may help client and significant other to cope with loss.

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