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Nursing Care Plan Dilation and Curettage

dilation and curetage nursing care plan (9)

Dilation and Curettage (D & C) is one of the most used traditional treatments throughout most of the 20th and 21st centuries. It has two main purposes, therapeutic or diagnostic. D&C removes tissue from the uterine cavity. The procedure can be applied to a pregnant or non-pregnant female and be either diagnostic or therapeutic’ sometimes the circumstances may overlap between the two.

Dilatation and Curettage

Therapeutically, the D&C may be used in the non-pregnant client with excessive bleeding who has failed medical management or become hemodynamically unstable. The D&C alone is inadequate for a full evaluation of the uterine disorder but provides a temporary reduction in bleeding. Indications for the D&C in pregnant clients include elective termination of pregnancy, early pregnancy failure, evacuation of a molar pregnancy, or suspected retention of products of conception. Its only contraindication is the desire to maintain a viable intrauterine pregnancy.

In a non-pregnant client, the endometrial lining is sampled and sent for pathological evaluation. There are two layers to the non-pregnant endometrial lining, the stratum basalis and the stratum functionalis. Removal of the stratum functionalis is the goal of D&C, but it will not affect the hypothalamic-pituitary-ovarian axis in regard to ovulation and future menses. The pregnant client will have the pregnancy or products of conception removed from the endometrial cavity trying to avoid removing tissue beyond the decidua basalis layer. The decidua basalis is where implantation takes place, and the basal plate is formed; it is also where the placenta will detach after birth. Avoiding removal of the tissue beyond this layer prevents the potential for adhesion formation.

The most common indication to undergo D & C is under the following circumstances

  • Dysfunctional Uterine Bleeding(DUB)
  • Polycystic Ovary Syndrome
  • Retained Product of Conception(POC) like Retained Placenta
  • Missed or Incomplete abortion.

Preoperative preparation of the patient

  • Admission is 24 hours before the operation
  • NPO post-midnight
  • Pre-op meds like analgesic, anti prostaglandin, and a laxative
  • Enema early morning on the day of operation
  • Health education on what to watch for following operation like large blood clots and signs of impending infection
  • Advised if there are no complications, she may be discharged the same day of operation or after 24 hours

Most women undergoing such procedures present no discomfort except for mild cramps, backache, and of course the passing of small blood clots for a day or two.  There will also be some vaginal bleeding or staining for several weeks which is normal.


The patient is monitored for signs and symptoms of complication which may include infection, uterine perforation, and intrauterine adhesions which may directly or indirectly be caused by the operation itself.  It is the responsibility of the nurse to assess and record any manifestation presented by the client. It is imperative too that the client be educated on what to look for after the operation so she can report it to the nurse for validation and further evaluation.

Care Plan

Nursing care planning for clients undergoing D&C involves physical, emotional, and spiritual aspects. Elective abortion is a sensitive issue, therefore, guidance from the healthcare professionals, especially nurses who are present at the client’s bedside, is essential to ensure a smooth transition of the intervention and the acceptance of the client. The following are nursing diagnoses associated with the dilatation and curettage.

  • Acute Pain
  • Risk for Injury
  • Risk for Infection

Dilation and Curettage Nursing Care Plan

Below are samples of nursing care plans for the problems identified above.

Acute Pain

Dilatation and curettage (D&C) basically include dilatation of the cervix and removal of the uterus content. Although D&C is not defined as a major operation, this procedure has invasive characteristics and may be associated with severe postoperative pain and periprocedural anxiety. Dilatation of the cervix, uterine manipulation, and the removal of the uterine content may cause pain during D&C. One of the typical side effects of D&C also includes postprocedural cramping, which may increase the client’s discomfort.

Nursing Diagnosis

  • Acute Pain

Related Factors

  • Disruption of endometrial tissue

Evidenced by

  • Verbalizations of pain
  • Facial mask of pain
  • Guarding or protective behaviors
  • Self-focusing or narrowed focus

Desired Outcomes

After implementation of nursing interventions, the client is expected to:

  • Verbalize relief of or reduced pain.
  • Appear relaxed, able to rest or sleep, and participate in daily activities accordingly.

Nursing Interventions

Assessment Rationale
Assess the client’s vital signs, noting tachycardia, hypertension, and increased respiration. Changes in these vital signs often indicate acute pain and discomfort. Note: Some clients may have a slightly lowered BP, which returns to the normal range after pain relief is achieved.
Evaluate pain frequently following the postprocedural phase, noting characteristics, location, and intensity on a 0-10 scale. Evaluation of pain provides information about the need for, the effectiveness of, interventions. It may not always be possible to eliminate pain; however, analgesics should reduce pain to a tolerable level.
Note the presence of anxiety or fear, and relate with the nature of and preparation for the procedure. Anxiety among clients undergoing various surgical procedures has been an issue not only for healthcare professionals since the perioperative anxiety may be harmful concerning intraoperative hemodynamics and recovery. Anxiety has been shown to act as a risk factor for the perception of significant pain.
Encourage the use of relaxation techniques such as deep-breathing exercises, guided imagery, visualization, or music. Relaxation techniques relieve muscle and emotional tension, enhance the sense of control, and may improve coping abilities.
Educate the client about the nature of discomfort expected. Anticipation of pain may help the client cope with the reality of its presence. Informing the client regarding the forthcoming procedure is an effective tool for reducing preoperative anxiety, which contributes to the perception of significant pain.
Provide additional comfort measures such as back rub and heat or cold applications. Heat or cold application may improve circulation, reduce muscle tension and anxiety associated with pain. It may also enhance the sense of well-being.
Administer pain medications, as indicated. Analgesics may be prescribed to alleviate the cramping after the procedure. Some cramping or mild abdominal discomfort is considered usual after D&C.
Administer local anesthesia before the procedure as indicated. The paracervical block (PCB) is a local anesthesia technique used widely for gynecological procedures. PCB produces significantly less pain during dilatation and aspiration as well as after the procedure. It also avoids the side effects commonly caused by general anesthesia, such as nausea, vomiting, dizziness, drowsiness, and greater hemodynamic changes.

Risk for Injury

Uterine perforation is the most common immediate complication in pregnant and non-pregnant D&Cs. Uterine perforation is most likely to occur at the fundus of the uterus, and risk factors are postpartum hemorrhage, post-menopausal status, nulliparity, and retroverted uterus. Many perforations go undetected and are not recognized, and the uterus is most commonly perforated during dilation or uterine sounding. When instruments pass further into the uterine cavity than appropriate for postpartum uterine, uterine perforation may occur.

Nursing Diagnosis

  • Risk for Injury

Risk Factors

  • Excessive pressure from the surgeon’s hand during the procedure
  • Adherent placenta
  • Postpartum placental implantation
  • Inappropriate handling of D&C instrument

Possibly evidenced by

  • (Not applicable; the presence of signs and symptoms establishes an actual diagnosis)

Desired Outcomes

After implementation of nursing interventions, the client is expected to:

  • Display hemodynamic stability through normal vital signs.
  • Be free of intrauterine bleeding.
  • Recognize signs and symptoms of postprocedural complications.

Nursing Interventions

Assessment Rationale
Assess the client’s vital signs, noting tachycardia, hypotension, and tachypnea. Hemorrhagic shock is induced by a certain amount of intra-abdominal bleeding. The body compensates for the bleeding by increasing the heart rate. As diastolic ventricular filling continues to decline and cardiac output decreases, systolic blood pressure drops.
Assess the client for the presence of abdominal pain or tenderness. Clinical symptoms of uterine perforation are prompt abdominal pain and peritoneal irritation resulting from intraperitoneal bleeding. Large defects in the intrauterine wall can result in acute abdominal pain as a result of intraabdominal hemorrhage or injury.
Assess for signs of significant vaginal bleeding. Brisk vaginal bleeding may be present, although, for some cases, it may be unnoticeable at first and gradually increase in time. Count and weigh the client’s perineal pads for each shift.
Educate the client on the signs and symptoms that should be reported immediately after the procedure or after discharge. Clinical symptoms of uterine perforation are prompt abdominal pain, dizziness, palpitations, peritoneal irritation, and significant vaginal bleeding. However, there are some instances wherein these symptoms are delayed to present and the client may only experience an inexplicable discomfort after the procedure, to which the healthcare provider should pay close attention.
Educate the client about the importance of follow-up visits. The immediate or short-term consequences of uterine perforation may be life-threatening, with a long-term complication that can affect the client’s future pregnancies.
Provide comfort measures and relaxation techniques to alleviate abdominal pain such as heat or cold applications, diversional activities, deep breathing exercises, guided imagery, etc. Heat or cold application may improve circulation, reduce muscle tension and anxiety associated with pain. Relaxation techniques relieve muscle and emotional tension and  enhance the client’s sense of control.
Monitor for signs of infection. Delayed presentation of the signs of uterine perforation may lead to infection. Signs of infection may include hyperthermia, chills, foul-smelling vaginal discharges, and body malaise.
Assist with ultrasonography as indicated. Perforation should be suspected when ultrasonography reveals hyperechogenic mass with several follicles in the postpartum uterus, especially if the client was asymptomatic after a difficult intrauterine operation. The ultrasound must be used for the detection of the location of the perforation.
Assist with laparoscopy after uterine perforation has been suspected. Laparoscopy is the preferred approach for a client with suspected uterine perforation who is hemodynamically stable. Laparoscopy is usually recommended to examine for injury and to complete the procedure if needed.

Risk for Infection

Surgical evacuation is one of the modalities of managing different types of miscarriage which occur very frequently in daily life and is associated with many complications that lead to an increase in maternal morbidity and mortality. Infection due to uterine perforation can be very serious when the perforation reaches the bowel, causing damage and necessitating performing laparotomy so as to manage the case.

Nursing Diagnosis

  • Risk for Infection

Risk Factors

  • Invasive procedures and/or increased environmental exposure
  • Incomplete evacuation of tissue fragments
  • Bowel perforation
  • Use of unsterile equipment

Possibly evidenced by

  • (Not applicable; the presence of signs and symptoms establishes an actual diagnosis)

Desired Outcomes

After implementation of nursing interventions, the client is expected to:

  • Remain afebrile
  • Achieve timely healing as appropriate
  • Verbalize understanding of individual exposure and risk factors
  • Identify interventions to prevent and reduce the risk of infection

Nursing Interventions 

Assessment Rationale
Monitor the client’s vital signs, including temperature. Frequent temperature elevations or onset of new fever indicate that the body is responding to a new infectious process or that medications are not effectively controlling incurable infections.
Note risk factors for the occurrence of infection- environmental exposure, compromised host, traumatic injury. Understanding the nature and properties of infectious agents and individual exposure determines the choice of therapeutic intervention.
Practice and demonstrate proper hand hygiene. Promote good hand hygiene by staff and visitors. Hand hygiene is the first-line defense to limit the spread of infection. In healthcare, the use of effective hand hygiene practices to prevent healthcare-associated infections, cross-infection, and reduce the spread of antimicrobial resistance has been common practice for many years. Nightingale called on nurses to wash their hands and faces frequently throughout the day, reflecting a long-standing recognition of the effectiveness of hand hygiene.
Verify sterility of all items used in procedure as event-related. Prepackaged items may appear to be sterile; however, each item must be scrutinized for manufacturer’s sterility statement or central sterile processing indicators, package integrity, environmental effect on the package, and delivery techniques.
Identify breaks in the aseptic technique and resolve them immediately upon occurrence. Contamination by environmental or personnel contact renders the sterile field unsterile, thereby increasing the risk of infection.
Encourage increased fluid intake. Adequate fluid intake enhances the immune system and aids in natural defense mechanisms.
Encourage the client to increase intake of protein-rich foods and vitamin C-rich foods. The client’s body must overcome infection and heal any wound ultimately. Nutrition is an essential component of her body’s defenses. The nurse should teach the client about foods that are high in protein (meats, cheese, milk, legumes) and vitamin C (citrus fruits and juices, strawberries, cantaloupe) because these nutrients are especially important for healing.
Emphasize the necessity of taking antibiotics as directed, especially dosage and length of therapy. Premature discontinuation of treatment when the client begins to feel well may result in the return of the infection. However, the unnecessary use of antibiotics may result in the development of secondary infections or resistant organisms.
Monitor the client’s WBC count. White blood cells (WBCs) are normally elevated during the early postpartum period to about 20,000 to 30,000 cells/mm³, which limits the usefulness of the blood count to identify infection. Leukocyte counts in the upper limits are more likely to be associated with infection than lower counts.
Administer antimicrobials, as indicated. If an infection occurs, one or more agents may be used, depending on identified pathogens. Intravenous antibiotics usually are prescribed for a postpartum infection. Frequently used antibiotics include ampicillin, gentamicin, and third-generation cephalosporins such as cefixime.
Obtain a specimen for culture and sensitivity, as indicated. A culture and sensitivity test of the uterine cavity may be performed as ordered by the healthcare provider to identify the pathogens and determine the appropriate antibiotic agent to administer.


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