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be curtailed, a situation that may contribute to feelings of loss of control. Assess the womans concerns and coping patterns to establish a framework for determining appropriate interventions. Nursing care plan primary nursing diagnosis: Fluid volume deficit related to blood loss. Nursing care plan intervention and treatment The patient may be confronted with a prolonged evaluation and a variety of treatments before uterine bleeding resumes a more normal pattern or stops completely. Activities are not restricted and can be continued as the woman tolerates them. If infection or anemia is identified, appropriate pharmacologic therapy is initiated. Hormonal manipulation may be indicated, requiring careful dosing and attention to compliance with the treatment plan. Surgical management typically begins with dilation and curettage to remove excessive endometrial buildup, but may include intrauterine cryosurgery, laser ablation of the endometrium, or as a last resort, a hysterectomy. Important interventions include strategies to assist the woman in maintaining normal activities during the evaluation. Instruct the woman about the signs and symptoms of toxic shock syndrome (fever, joint and muscle aches, malaise, weakness) if she continues to use tampons; more frequent than normal changes of the tampon may be indicated. The use of incontinence pads may be more beneficial than the standard feminine napkin in the presence of heavy bleeding. Issues related to sexuality, especially if hysterectomy is indicated, require an accepting, open attitude of the nurse. The woman may feel her femininity is threatened but may have difficulty expressing these feelings. You may need to initiate discussions regarding the impact of evaluation and treatment on the woman. If appropriate, consider the effect on the womans partner and include the partner in all discussions. Nursing care plan discharge and home health care guidelines Provide a list of prescribed medications, if any, that includes the name, dosage, route, and side effects and the signs and symptoms of potential complications, including hypotensive episodes. Explain the need for careful monitoring and follow-up of the bleeding. Encourage the patient to keep a menstrual calendar and record daily bleeding patterns. Teach the patient to have appropriate laboratory follow-up of the complete blood count if indicated.