INTRODUCTION
Ectopic Pregnancy is a complication of pregnancy in which the pregnancy implants
outside the uterine cavity. With rare exceptions, ectopic pregnancies are not viable.
Furthermore, they are dangerous for the mother, internal bleeding being a common
complication. Most ectopic pregnancies occur in the Fallopian tube , but
implantation can also occur in the cervix, ovaries, and abdomen. An ectopic
pregnancy is a potential medical emergency, and, if not treated properly, can lead
to death.
II. OBJECTIVES
General: To have a comprehensive study and knowledge about ectopic pregnancy.
Specific
1.) We will have better understanding of ectopic pregnancy by reading books, articles and journals
that are related with the disease;
2.) Understand clearly the pathophysiology of the disease, risk factors, manifestations and
treatment and modalities of the disease; and
3.) Equip ourselves with skills and health teachings that are appropriate for the care of patients with
ectopic pregnancy.
Mrs. A. has no previous medical problem and never hospitalized due to serious illness. Mrs. A. had
her first pregnancy last 2000 and delivered a live full term baby girl via normal spontaneous delivery.
On her second pregnancy last 2001, she had an incomplete abortion and undergo Dilation and
Curettage.
Mrs. A. is a G3P1 (1011) 9 3/7 weeks AOG with chief complaint of hypogastric pain and vaginal
bleeding.
On October 14, Mrs. A experienced vaginal spotting that lasted for 3 days so she decided to went to
her doctor for a consult and advised her to undergo trans-vaginal ultrasound. The UTZ revealed no
intrauterine, no extrauterine pregnancy with thin endometrium. She had her pregnancy test and
revealed positive with increase HCG level and advised her to take Duphaston three times a day.
One day prior to hospitalization, the patient experienced hypogastric pain and cramping and non-
radiating with increase amount of vaginal bleeding that consumed 2 pads per day with minimal to
moderately soaked.
C. Family History
Mrs. A. had a familial history of hypertension on her father side. No known history of cancer,
asthma, diabetes mellitus and thyroid disease.
V. PHYSICAL ASSESSMENT
General Normal Standards Actual Findings Interpretation and
Appearance Analysis
1. Posture/Gait >Straight posture, have >Patient can lie on bed but >Limitations in usual role
balance gait unable to stand and sit on activities
her own. >The patient needs
guidance from the nurse
because of pain from
surgical site.
>Pain tolerance is the
maximum amount and
duration of pain that an
individual is willing to
endure. Some clients are
unable to tolerate even
the slightest pain.
INTERNAL GENITALIA
a. Fallopian tube/Oviduct – 4 inches long from each side of the uterus (fundus). Ittransports the
mature ova form the ovaries to the uterus and provide a place for fertilization of the ova by the
sperm in its outer 3rd or outer half.
Parts:
Interstitial – lies within the uterine wall
Isthmus – portion that is cut or sealed in a tubal ligation.
Ampulla – widest, longest portion that spreads into fingerlike projections/fimbriae and it is
where fertilization usually occurs.
Infundibulum - rim of the funnel covered by fimbriated cells (hair covered fingerlike
projections) that help to guide the ova into the fallopian tube.
b. Ovaries – Oval, almond sized, dull white sex glands on either side of the uterus that measures 4 by
2 cm in diameter and 1.5 cm thick. It is responsible for the production, maturation and discharge of
ova and secretion of estrogen and progesterone.
c. Uterus – hollow, pear-shaped muscular organ, 3 inches long, 2 inches wide, weighing 50-60 grams
held in place by broad and round ligaments, and abundant blood supply from the uterine and
ovarian arteries. It is located in the lower pelvis, posterior to the bladder and anterior to the rectum.
Organ of menstruation, site of implantation and provide nourishment to the products of conception.
Layers:
1. Perimetrium – outermost layer of the uterus comprised of connective tissue, it offers added
strength and support to the structure.
2. Myometrium – middle layer, comprised of smooth muscles running in 3 directions; expels fetus
during birth process then contracts around blood vessels to prevent hemorrhage.
3. Endometrium – Inner layer which is visibly vascular and is shed during menstruation and
following delivery.
Divisions of the Uterus:
1. Fundus – upper rounded, dome-shaped portion that can be palpated to determine uterine growth
during pregnancy and the force of contractions and for the assessment that the uterus is returning to
its non-pregnant state following child birth.
2. Corpus – body of the uterus.
3. Isthmus – area between corpus and cervix which forms part of the lower uterine segment. It
enlarges greatly to aid in accommodating the fetus. The portion that is cut when a fetus is delivered
by a caesarian section.
4. Cervix – lower cylindrical portion that represents 1/3 of the total uterus. Half of it lies above the
vagina; half of it extends to the vagina. The cavity is termed the cervical canal. It has 2 openings/Os:
internal os that open to the uterine cavity and the external os that opens to the vagina.
5. Vagina – a 3-4 inch long dilatable canal located between the bladder and the rectum, it contains
rugnae which permit considerable stretching without tearing. It acts as an organ of
intercourse/copulation and passageway for menstrual discharges and fetus. Doderlein’s bacillus is the
normal flora of the vagina which makes the pH of vagina acidic, detrimental to the growth of
pathologic bacteria.
EXTERNAL GENITALIA
a. Mons Veneris/Pubis – Pad of fat which lies over the symphysis pubis where dark and curly hair
grows in triangular shape that begins 1-2 years before the onset of menstruation. It protects the
surrounding delicate tissues from trauma.
b. Labia Majora – Two (2) lengthwise fatty folds of skin extending from mons veneris to the perineum
that protects the labia minora, urinary meatus and vaginal orifice.
c. Labia Minora – 2 thinner, lengthwise folds of hairless skin extending from clitoris to fourchette.
Glands in the labia minora lubricates the vulva
Very sensitive because of rich nerve supply
Space between the labia is called the Vestibule
d. Clitoris – small, erectile structure at the anterior junction of the labia minora that contains more
nerve endings. It is very sensitive to temperature and touch, and secretes a fatty substance called
Smegma. It is comparable to the penis in its being extremely sensitive.
e. Vestibule – the flattened smooth surface inside the labia. It encloses the openings of the urethra
and vagina.
f. Skene’s Glands/Paraurethral Glands – located just lateral to the urinary meatus on both sides.
Secretion helps lubricate the external genital during coitus.
g. Bartholin’s Gland/Vulvovaginal Glands – located lateral to the vaginal opening on both sides. It
lubricates the external vulva during coitus and the alkaline pH of their secretion helps to improve
sperm survival in the vagina.
h. Fourchette – thin fold of tissue formed by the merging of the labia majora and labia minora below
the vaginal orifice.
i. Perineum – muscular, skin-covered space between the vaginal opening and the anus. It is easily
stretched during childbirth to allow enlargement of vagina and passage of the fetal head. It
contains the muscles (pubococcygeal and levator ani) which support the pelvic organs, the arteries
that supply blood and the pudendal nerves which are important during delivery under anesthesia.
j. Urethral meatus – external opening of the urethra. It contains the openings of the Skene’s glands
which are often involved in the infections of the external genitalia.
k. Vaginal Orifice/Introitus – external opening of the vagina, covered by a thin membrane
called Hymen.
VII. PATHOPHYSIOLOGY
CBC
Test Oct. 23 Oct. 24 Reference Values
Hemoglobin 10.8 12.3 12:00 – 15.00 g/dL
Hematocrit 33.0 38 36.00 – 46.00 %
RBC Count 3.68 4.23 4.00 – 4.50 x 10^ 6/L
MCV 89.7 89 80.00 – 100.00 fl
MCH 29.3 29 27.00 – 31.00 pg
MCHC 32.7 33 32.00 – 36.00 %
Platelets 212 217 150.00 – 400.00 x 10^
3/L
WBC Count 6.63 9.7 4.50 – 11.00 x 10^ 3/L
Eosinophil 1 1 1.00 – 4.00 %
Neutrophil 60 66 36.00 – 66.00 %
Lymphocyte 32 23 22.00 – 40.00 %
Monocyte 8 10 4.00 – 8.00 %
RDW 12.7 12.8 8.50 – 15.00
Medical
Surgical
If hemorrhage has already occurred, surgical intervention may be necessary. However, whether to
pursue surgical intervention is an often difficult decision in a stable patient with minimal evidence of
blood clot on ultrasound.
Surgeons use laparoscopy or laparotomy to gain access to the pelvis and can either incise the
affected Fallopian and remove only the pregnancy (salpingostomy) or remove the affected tube with
the pregnancy (salpingectomy).
Pre-operatively
Risk for ineffective tissue 2 A potential problem that needs intervention to prevent
perfusion related to hemorrhage risk for hypovolemic shock and may lead to maternal
mortality
Intra-operatively
Post-operatively
Nursing Diagnosis Rank Justification
Grieving, dysfunctional related 1 An actual problem that needs attention because it
to perceived loss of a child may lead to psychological problem( major
depression, anxiety and suicide)
Risk for infection related to 2 It is a potential problem that should be given prompt
surgical incision interventions so as not to worsen and aggravate the
patient’s condition.
It is also a sign that we need to monitor, and check if
the patient has the risk for infection
Ineffective individual coping 3 It is a possible problem that if not given proper
related to personal vulnerability assessment and intervention may lead to serious
problem that may develop not just physically but also
emotionally.
Pre-operative
After 30
Objecti After 30 ●Monitor CBC ●To minutes of
ve minutes of determine nursing
Facial nursing the interventio
mask interventio ●Encourage verbalization of amount of n, the
of pain n,the feeling about pain. blood patient
Guardi patient will loss. was able
ng report ●It can to report
behavi reduction reduce reduction
or of pain anxiety of pain
Pain from 8 to 4 and fear from 8 to 4
scale of pain thereby of pain
of 8 (1 scale as ●Provide comfort measure like reduce scale as
as no evidenced backrubs ,deep breathing. perceptio evidenced
pain by less Instruct in visualization n of by less
10 as facial exercises. intensity facial
worst grimace. of pain. grimace.
pain) ●It may
enhance
patient’s
coping
● Provide diversional activities. abilities
by
refocusing
attention.
●Aids in
Dependent refocusing
●Administer medications as attention
indicated. and
enhancing
coping
with
Collaborative limitation.
●Laboratory as indicated.
●To
maintain
acceptabl
e level of
pain.
●To
determine
blood loss
Independent:
Ectopic Review history for preexisting
pregnancy is conditions/risk factors.
gestation
located outside
the uterine Monitor vital signs.
cavity.
Predisposing Provide perineal care per
protocol
factors:
Collaborative:
adhesion of the
Carry out preoperative skin
tube preparation; scrub according to
,salphingitis,co protocol.
ngenital and
developmental
anomalies of Verify sterility and integrity of
the fallopian all items used in the procedure.
tube,previous
ectopic
pregnancy,use Verify that preoperative skin
d of IUD for preparation was done
more than 2 aseptically.
years and
Examine skin for breaks or
multiple
irritation, signs of infection.
induced
abortions,
menstrual Identify breaks in aseptic
reflux and technique and resolve
decreased immediately on occurrence.
tubal motility.
Administer antibiotics, as
ordered.
Intra-operatively
CUES NURSING GOAL and NURSING INTERVENTIONS RATIONA EVALUATI
DIAGNOSIS OBJECTIVE LE ON
S
An
unsterile
item that
touches
sterile
items is
considered
unsterile.
May be
given
prophylacti
cally for
suspected
infection
or
contamina
tion
NURSING OBJECTIVE NURSING INTERVENTIONS RATIONALE EVALUATIO
DIAGNOSIS and GOAL N
Independent After 8
Grieving, Goal: Identify(be aware of) stage ●To assess hours of
dysfunctional After the of grief being expressed: contributing nursing XI. DRUG ANALYSIS
related to end of Bargaining, Anger, Denial, /causative interventio
Generic Name
perceived loss Dosage Depression,
nursing ActionAcceptanceIndication Contraindicati
n the Adverse Effect Nursing Consideration
factors that
on
of a child care the precipitates/ patient is
Paracetamol 600 mg IV
patient PRNBe aware
will Analgesic and Fever reduction.
of avoidance Paracetamol
contributes able to GI: hepatic 1. Do not use this
Antipyretic Temporary should not be failure medication without medical
be able to behaviors (anger, grief and to verbalizes
relief of mild to used in GU: renal failure direction for fever.
demonstrat withdrawal) the a sense of Skin: rash,
indicate hypersensitivity
moderate pain 2. Do not self medicate
e progress to the progress urticaria
appropriate adults for pain more than
in dealing Identify factors and ways toward
choice ofpreparation and 10 days without consulting
with stages individual has dealt with therapeutic resolution
in severe liver a physician.
of grief at previous loss(es) communicat of the grief
diseases. 3. Do not take other
own pace. ion and hope medications containing
for the acetaminophen without
After 8 To further future medical advice, overdosing
hours of assess the and chronic use can cause
liver damage and other
nursing present
toxic effects
interventio situation
Cefuroxime 750 mg IV q8 Semi- synthetic Treat wide Contraindicated Diarrhea, 1. Inform the physician if
n the cephalosporin variety of in patients nausea and you have liver or kidney
patient will antibiotic infection hypersensitivity vomiting, disease.
be able to similar to ●Assist to drug or other abdominal pain. 2. Instruct the patient to
verbalizes penicillin patient to
cephalosporin. Headache, rash, follow the prescribed
a sense of ●Encourage verbalization deal Use cautiously vaginitis, and frequency of the drug even
progress without confrontation in breastfeeding mouth ulcers.
appropriatel if he feels better.
toward about realities women and in
y with loss 3. Instruct the patient to
resolution patients with
-helpful in take it with meals.
of the grief beginninghistory of colitis 4. Instruct the patient to
or renal report any adverse reaction
and hope Encourage patient to talk resolution
insufficiency. of the drug.
for the about what the patient and
Demerol 25 mg IV Analgesic, Medical: Hypersensitivity Cardiovascular: 1. If I.V. administration is
future chooses and do not try
Narcotic to
Management acceptance
of to meperidine Hypotension required, inject very slowly
force the patient to face
moderate to or any Central nervous using a diluted solution;
as the fact severe pain; component; system: administer over at least 5
evidenced adjunct to patients Fatigue, minutes; intermittent
by no Active listen feelingsanesthesia
and and receiving MAO drowsiness, infusion.
guarding preoperative
be available for support/ inhibitors dizziness 2. May cause hypotension,
behavior sedation
assistance(speak in soft, presently or in Gastrointestinal: dizziness, drowsiness,
and caring voice) the past 14 Nausea, impaired coordination, or
absence of days vomiting, blurred vision; loss of
constipation appetite, nausea, or
facial mask Acknowledge reality of
Neuromuscular vomiting; constipation.
of pain. feelings of guilt and assist & skeletal: 3. Report chest pain, slow
patient to take steps Weakness or rapid heartbeat, acute
toward resolution
• Patients who have received spinal anesthesia may experience nausea and occasionally,
vomiting. It is therefore preferable to instruct the patient to eat a bland light meal or a
liquid diet once fully awake after surgery. Regular diet may be resumed the next day.
Also, pain medication may cause nausea if taken on an empty stomach. It would be better
to take that medication with a piece of toast or some food.
• To help to avoid constipation and promote healing eat fruits and vegetables and drink 6
to 8 glasses of water each day, stool softeners or mild laxative may be needed if no
positive bowel movement within 3 days after surgery as prescribed by the doctor.
• Patient should void spontaneously within 6 to 8 hours after catheter is removed. Normal
bowel function should return by third or fourth post op day.
• Instructed the patient of no heavy lifting while in recovery from surgery, must not lift
weights over 15 pounds, heavy lifting puts too much strain on lower abdomen and
abdominal muscle may rupture, heavy lifting may pop the stitches in incision site.
• Walk or move legs as much as possible, to prevent blood clots and gradually resume
normal activity.
• Support abdomen when coughing, turning and deep breathing. Place a pillow over
abdomen and apply pressure on it to support and minimize pain.
• Medications compliance was instructed, teach patient and family to care for the wound
and perform dressing changes and irrigations as prescribed.
• Antibiotic is usually prescribed for seven to ten days following surgery. Instruct to take
them as ordered.
• Remind to keep the incision clean and dry during first week after surgery to prevent
infection.
• Instruct the patient that she may shower after removal of dressing; wash it with soap and
water then pat dry and instruct not to use oils and lotion over incision area.
• Instruct the patient to have slowly increase activities. Begin with light chores, short walks.
• Instruct the patient to avoid excessive stair climbing for two weeks after the surgery.
• Refer for home care nursing as indicated to assist with care and continued monitoring of
complications and wound healing.
• Reinforce need for follow-up appointment with the surgeon one week after the discharge
• Instruct the patient not to engage in strenuous exercise or resume sexual intercourse until
check up with the doctor.
XIII. BIBLIOGRAPHY