Ectopic Pregnancy

CARDENAS, Jaymar CARPIO, Marco Angelo CASABUENA, Christia CASTILLO, Maria Fe CELISPARA, Hanna Mariel CENTENO, Jhuwena CENTENO,
Mier CILEK, Monika COBARRUBIAS, Jedidiah Thomas CONDE, Ma. Angela Francesca CONG, Jan Ferbe CONOL, Jenine Ezra
Ectopic Pregnancy
In line with the partial fulfillment in Related Learning Experience
CARDENAS, Jaymar CARPIO, Marco Angelo CASABUENA, Christia CASTILLO, Maria Fe CELISPARA, Hanna Mariel CENTENO, Jhuwena CENTENO, Mier CILEK, Monika COBARRUBIAS, Jedidiah Thomas CONDE, Ma. Angela Francesca CONG, Jan Ferbe CONOL, Jenine Ezra
Introduction
Ectopic pregnancy is any pregnancy that occurs outside the uterus. The vast majorities (95%) of these are in the fallopian tubes. Other possibilities are the ovary, cervix, or abdominal cavity. It occurs in about 1 out of 200 pregnancies. It is very serious because when the pregnancy grows in these abnormal areas, it can easily cause massive, rapid bleeding, which can result in a decrease in fertility and even death. Usually, some sort of anatomical problem exists which traps the fertilized egg in the tube. Pelvic Inflammatory Disease (PID), which leads to scarring of the tubes, is the most common cause, comprising about 30%-50% of all ectopics. Pelvic infections include chlamydia and gonorrhea. Common symptoms that a woman may experience early in an ectopic pregnancy: a) Abdominal pain b) Late or missed period c) Vaginal bleeding d) Tissue passage from the vagina e) Pregnancy symptoms Ectopic pregnancy is usually found in the first 5-10 weeks of pregnancy.
Objectives
At the end of the case presentation, the researcher will be able to have a deeper understanding about Ectopic Pregnancy. Specifically, students will be able to: have an overview about the complication, Ectopic Pregnancy enumerate treatment and management of Ectopic Pregnancy formulate an appropriate nursing care plan for patients undergoing Ectopic Pregnancy
Personal Profile
Name: Patient LA Gender: female Birthday: April 6, 1984 Age: 25 years old Nationality: Filipino Religion: Catholic Civil Status: Married
Nursing Theory
Lydia Hall Care, Core, Cure Theory
Care Core
Cure
Care, Core, Cure Theory

The theory contains of three independent but interconnected circlesthe core, the care and the cure. According to the theory, the core is the person or patient to whom nursing care is directed and needed. It has been mentioned that the core has goals set by the patient herself and not by any other person, and that these goals need to be achieved. The core, in addition, behaved according to his feelings, and value system. The cure, on the other hand is the attention given to patients by the medical professionals. It has been explicit in stating that the cure circle is shared by the nurse with other health professionals. These are the interventions or actions geared on treating or curing the patient from whatever illness or disease he may be suffering from. Some interventions in relation to this are prescribing pharmacologic therapies and performing diagnostic tests. The highlight however is the care model. This is the part of the model reserved for nurses, and focused on performing that noble task of nurturing the patients, meaning the component of this model is the motherly care provided by nurses, which may include, but is not limited to provision of comfort measures, provision of patient teaching activities and helping the patient meet their needs where help is needed.
Care, Core, Cure Theory

That means that if all three circles exhibit harmony and balance, the patient will be the one to benefit from it all since his needs are being put into priority but the meeting of it depends on which circle of the model is responsible for meeting such activities. It was hard not to see that in all of the circles of the model, the nurse is always presents, but the bigger role she takes belongs to the care circle where she acts a professional in helping the patient meet his needs and attain a sense of balance. In relation to Patient LA, the patient serves as the core together with the relatives whom nursing care is needed and must be given. The patient sets goal for the relief and this must be achieved according to what the patient feels. On the other hand, the attention the nurses give to the patient serve as the cure. The patient will achieve his goal with the help of all the medical team. Lastly, the care which is the task for the nurses. It focuses on performing the tasks. The nurses will give necessary interventions and actions that gears in treating and curing the patient (core). These three components, the patient, the attention and the care by the nurse should have balance and each one has benefit to one another not to the patient only.
History of Present Illness

2 days prior to admission she had experienced abdominal pain. As well as nausea and vomiting. Consultation was done and advice her to do a pregnancy test. Few hours before admission the patient has undergo to ultrasound and found out that the embryo was in the left fallopian tube and not in the uterine wall. The patient had decided to remove the embryo.
Physical Assessment
Conjunctiva 1. Color, texture and presence of lesions in the bulbar conjunctiva 2. Color, texture and presence of lesions in the palpebral conjunctiva Pinkish or red in color; with presence of small capillaries; moist; no foreign bodies; no ulcers Pinkish or red in color; with the presence of small capillaries; moist; no foreign bodies; no ulcers Due to fluid and blood loss
pale
pale
Due to fluid and blood loss
Abdomen
No swelling, no warmth, no redness, no pain, no tenderness when palpated
(+) pain
Ruptured fallopian tube
Definition of Terms
Culdocentesis Incision made into the wall of vagina, usually the posterior wall, close to cervix. This was formerly used to confirm diagnosis of ectopic pregnancy but has now replaced by laparoscopy Endometrium The mucous membrane lining the uterus, which becomes progressively thicker and more glandular and has an increased blood supply in the latter part of the menstrual cycle. Blastocyst Early stage of embryonic development that consists of hollow ball of cells with a localized thickening (inner cell mass) that will develop into the actual embryo Corpus luteum The glandular tissue in the ovary that forms at the site of a ruptured follicle after ovulation. It secretes the hormone progesterone, which prepares the uterus for implantation.
Anatomy and Physiology
Embryo
Uterus: The uterus (womb) is a hollow, pear-shaped organ located in a woman's lower abdomen between the bladder and the rectum. The narrow, lower portion of the uterus is the cervix; the broader, upper part is the corpus. The corpus is made up of two layers of tissue. In women of childbearing age, the inner layer of the uterus (endometrium) goes through a series of monthly changes known as the menstrual cycle. Each month, endometrial tissue grows and thickens in preparation to receive a fertilized egg. Menstruation occurs when this tissue is not used, disintegrates, and passes out through the vagina. The outer layer of the corpus (myometrium) is muscular tissue that expands during pregnancy to hold the growing fetus and contracts during labor to deliver the child.
Pathophysiology
Irregular menses
Transport of a blastocyst to the uterus is delayed.
The blastocyst implants at another available vascularized site, usually the fallopian tube lining.
Inflammation of fallopian tube
Uterine enlargement and contraction
Fallopian tube is ruptured
Ovum is discharge in the abdominal cavity
PAIN
Dizziness
Faintness
Nausea
Vomiting
BLOOD LOSS
Peritoneal reaction to blood escaping from the tube.
Laboratory Results
Ultrasound
Diagnosis: Normal right anteverted with slightly thickened endometrium, cystic to right ovary to consider corpus luteum, complex mass noted in the left abdomen. To consider ectopic genitalia with HCG determinate s clinically.
Hematology
Findings: White blood cells Neutrophils Lymphocytes Hemoglobin Hematocrit 12.1 0.62 0.38 12 35 Normal: 4.5-11 /dl 0.1-0.7/dl 1-2.8/dl 12-16 gm/dl 38%-46% Interpretation: It has a sign of infection. Normal Anemic or immunodeficient Normal Because of the blood loss
Drug Study
Drug Ceferoxime 750 mg
Classification Anti-infectives
Action Inhibit cell wall synthesis Promoting cell wall instability usually bactericidal
Indication Pharyngitis, tonsillitis, infection of the urinary or lower respiratory tracts, and/or skin structure infection caused by Streptococcus pneumonia and Sypogenes. Serious lower respiratory tract infection, UTI, skin or skin structures, bone or joint infection, septicemia, meningitis and gonorrhea. Uncomplicated UTI Otitis Media Phrayngitis and Tonsillitits Perioperative operative operation Early lyme disease
Contraindication Hypersensitive to drug or other cephalosporins use catiously in patients hypertensive to penincillin because if possibility of crosssensitivity with other beta-lactam antibiotic use catiously in breast-feeding women and in patients with history of colitis and renal insufficiency.
Side Effects Transient neutropenia eosinophilia hemolytic anemia Thrombophenia temperature elevation pain Induration sterile abscesses tissue sloughing
Nursing interventions Ask patient if allergic to penicillins or cephalosporins Obtain specimen for culture and sensitivity test before giving first dose. R: This medication can cause you to have unusual results with certain lab tests to check for glucose (sugar) in the urine. Tablets may be crushed, if absolutely necessary for patients who cant swallow. If large doses are given, therapy is prolonged, or patient is at high risk, monitor patient for s&s of superinfection R: The combined infection has also been shown to reduce the overall effectiveness of the immune response
Medical Management
Medical Management
Nursing Management
Action: Rationale:
Other Procedures
Procedures: Rationale: a test that can find a decreased proportion of red blood cell which reflect the bodys inability to produce enough red blood cells to replenish what has been out of blood stream. And it is use to find a reduced proportion of red blood cells or an elevation of white blood cells. which can show whether the uterus contains a developing fetus or if masses are present elsewhere in the abdominal area. It reveals of a viable fetus. Catheterization allows the patient's urine to drain freely from the bladder for collection, or to inject liquids used for treatment or diagnosis of bladder conditions.
Ultrasound
CBC
catheter
Surgical Management
Laparoscopy - to visually detect unruptured tubal pregnancy and thereby avoid the risk of its rupture. And reveal pregnancy outside the uterus. Salpingectomy -removal of the fallopian tube Laparotomy and salpingectomy if culdocentesis shows blood in the peritoneum; possibly after laparoscopy to remove affected fallopian tube and control bleeding.
Problem List
Cues
Subjective: N/A Objective: y Lab results Hematocrit: 35 Hemoglobin: 12 y Pale skin Subjective: Medyo nananakit ang tiyan ko ngayon. as verbalized by the patient. Objective: y Evidence of sutured abdomen y Facial expressions seen expressing pain Subjective: Sayang talaga, wala lang sa lugar yung pinagbubuntis ko kaya ko pinaoperahan na. as verbalized by the patient. Objective: y feels down y repetitive verbalization of the past surgery
Nursing process
Deficient fluid volume related to blood loss
Rank
1
Justification
Prolonged fluid loss may lead to severe dehydration and must be implemented every after surgical procedure done to the patient.
Acute pain related to incised abdominal area
Pain must be achieved because it can alter the normal function of an individual thus altering her daily activity.
Grieving related to loss of child
Stress. If pregnancy is desired, loss may be expressed and the impact may not be fully realized until much later. For as long as there is loss, grief reaction will follow and would give persistent psychological distress
Concept Mapping
Client who has undergone Exploratory Laparotomy with underlying condition of Ectopic Pregnancy Subjective: N/A Objective:
Hematocrit: 35
Hemoglobin: 12
Monitor Vital Sings regularly. Desired outcomes The patient will be able to maintain fluid balance and understand its causative factors and find appropriate intervention for it.
Nursing Diagnosis Risk for deficient fluid volume related to blood loss
Keep fluids within patients reach and encourage frequent fluid intake as possible.
Administer IV fluids as possible
Maintain accurate I/O and weigh daily.
Discuss factors related to occurrence of dehydration.
Client who has undergone Exploratory Laparotomy with underlying condition of Ectopic Pregnancy CARDENAS, Jaymar CARPIO, Marco Angelo CASABUENA, Christia CASTILLO, Maria Fe CELISPARA, Hanna Mariel CENTENO, Jhuwena CENTENO, Mier CILEK, Monika COBARRUBIAS, Jedidiah Thomas CONDE, Ma. Angela Francesca CONG, Jan Ferbe CONOL, Jenine Ezra
Subjective: Medyo nananakit ang tiyan ko ngayon. As verbalized by the patient. Objective: Evidence of sutured abdomen Facial expressions seen expressing pain Encourage diversional activities like talking to others reading newspaper, etc. Desired outcome( s): The patient will be able to control the pain and will also find ways to lessen its occurren ce.
Nursing Diagnosis Acute pain related to incised abdominal area
Administer analgesics as indicated. Then notify if regimen is inadequate to meet goal
Instruct in usage of relaxation techniques like deep breathing exercises to promote proper blood circulation.
Use pillows, cloth into the incised area to lessen impact whenever the patient moves or touches it.
Client who has undergone Exploratory Laparotomy with underlying condition of Ectopic Pregnancy CARDENAS, Jaymar CARPIO, Marco Angelo CASABUENA, Christia CASTILLO, Maria Fe CELISPARA, Hanna Mariel CENTENO, Jhuwena CENTENO, Mier CILEK, Monika COBARRUBIAS, Jedidiah Thomas CONDE, Ma. Angela Francesca CONG, Jan Ferbe CONOL, Jenine Ezra
Subjective: Sayang talaga, wala lang sa lugar yung pinagbubuntis ko kaya ko pinaoperahan na. as verbalized by the patient. Objective: deels down repetitive verbalization of the past surgery
Acknowledge reality of feelings of guilt/blame Desired outcome s): The patient will be able to demonstr ate progress in dealing with stages of grief at own pace.
Nursing Diagnosis Grieving related to loss of child
Provide comfort and availability as well as caring for physical needs.
Respect patients need for privacy or silence.
Encourage involvement in usual activities, exercise and social activities within limits of physical activity.
Discharge Planning
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Ectopic Pregnancy

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CARDENAS, Jaymar CARPIO, Marco Angelo CASABUENA, Christia CASTILLO, Maria Fe CELISPARA, Hanna Mariel CENTENO, Jhuwena CENTENO,

Care, Core, Cure Theory

Care, Core, Cure Theory

History of Present Illness

Due to fluid and blood loss

No swelling, no warmth, no redness, no pain, no tenderness when palpated

Ruptured fallopian tube

Anatomy and Physiology

Transport of a blastocyst to the uterus is delayed.

Inflammation of fallopian tube

Uterine enlargement and contraction

Fallopian tube is ruptured

Ovum is discharge in the abdominal cavity

Peritoneal reaction to blood escaping from the tube.

Drug Ceferoxime 750 mg

Acute pain related to incised abdominal area

Grieving related to loss of child

Administer IV fluids as possible

Maintain accurate I/O and weigh daily.

Discuss factors related to occurrence of dehydration.

Nursing Diagnosis Acute pain related to incised abdominal area

Administer analgesics as indicated. Then notify if regimen is inadequate to meet goal

Nursing Diagnosis Grieving related to loss of child

Provide comfort and availability as well as caring for physical needs.

Respect patients need for privacy or silence.

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