Case Study on Ectopic Pregnancy

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Transcript of Case Study on Ectopic Pregnancy

A Case Study on Ectopic Pregnancy

Submitted to:

Geetha Reddy Mam

Submitted by:

G.sudeshna (08immn13) V.Prashanth (08immn12) V.Srikanth (08immn11)

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Index

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I)INTRODUCTIONWe the I.Msc Nursing sciences group was given the opportunity to have an exposure at FERNANDEZ HOSPITAL; Bogulkunta branch post opt Ward; and on found a commendable case reasonable to be presented for case study.

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I) OBJECTIVES...................................................................................... II)INTRODUCTION....................................................... III.PATIENTS HEALTH HISTORY.............................................................. a)PERSONAL DATA....................................................................................... b)PRESENT HEALTH STATUS.................................................................. c)PAST MEDICAL HISTORY....................................................................... d)FAMILY HEALTH HISTORY .. e)PHYSICAL ASSESSMENT........................................................................... IV.ANATOMY AND PHYSIOLOGY........................................................... V. PATHOPHYSIOLOGY......................................................................... VI.DIAGNOSIS............................................................................................ a)DEFINITION b)RISK AND PREDISPOSING FACTORS c) SIGNS AND SYMPTOMS .. d) DIAGNOSTIC EXAMS............................................................................ VII. SURGICAL PROCEDURE..................................................................... VIII. MEDICAL MANAGEMENT........................................................................ XI. SURGICAL MANAGEMENT...................................................................... X. NURSING MANAGEMENT..................................... XI. DRUG STUDY........................................................................ XII. CONCLUSION ... XIII.REFERENCE

Naga Lakshmi, was one of the patients admitted to the Gyne Ward. She was admitted due to diagnosed ruptured ectopic pregnancy. She has undergone Laparoscopy bilateral Salpingectomy. Ectopic Pregnancy occurs in about 1 in 250 pregnancies amounting to approximately; An ectopic pregnancy is commonly referred to as a tubal pregnancy because 95 percent occur in a fallopian tube. An ectopic pregnancy needs to be treated immediately to avoid fallopian tube damage or life threatening blood loss. When identified early, ectopic pregnancies are treatable with medication that stops the pregnancy. The group chose Naga Lakshmi as their subject primarily because her case posed as a Very intricate case requiring due understanding and knowledge. The group recognizes their partial knowledge about ectopic pregnancy and the surgical procedures involved in such condition, thus making this case a good avenue to broaden the proponents knowledge about the disease and the surgical procedures involved.

II)OBJECTIVESGeneral Objective: The main goal of the group is to be able to present the case study of our chosen client that would provide a comprehensive discussion of the pathological mechanism of the disease to yield significant information for the case study. Specific Objectives:

In order to meet the general objective, the group aims to: yestablish rapport to the patient and the patientd s significant others, yinterpret the pertinent data gathered from the patient and her significant others, ystate past and present health history of the patient, ydefine the complete diagnosis of the patient, ypresent the cephalocaudal assessment obtained from the patient, ydiscuss the anatomy and physiology of the organ involved in the patientd s disease, ypresent the etiology and symptomatology of the patientd s disease, ytrace the pathophysiology of the patientd s disease, yinterpret the laboratory test results of the patient, ydiscuss the nature of the drugs given to the patient, ydiscuss the surgical procedure performed to the patient ypresent a specific, measurable, attainable, realistic and time-bounded nursing care plans for the client yjustify the clientd s prognosis according to the different criteria

III)PATIENT HEALTH HISTORY

a)PERSONAL DATAA 31yr old lady ,G3P2L2 (Post Tubectomy) with 6+1 weeks of amenorrhea ,presents on 14-02-11 with complaints of right Iliac fossa pain since 3-4days .TVS SCAN done outside showed uterus measuring 7.6 X 3.7cm,ET-16mm. There was evidence that of single gestational sac in right tubal region measuring 7mm with decadal reaction, right tubal pregnancy and minimal free fluid in the pelvis. Scan done on 15-02-11 showed echogenic SOL in the right

adnexa.measures 32 x31 mm with 4mm gestational sac, measured moderate ascites ,ET measured 23 mm. Explained the patient regarding the need of laparoscopy / laprotomy+_bilateral salpingectomy (in view of tubectomy failure)

b) Present illness or present health statusDuring the 1st week of Jan, the patient experienced on and off vaginal spotting. No other signs and symptoms related to ectopic pregnancy manifested during this time. This condition persisted and on the 2nd week of Feb. The patient noted hypogastric pain and described it like having dysmenorrhea.. The severity of the pain increased, added with another vaginal spotting made her decide to eventually seek for medical help.

C) Past Medical History The patient was born via normal spontaneous vaginal delivery. There were no complications or abnormalities when she was delivered. She does not have any information about her immunization status. According to her, she had a chicken pox when she was 9 years old. She does not usually get cough or colds but experiences fever at times due to weather conditions.

During the first month of her pregnancy of her first child, she had bleeding. She sought for medical help and was asked to take a rest and avoid strenuous activities to avoid complications in her pregnancy. She delivered her first two babies via normal spontaneous vaginal delivery.

d) Family health statusHer father died 5 years ago due to cardiac arrest. On the other hand, her mother is still living and is hypertensive. Among her 3 siblings, one is also hypertensive.

e) PHYSICAL ASSESSMENTA. Skin The patient s skin is ry with goo skin turgor. Skin color is brown which is uniform in all areas except for areas that are not usually expose to sun such as the axillae, the legs an soles of the feet. Skin is warm to touch, which is uniform on both extremities. A surgical woun covere by a sterile ressing is note on the hypogastric area of the patient s ab omen. Both the right an left han s have scratches as it serve as IV insertion sites.

B. Hair Hair is evenly distributed over scalp. It is oily and black in color. Dandruffs are present. Fine hairs are evenly distributed on both extremities. C. Nails Nails were unclean and not well trimmed with whitish to light pink nail beds, with normal angle curvature, and with a capillary refill of 3 seconds. Fingernails and toenails were pale. Surrounding tissues were intact; no lesions nor lacerations were observed. The Head A. Skull and Face The patient s hea is normocephalic an proportional to bo y size. Presences of no ules or masses are not note . Facial features an movements are symmetrical. The patient is able to raise her eyebrows, close her eyes, frown, an smile. Her face manifests a feeling of slight tire ness. B. The Eyes The hair in the patient s eyebrows is evenly istribute ; skin is intact an symmetrically aligne with equal movement an there was no note scaling an flakiness of skin. The eyelashes are equally istribute an curle slightly outwar . Her eyeli s close symmetrically; ischarges an iscolorations were not note . Her pupil size in both eyes are equal, with a iameter of 3mm when ilate an 2mm when constricte ; with brisk reaction to light accommo ation. Accor ing to her, when looking straight ahea , she can see objects in periphery. There was no e ema or ten erness note over her lacrimal glan s. C. Nose an Sinuses The external nose is symmetrical, straight an uniform in color. Nasal flaring was not note . Color is the same with the entire face; there was no ten erness note upon palpation. Lesions an ten erness were both absent. Nasal mucosa was pinkish. Both left an right nares were patent, with no ischarges; air coul freely move in an out when the patient breathes. The nasal septum is intact an in the mi line without eviations. The frontal an maxillary sinuses were non-ten er upon palpation. Sense of smell was goo .

D. Ears Auricles are smooth, symmetrical and no discoloration noted. Her external pinna is normoset; deformities, lesions or inflammations were not present. Pinna recoils after it is being folded; it is firm and non tender. The ears were physically symmetrical in size and normoset since both are located in line with the outer canthus of his eyes. Normal voice tones are audible. E. Mouth and Oropharynx There were no lesions and masses noted on the lips and they appear moist and pinkish. Oral mucosa was pinkish and the tongue was located at the midline, pink in color, slightly dry and furry with whitish coating. She was able to move her tongue freely. The gums was pinkish, with no signs of bleeding. The uvula is in the midline and the mucosa surrounding it is slightly pink. His tonsils were free from inflammation. Dental carries were present Neck The muscles in her neck were equal in size. His neck movement was coordinated and difficulty in moving was not noted. He was able to flex, hyperextend, laterally flex and rotate his neck without distress. He can also turn his head on one side against the resistance of our hand with the similar strength and shrug his