Ectopic Pregnancy

CARDENAS, Jaymar

CARPIO, Marco AngeloCASABUENA,

ChristiaCASTILLO,

Maria FeCELISPARA, Hanna MarielCENTENO,

JhuwenaCENTENO,

MierCILEK,Monika

COBARRUBIAS,Jedidiah Thomas

CONDE, Ma. Angela Francesca

CONG,Jan FerbeCONOL,

Jenine Ezra

Ectopic Pregnancy

In line with the partial fulfillment in Related Learning Experience

CARDENAS, Jaymar


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

IntroductionEctopic pregnancy is any pregnancy that occurs outside the uterus. The vastmajorities (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 fertilizedegg in the tube. Pelvic Inflammatory Disease (PID), which leads to scarring ofthe tubes, is the most common cause, comprising about 30%-50% of allectopics. Pelvic infections include chlamydia and gonorrhea.

Common symptoms that a woman may experience early in an ectopicpregnancy:

a) Abdominal painb) Late or missed periodc) Vaginal bleedingd) Tissue passage from the vaginae) Pregnancy symptoms

Ectopic pregnancy is usually found in the first 5-10 weeks of pregnancy.

CARDENAS, Jaymar


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

Objectives

At the end of the case presentation, the researcher will

be able to have a deeper understanding aboutEctopic 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

CARDENAS, Jaymar


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

Personal Profile

Name: Patient LAGender: femaleBirthday: April 6, 1984Age: 25 years oldNationality: FilipinoReligion: CatholicCivil Status: Married

CARDENAS, Jaymar


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

Nursing Theory

Lydia Hall“Care, Core, Cure”

Theory

Care Core

Cure

CARDENAS, Jaymar


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

Care, Core, Cure TheoryCARDENAS,

JaymarCARPIO,

Marco AngeloCASABUENA,

ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

The theory contains of three independent but interconnected circles—the 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 TheoryCARDENAS,

JaymarCARPIO,


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

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 apregnancy 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.

CARDENAS, Jaymar


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

Physical AssessmentCARDENAS,

JaymarCARPIO,


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

Conjunctiva

1. Color, texture and presence of lesions in the bulbar conjunctiva

Pinkish or red in color; with presence of small capillaries; moist; no

foreign bodies; no ulcers

paleDue to fluid and blood

loss

2. Color, texture and presence of lesions in

the palpebral conjunctiva

Pinkish or red in color; with the presence of small

capillaries; moist; no foreign bodies; no ulcers

paleDue to fluid and blood

loss

AbdomenNo swelling, no warmth, no redness, no pain, no

tenderness when palpated

(+) painRuptured fallopian

tube

Definition of TermsCuldocentesisIncision 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

EndometriumThe 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.

BlastocystEarly 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 luteumThe 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.

CARDENAS, Jaymar


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

Anatomy and Physiology

CARDENAS, Jaymar


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

CARDENAS, Jaymar


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

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 oftissue.

In women of childbearing age, the inner layer of the uterus(endometrium) goes through a series of monthly changes known asthe menstrual cycle.

Each month, endometrial tissue grows and thickens in preparationto receive a fertilized egg. Menstruation occurs when this tissue isnot used, disintegrates, and passes out through the vagina. Theouter layer of the corpus (myometrium) is muscular tissue thatexpands during pregnancy to hold the growing fetus and contractsduring labor to deliver the child.

CARDENAS, Jaymar


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

Pathophysiology

CARDENAS, Jaymar


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

CARDENAS, Jaymar


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

BLOOD LOSSPeritoneal reaction to

blood escaping from the tube.

Nausea Vomiting

Transport of a blastocyst to the

uterus is delayed.

Irregular menses

Inflammation of fallopian tube

Uterine enlargement and contraction

PAIN

Fallopian tube is ruptured

Ovum is discharge in the abdominal cavity

Dizziness Faintness

The blastocyst implants at another available vascularized site, usually the

fallopian tube lining.

Laboratory Results

CARDENAS, Jaymar


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

UltrasoundCARDENAS,

JaymarCARPIO,


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

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.

HematologyCARDENAS,

JaymarCARPIO,


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

Findings: Normal: Interpretation:

White blood cells 12.1 4.5-11 /dl It has a sign of infection.

Neutrophils 0.62 0.1-0.7/dl Normal

Lymphocytes 0.38 1-2.8/dlAnemic or

immunodeficient

Hemoglobin 12 12-16 gm/dl Normal

Hematocrit 35 38%-46%Because of the blood

loss

Drug Study

CARDENAS, Jaymar


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

DrugClassificatio

nAction Indication Contraindication Side Effects Nursing interventions

Ceferoxime750 mg

Anti-infectives Inhibit cell wall synthesis

Promoting cell wall instability

usually bactericidal

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

UTIOtitis Media

Phrayngitis and Tonsillitits

Perioperative operative operationEarly lyme

disease

Hypersensitive to drug or other

cephalosporinsuse catiously in

patients hypertensive to penincillin because if possibility of cross-sensitivity with other beta-lactam antibiotic

use catiously in breast-feeding women and in

patients with history of colitis and renal

insufficiency.

Transient neutropeniaeosinophiliahemolytic anemia

Thrombopheniatemperature

elevation pain

Indurationsterile

abscesses tissue sloughing

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 can’t swallow.

If large doses are given, therapy is prolonged, or patient is at high risk, monitor patient for s&s of superinfectionR: The combined infection has also been shown to reduce the overall effectiveness of the immune response

Medical Management

Medical Management

CARDENAS, Jaymar


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

Action: Rationale:

CARDENAS, Jaymar


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

Nursing Management

Procedures: Rationale:

Ultrasound

a test that can find a decreased proportion of red blood cell which reflect the body’s 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.

CBC

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.

catheter

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.

CARDENAS, Jaymar


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

Other Procedures

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 showsblood in the peritoneum; possibly after laparoscopy toremove affected fallopian tube and control bleeding.

CARDENAS, Jaymar


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

Problem List

CARDENAS, Jaymar


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

CARDENAS, Jaymar


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

Cues Nursing process

Rank Justification

Subjective: N/AObjective: Lab resultsHematocrit: 35Hemoglobin: 12 Pale skin

Deficient fluid volume related to

blood loss

1 Prolonged fluid loss may lead to severe dehydration and must be implemented every after surgical procedure done to the patient.

Subjective:“Medyo nananakit ang tiyan ko ngayon.” as verbalized by thepatient.Objective: Evidence of sutured

abdomen Facial expressions

seen expressing pain

Acute pain related to incised abdominal

area

2 Pain must be achieved because it can alter the normal function

of an individual thus altering her daily activity.

Subjective:”Sayang talaga, wala lang sa lugar yung pinagbubuntis ko kaya ko pinaoperahan na.”as verbalized by the patient.

Objective: feels down repetitive

verbalization of the past surgery

Grieving related to loss of child

3 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

CARDENAS, Jaymar


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

CARDENAS, Jaymar


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

Client who has undergone Exploratory Laparotomy with

underlying condition of Ectopic Pregnancy

Keep fluids within patients reach and encourage frequent fluid intake as

possible.

Maintain accurate I/O and weigh daily.

Administer IV fluids as possible

Discuss factors related to occurrence of dehydration.

Nursing Diagnosis

Risk for deficient

fluid volume

related to blood loss

Desired outcomesThe patient will be able to maintain fluid balance and understand its causative factors and find appropriate intervention for it.

Subjective:N/A

Objective:Hematocrit: 35

Hemoglobin: 12

Monitor Vital Sings regularly.

CARDENAS, Jaymar


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

Client who has undergone Exploratory Laparotomy with

underlying condition of Ectopic Pregnancy

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

goal

Use pillows, cloth into the incised area to lessen impact whenever the patient

moves or touches it.

Instruct in usage of relaxation techniques like deep breathing

exercises to promote proper blood circulation.

Nursing DiagnosisAcute pain related to incised

abdominal area

Desired outcome(s): The patient will be able to control the pain and will also find ways to lessen its occurrence.

Subjective:“Medyo nananakit ang tiyan ko ngayon.” As verbalized by the patient.Objective:Evidence of sutured abdomenFacial expressions seen expressing pain

Encourage diversional activities like talking to others reading newspaper,

etc.

CARDENAS, Jaymar


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

Client who has undergone Exploratory Laparotomy

with underlying condition of Ectopic Pregnancy

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

Encourage involvement in usual activities, exercise and social

activities within limits of physical activity.

Respect patient’s need for privacy or silence.

Nursing DiagnosisGrieving related to loss of child

Desired outcomes): The patient will be able to demonstrate progress in dealing with stages of grief at own pace.

Subjective:”Sayang talaga, wala lang sa lugar yung pinagbubuntis ko kaya ko pinaoperahan na.” as verbalized by the patient.Objective:deels downrepetitive verbalization of the past surgery

Acknowledge reality of feelings of guilt/blame

Discharge PlanningCARDENAS,

JaymarCARPIO,


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

Thank you CARDENAS, Jaymar


ChristiaCASTILLO,


JhuwenaCENTENO,

MierCILEK,Monika




Jenine Ezra

Thank you

Thank you Thank you

Thank you Thank you

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Thank you

Ectopic Pregnancy

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