The presentation

Nursing care

Ectopic Pregnancy

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ROSMINAHRUSLYRESKI

OUTLINE

Background

Anatomy physiology reproductive organs

Definition

Etiology

Risk Factors

Signs and Sympton

Patofisiology

Complication

Supporting investigation

Management / treatment

Nursing Care

Background

Ectopic pregnancy is an abnormal location of the implantation of a fertilized egg cell, where the location of the products of conception grow and develop are not on the endometrial cavity of the uterus.

These abnormalities can cause many complications in pregnancy one of which is the Ectopic Pregnancy Impaired

By The Centers for Disease Control and Prevention in the United States the incidence of ectopic pregnancy ranges from 1-2% of all pregnancies and is a major cause of death Mothers common in the first trimester of pregnancy.

In Indonesia, particularly West Java at Dr dr. Hasan Sadikin period in 2011 found 103 cases with the most common location on the tube that is 82 cases

Anatomy physiology reproductive organs inner female genitalia

Ovarium

fallopian tube

Uterus

Vagina

Definition

Ectopic pregnancy is a pregnancy where implantation / nidasi / fruit attachment pregnancy outside the normal place, ie outside the uterine cavity.

While known as ruptured ectopic pregnancy is an ectopic pregnancy who experienced abortion rupture in the tube wall.

Etiology

Most of the causes are not well known. Each pregnancy is known to egg growth ampulla tuba section, and on the way to the uterus then obstacles when they dituba fallopian nidasi.

According Trijatmo Rachimhadhi in his book describes some of the factors associated with ectopic pregnancy causes impaired :

Cont ...

Factor in the lumen of the tube.Factors tuba lumen wallFactors beyond the walls of the

tube lumenOther factors

factors associated with ectopic pregnancy causes impaired

Mechanical factors

Functional Factor

Improving the acceptance of tubal mucosa of the fertilized ovum.

Other things like; KET history and the history of previous induced abortion

location of ectopic pregnancy

Cont ...

Risk Factors

a.Endosalpingitis.

b. Diverticula.

c. Tumor pressing on the tube.

d. Previous surgery, such as tubal ligation or resection.

e. Ovum transfer.

f. Konginital defects of the reproductive tract.

g. Ectopic endometrial implants in the fallopian mucosa.

h. Sexually transmitted infection in the tubes.

i. Intrauterine devices.

j. Smoking.

k. Hormonal contraception.

(Williams & Wilkins, 2011).

Signs and Symtompspregnancy has not been disturbed

a little pain in the lower abdomen that is not how ignored. On vaginal examination, uterus enlarged and flabby, even though the amount may not be according to gestational age. Tuba containing products of conception because they flabby hard palpable on bimanual examination

Interrupted tubal pregnancy symptoms are very different from bleeding a lot to arrived in the abdominal cavity until there are no obvious symptoms make diagnosis difficult

Cont ..

Pain is the main complaint on ruptured ectopic pregnancy. At tubal rupture lower abdominal pain occurs suddenly - arrived and strong intensity accompanied by hemorrhage that caused the mother fainted and went into shock.

Beeding pervaginaAmenore

Ruptured Etopic Pregnancy

gastrointestinal complaints

Tenderness of the abdomen and pelvis.

Amenore.

Vaginal spotting or bleeding

Changes uterus

Blood pressure and pulse

Hipovolemi

Temperature

Pelvic masses

Pelvic Hematokel

Patofisiology

In normal pregnancy, the process of fertilization (meeting the egg by the sperm) occurs in the fallopian then the fertilized egg cell is driven and implantation in the uterine endometrial cavity.

Ectopic pregnancy can be caused, among other factors inside the tube and outside the tube, so that the result of conception obstructed or can not enter the uterine cavity, so that the fertilized egg grows and implants (stuck) in some places the female reproductive organ cells in the uterine cavity, among others in the fallopian tubes (fallopian tubes) cervical canal (cervix), ovary (ovarian), and the abdominal cavity. Most occur in the fallopian tube (90%). (Mitayani, 2009).

Complication

Ectopic pregnancy complications can occur secondary to late diagnosis error, or management of approach.

Failure diagnosis quickly and accurately may result in tubal or uterine rupture, depending on the location of the pregnancy, and this can cause massive bleeding, shock, DIC and death.

Complications arising from the surgery include bleeding, infection, damage to surrounding organs (intestines, bladder, ureter, and large blood vessels). In addition there are also complications related to anesthesia action.

Supporting investigation

Complete blood count

HCG-B levels decreased

Toucher vaginal

Ultrasonografi

Kuldosintesi

Oksitosin Test

Foto Rontgen

Histerosalpingografi

ECG

Management / treatment

Surgical :

- 1. Tubektomi

- 2. Laparatomi

- 3. Laparoskopi

- 4. Blood Tanfusi

Nursing :

1. Collaboration with the medical team in drug delivery

2. Implementation of chemotherapy

3. Create a calm and comfortable atmosphere to reduce pain and anxiety.

4. Post-action counseling and self care during home

Nursing Care

1. Assessment2. Phisical Assessment3. Diagnosa 4. Intervention

Diagnosa 1. Ineffective tissue perfusion gastrointestinal associated

with defisit hemoglobin, as a result of more bleeding

in the uterus.

2. Deficit fluid volume associated with the rupture at the site of

implantation, Bleeding

3.Pain associated with a ruptured fallopian tube, intraperitoneal

hemorrhage

4.The weakness relates to the amount of blood that comes out

when bleeding

5. Grieving associated with fetal death

6. Anxiety associated with the process will be done surgery

7. Lack of knowledge related to lack of understanding or do not

know the sources of information.

Cont ...

POST OP :

1. Acute pain associated with skin

diskontinuitas tissue secondary to

laparotomy

2.The risk of wound infection associated with

the operation and installation of equipment

maintenance

For Intervention

Please Check your Nanda’s Book

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