Ectopic Pregnancy Status Post Left Salpingectomy

7/29/2019 Ectopic Pregnancy Status Post Left Salpingectomy

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By:Oronce, Aiza F.

Cruz, Kryzia MargaretMacaranas, Bien

Balanon, Mark PauloChong, Mike Neilsen

Edrada, JoneilNgking, Amado II.

BSN 3



An ectopic pregnancy, or eccyesis, is a complication ofpregnancy 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 bleedingbeing a common complication. Most ectopic pregnancies occur inthe Fallopian tube (so-called tubal pregnancies), but implantationcan also occur in the cervix, ovaries, and abdomen. An ectopicpregnancy is a potential medical emergency, and, if not treatedproperly, can lead to death.

Ectopic pregnancy can be difficult to diagnose becausesymptoms often mirror those of a normal early pregnancy. Thesecan include missed periods, breast tenderness, nausea, vomiting,or frequent urination.

The first warning signs of an ectopic pregnancy are often painor vaginal bleeding. You might feel pain in your pelvis, abdomen,or, in extreme cases, even your shoulder or neck (if blood from aruptured ectopic pregnancy builds up and irritates certain nerves).Most women describe the pain as sharp and stabbing. It mayconcentrate on one side of the pelvis and come and go or vary in

intensity.



An ectopic pregnancy results from a fertilized egg's

inability to work its way quickly enough down the fallopiantube into the uterus. An infection or inflammation of thetube might have partially or entirely blocked it. Pelvicinflammatory disease (PID), which can be caused bygonorrhea or chlamydia, is a common cause of blockage of

the fallopian tube.Endometriosis (when cells from the lining of the uterusimplant and grow elsewhere in the body) or scar tissue fromprevious abdominal or fallopian surgeries can also causeblockages. More rarely, birth defects or abnormal growths

can alter the shape of the tube and disrupt the egg'sprogress.



The significance of the study is for us third year students toapply the principles and concepts that we have learned inthe NCM 101 (Maternal and Child Nursing) in our rotationat St. Mattheus Hospital, with the following specific learningobjectives:

1. Cognitive To be able to review concepts and theories in maternal and

child nursing. To be able to describe the development, pathophysiology,

medical-surgical management, and nursing care of a clientwho had undergone an ectopic pregnancy. To be able to design a Nursing Care Plan for the patient. To be able to provide information and heath teachings to the

patient in the postpartum period.



2. Psychomotor

To be able carry-out hospital routines and thetreatment prescribed to the patient.

To be able to perform nursing procedures andnursing considerations for a client in the

preoperative and postoperative stages To be able to implement the nursing care plan

3. Affective

To be able to establish a good workingrelationship with the patient and hospital staff.



The "Core, Care, andCure" theory wasdeveloped in the late

1960's. She postulated that

individuals could beconceptualized in three

separate domains: thebody (care), the illness,(cure), and the person(core).



Nursing functions in all three of the circles (core, care, andcure) but shares them to different degrees with otherdisciplines. For example, the nurse's function in the curecircle is limited to helping patients/families deal with themeasures instituted by the physician. She felt that the carecircle was exclusive to nursing. The core circle was sharedwith social workers, psychologists, clergy, etc.

For the care aspect which goal is to comfort the patient, weshould complete such basic daily biological functions as

eating, bathing, elimination, and dressing. By this we areproviding opportunity for closeness, and as this develops,the patient can share and explore feelings with the nurse,which in this case the chance for having another baby. Ourpatient experience an ectopic pregnancy which deeplyaffects her reproductive system, so for the “care” or the

body we as nurses function as a support for her, so weshould explain deeply and carefully that there are stillpossible ways to have another baby and that she should alsoface the reality.



Patient once verbalized that she didn’t know that she ispregnant until she experienced abdominal pain. The

goal of the core or the person is to discuss with thepatient her condition which may help her with thenurse find a way for a fast recovery, with the use oftherapeutic communication we somehow develop aninterpersonal relationship with the patient, by this weshould help the patient verbally express feelingsregarding the disease process and its effects, as well asdiscuss the patient’s role in recovery.

Cure or the illness, we are the one who are givingthe medications, monitor the patient, and the onewhich is in close contact with the patient, so any

confusion with the prescription or orders of thedoctors, we are the one that will act as their advocate,we are the one that will help the patient and family tounderstand it.



Patient’s Profile

Name: MC Address: San Mateo, Montalban Sex: Female Age: 22 years old. Date of Birth: September 03, 1988 Educational Attainment: High School Graduate Nationality: Filipino Religion: Catholic

Civil Status: Single Date of admission: September 19, 2010 Time admitted: 5:40pm Chief Complaint: Abdominal Pain



E. Social History

Patient MC is currently living with her step mother and live-in partners atNovaliches. She claims to have experienced engaging in smoking and alcohol at theage of 18 because of grieving from the loss of her first baby but claims to haveceased 6 months after death. She denies to have engaged in drugs. She loves to eatlongganisa and other meat products but also includes vegetables on her daily foodintake. She sometimes skips meals.

F. Developmental Data

According to Erik Erikson’s Psychosocial Theory, the patient developmental

task at her age (22) is Intimacy versus Isolation. At this stage it involves theaffiliation or the ability to give and receive love, commitments and mutuality withothers, collaboration in work and affiliations, sacrificing for others and responsiblesexual behavior. Intimacy is achieved when an individual has developed thecapacity for giving oneself to another and is learned when one has been therecipient of this type of giving within the family.

In relation to the patient, the patient has been able to receive and learn love fromher family members however, achieving intimacy might be at a struggle lately asshe has no plan of marriage or commitment and her child from her live-in-partnerresulted into a loss. In addition to that, she confirms that she does not enjoy sexualencounter with her live-in partner and her dad is currently at her province. On theother hand the patient has is with her step-mother and live-in-partner who gives

emotional support and love at her stay at the hospital



FamilyGenogram



Family History

According to the patient, her grandmother on her mother’s sidedied with a disease related to a heart problem, Moreover hermother died also with a cardiac related problem upongiving birth to her.

According to the patient, her first baby died on October 22,2006, 11 months after birth because of inability to admit her

baby at Philippine Heart Center as recommended by doctorsbecause her first born had a uncorrected ventricular septaldefect. Her Gravida 3 was unexpected and has resulted toan ectopic pregnancy.

No other illness on the father’s side was traced by her. No othernoted disease like Asthma, Diabetes, Tuberculosis, Cancer,or Liver diseases is in their family except for a cardiacrelated problem.



Anatomy of female reproductive system The female reproductive system is designed to carry out severalfunctions. It produces the female egg cells necessary forreproduction, called the ova or oocytes. The system is designed totransport the ova to the site of fertilization. Conception, thefertilization of an egg by a sperm, normally occurs in the fallopiantubes. The next step for the fertilized egg is to implant into thewalls of the uterus, beginning the initial stages of pregnancy. Iffertilization and/or implantation do not take place, the system isdesigned to menstruate (the monthly shedding of the uterinelining). In addition, the female reproductive system producesfemale sex hormones that maintain the reproductive cycle.

During menopause the female reproductive system graduallystops making the female hormones necessary for the reproductivecycle to work. When the body no longer produces these hormonesa woman is considered to be menopausal.



Parts of the FemaleReproductive Anatomy:

The female reproductive

anatomy includes partsinside and outside thebody.

The function of theexternal female

reproductive structures(the genitals) is twofold:To enable sperm to enterthe body and to protectthe internal genitalorgans from infectiousorganisms. The mainexternal structures of thefemale reproductivesystem include:



Labia majora: The labia majora enclose and protect the otherexternal reproductive organs. Literally translated as "large lips,"the labia majora are relatively large and fleshy, and are comparableto the scrotum in males. The labia majora contain sweat and oil-secreting glands. After puberty, the labia majora are covered with

hair. Labia minora: Literally translated as "small lips," the labia minora

can be very small or up to 2 inches wide. They lie just inside thelabia majora, and surround the openings to the vagina (the canalthat joins the lower part of the uterus to the outside of the body)and urethra (the tube that carries urine from the bladder to the

outside of the body). Bartholin's glands: These glands are located besides the vaginal

opening and produce a fluid (mucus) secretion. Clitoris: The two labia minora meet at the clitoris, a small, sensitive

protrusion that is comparable to the penis in males. The clitoris iscovered by a fold of skin, called the prepuce, which is similar to the

foreskin at the end of the penis. Like the penis, the clitoris is verysensitive to stimulation and can become erect.

The internal reproductive organs in the female include: Vagina: The vagina is a canal that joins the cervix (the lower part

of uterus) to the outside of the body. It also is known as the birth

canal.



Date/ Time Laboratory Results/

Vital Signs

Medications Treatment Nursing

Intervention

September 19, 2010

5:40pm

September 19, 2010

8:00pm

URINALYSIS

Color: yellow

Transparency: Clear

Reaction: 6.0

Specific Gravity:

1.020

RBC: 1-2 hpf

Pus Cells: 2-3 hpf

Albumin: Negative

Amorphous Urates:

++

Epithelium

Squamous Cells: ++

-Cefazolin 2 g IV as

Loading Dose

-Then shift to

Cefazolin 500mg IV

every 6 hours

-Tramadol 100mg

slow IV push every 8

hours at 3 doses

-Ketorolac 30 mg IV

push every 6 hours at

4 doses

-IVF Started

D5LR 1L at

20gtts/min

-Second line PNSS

1L at 20gtts/min

-To PACU

-Monitor Vial Signs

every 15 minutes and

record

-Regulate present

IVF:

1. D5LR 1L at30gtts/min

2. PNSS at KVO

rate

-Flat on bed for 6

hours

-O2 at 5LPM via

Facemask

-Monitor Urine

Output every hour

and record-Watch out for

hypotension and

bleeding

Assess patient to

know previous/

present status of the

patient.

Check the level of

pain. Base on the

pain scale. Check for

PQRST (

precipitating/predisp

osing factor, quality,

radiation, severity,

time )

Prepare the

medications anddouble check it.

Check for the

expiration date.

Make sure to apply

the 10Rights.

Check the O2 at

5lpm every q15

Regulate and check

the IVF fluid q15.

Monitor V.Sthoroughly every 15

minutes and record.

Monitor Urine

Output every hour

and record

Watch out for

hypotension and

bleeding

Reassess



Date/ Time Laboratory

Results

Medications Treatment Nursing Intervention

September 20,

2010

2:30 am

7:45am

9:00am

-Cefalexin 500mg

capsule every 6

hours for 7 days

-Mefenamic Acid

500mg capsule

every 6 hours for

pain

-multivitamins 1

cap once a dat-Ferrous Sulfate 1

cap once a day

-Cefalexin 500mg

capsule every 6

hours for 7 days

-Mefenamic Acid

500mg capsule

every 6 hours for

pain

-multivitamins 1

cap once a dat

-Ferrous Sulfate 1

cap once a day

-May transfer to ward

-Continue VS monitoring

every hour for 6 hours

-Continue IVF to

complete IV antibiotics

for 24 hours then shift to

Oral

-May remove IFC at

6pm

-Encourage early

ambulation

-Continue VS monitoring

-Patient seen and

examined

-Monitor Input and

Output hourly and record

-Continue present

medications

Assess patient to know

previous/ present status of

the patient.

Patient’s Lab results, V.S,Chart.

Continue VS monitoring

every hour for 6 hours

Check the level of pain.

Base on the pain scale.

Check for PQRST (

precipitating/predisposing

factor, quality, radiation,

severity, time )Prepare the medications and

double check it. Check for

the expiration date. Make

sure to apply the 10Rights.

Teach on how to prevent

infection, proper hygiene,

and proper nutrition to

prevent infection and to

boost immunity.

Monitor Input and Output

hourly and record

Reassess patient




Results/Vital

Signs


Intervention

September 23,

20106am

-Cefalexin

500mg capsuleevery 6 hours for

7 days

-Mefenamic Acid

500mg capsule

every 6 hours for

pain

-multivitamins 1

cap once a day

-Ferrous Sulfate

1 cap once a day

-follow up Labs

-continuemedications and

Vital Signs

Monitoring

Assess patient to

know previous/ present status of

the patient. Esp.

to follow up

Laboratory

results.

Continue Health

Teachings esp. to

encourage patient

full ambulation

Continue

medications and

VS monitoring, I

and O.Monitoring and

recording.

Reassess patient.




Results/Vital

Signs


Intervention

September

25,20106:33am

BP 110/70mmHg

Temp 36.50

CPR 73bpm

RR 20cpm

Pain Scale: 2/10

-Cefalexin

500mg capsuleevery 6 hours for

7 days

-Mefenamic Acid

500mg capsule

every 6 hours for

pain

-Multivitamins 1cap once a day

-Ferrous Sulfate

1 cap once a day

-follow up all lab

results-continue ordered

medications and

Vital Signs

Monitoring

Assess patient to

know previous/ present status of

the patient.

Continue Health

Teachings esp. to

encourage patient

full ambulation

Continuemedications and

VS monitoring, I

and O.

Monitoring and

recording.

Reassess patient.

MGH.

BLOOD MORPHOLOGY September 19, 2010



Exam Name Result Normal Findings Analysis Interpretation

Haemoglobin 112 110-150 g/L Normal

Hematocrit 0.35 0.37-0.45 Decreased Indicates anemia or massive blood

loss.

WBC Count 14.6 4.6 x 10^g/L Increased Associated with inflammatory

process from trauma acquired from

surgery.

RBC Count 3.75 4.0-5.5^3/L Decreased Indicate anemia, dilution due to

fluid overload or hemorrhagelasting more than 24 hours.

Platelet Count 360 150-400 x 10g/L Normal

Differential Count:

Segmenters

Lymphocytes

Monocytes

0.70 0.50-0.70 Normal

0.26 0.20-0.40 Normal

0.04 0-0.07 Normal

MCV 93.2 80.9-99.9 fL Normal

MCH 29.9 27.0-31.0 pg Normal

MCHC 320 330-370 g/L Normal



Physical Result Normal Findings Analysis Interpretation

Color Yellow Amber-Yellow Normal

Transparency Clear Clear-Hazy Normal

pH 6.0 4.5-7.8 Normal

Specific Gravity 1.020 1.001-1.035 Normal

Cells

Red Blood Cells 1-2 hpf 0-5 hpf Normal

Pus Cells 2-3 hpf Negative Positive Indicates the presence of infection

Chemical

Albumin Negative Negative Normal

Sugar Negative Negative Normal

Epithelium

Squamous Cells +2 0-4/hpf Normal

BLOOD TYPING September 19, 2010 Type: O

Rh: +

URINALYSIS September 20, 2010



Medication

Instruct the patient to take her medicines as prescribed by her physicians.

Do not buy medicines or other food supplements without the doctor’sorder.

Do not quit taking medicines until the physician said so.

Exercise

Advise the patient to continue to do exercises such as Deep breathing andcoughing exercises because these exercises can promote fasterrecovery.

After several weeks the client should have a routine exercise like walkingto remain physically fit.

Exercise helps blood move through the body and may help prevent blood

clots from forming.Treatment

1. Cefalexin 500mg capsule every 6 hours for 7 days

2. Mefenamic Acid 500mg capsule every 6 hours for pain

3. Multivitamins 1 cap once a day

4. Ferrous Sulfate 1 cap once a day



Health Teaching Instruct the patient to do proper wound care.Teach patient and also her relatives to do aseptic technique while doing wound

care by washing his/her hands to minimize the spread of infection.

Proper wound care can help prevent the spread of infectious microorganisms.

Out- patient follow up The patient must have a regular check-up with her physician routinely. Instruct the client to write down any questions he may encounter during the

past days so that she can ask questions to her physicians if she has concerns forher conditions and how will she take care her health.

Diet Encourage the patient to eat nutritious foods such as vegetables and fruits. Try to lessen foods that are too salty and fatty. Ask the physician about her diet such as how many servings of fat,

carbohydrates, protein and sweets. In that way, she will know what dishes she will eat to promote good health.

Spiritual Advise the patient to continue to have faith in God in spite of losing two of her

babies. She must read the bible regularly to regain her trust to the Lord. Encourage the patient to have a one on one relationship with God so that she

can have a peaceful mind and a positive outlook in life.

Ectopic Pregnancy Status Post Left Salpingectomy

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