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c
ECTOPIC
PREGNANCY
(S/P BTL 1 YEAR)
V
V
The classic clinical triad of ectopic pregnancy is pain,
amenorrhea, and vaginal bleeding. Unfortunately, only 50% of
patients present typically. Patients may present with other
symptoms common to early pregnancy, including nausea, breast
fullness, fatigue, low abdominal pain, heavy cramping, shoulder
pain, and recent dyspareunia. Astute clinicians should have a
high index of suspicion for ectopic pregnancy in any woman who
presents with these symptoms and who presents with physical
findings of pelvic tenderness, enlarged uterus, adnexal mass, or
tenderness. The result of the ultrasound is tge most reliable
indicator that a woman is suffering from ectopic pregnancy.
Early detection means saving the woman from blood loss and
death.
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FACTOYS
VÊ ÊV
X
V VV
XPelvic Inflammatory Disease
XEndometriosis X
XCongenital anomalies of the
fallopian tubes XV
XT-shaped uterus
XÊ
XYuptured appendix
XPrevious tubal surgery or
tubal pregnancy
Ê
TYPES
VÊV
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Dysfunction of the cilia which usually propel
The fertilized ovum through the tube into the
uterine cavity
Internal hemorrhage
On the tube as the
Affected area starts to
rupture
Profound drop on
cardiac output
S/sx: <BP
Hypovelemic Shock >HY,YY,sweating
DOB
Yestlessness
and other signs
DEATH
(may occur)
ëII. MEDICAL MANAGEMENT
Ê
DATE/TI2E V
For medical/surgical
Please admit to ward management
August
19,2010
Secure consent to care To obtain patient
10:00 am
permission to conduct
B/P ± 130/90
treatment
HY ± 101
To prevent aspiration and
YY ± 22
NPO other complications
T ± 37.6
during/after the operation
Baseline purposes in
TPY q 4 hrs determining any deviation
from normal reading
LABS:
Determining hemoglobin
CBC stat
hematocrit count
BT stat
To identify the patient¶s
blood type for possible blood
transfusion intra and post
operatively
HBSAG det stat
To determine if reactive to
hepatitis B and if so to
execute strict isolation
techniques/procedures
Urinalysis stat
To detect any abnormalities
Start D5LY 1L at
Hypertonic solution that
40gtts/min
provide accessible means
for emergency drug therapy
Ê
DATE/TI2E V
2EDS:
Cefazolin 1g IVTT q 8 Act as prophylaxis
hrs ANST ( )
Please inform
OY/Anesthesiologist on For the staff to prepare
call materials/instruments for
the specified operation
To secure 2 ³U´ of WB
with proper typing and
Xfor cases of massive blood
cross- matching- standby
loss during the operation
for OY use
and possible blood
transfusion
Start bloodline of
XHypotonic solution for
PNSS1L
possible BT
DATE/TI2E Ê V
PYE-OP OYDEYS
11:00am
POST OP OYDEYS
For close monitoring of
To PACU patient¶s vital signs
1:40pm
4. Famotidine 20 mg
ho IVTT q 12h x 2 doses
DATE/TI2E Ê V
Dr. Estopia
DATE/TI2E
Ê V
August 20,
Please remove FBC X to prevent infection
2010
6:00 A2
2ay have clear liquids then X facilitate normal intake
(+) flatus
soft diet of foods gradually
FESO4 OD x 1 mo
For prevention of anemia
and to provide dietary
supplements
Dr.Galang
DATE/TI2E IVTFF: V
D6LY 1L at 30gtts/ min
August
21,2010 Provide accessible means
for emergency drug
8:00am Cont meds
therapy
Yefer
for continued care and
determine any
complications
Dr.Chavez
DATE/TI2E Terminate IVF V
2GH anytime
X
V
V
White Cell 5.0 ± 10 Elevated
Count
Hemoglobin 12.9 13.7-16.7 normal Below normal
Color: yellow
YBC 0-2/hpf
Specific gravity: 1.025
epithelium: occasional
Yeaction: 6.0
Sugar (-)
Albumin (+)
V
Control: 15.1 secs
Patient: 20.5 secs
% activity 48%
INY 1.48
Findings: in line of positive pregnancy
suggestive of ruptured ectopic pregnancy
VS before BT: T:36.0C
HY: 68bpm
YY: 20cpm
Time transfuseD:
transfuseD: 12:30pm ended: 4:49pm
Blood Type: ³O´
Unit: 1 or 500cc
Component: Whole blood
Serial number: BPH2690
Adverse Yeaction: none
VS After BT: T:36.0C YY:19cpm
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Name of Drug: KETOYOLAC (Ketomed)/2EFENA2IC ACID 500mg
Date Ordered: August 19 , 2010
Classification: NSAID
Dose/Fequency/Youte:30 mg IVTT (intravenously) every 8hours
2echanism of Action: The anti-inflammatory, analgesic, and antipyretic
effects of the NSAIDs are largely related to inhibition of
prostaglandin synthesis.
Specific indication (why drug is ordered): Short-term management of
pain; topically to relieve ocular itching.
Adverse effects: Adverse effects associated with acetaminophen use
include headache, hemolytic anemia, renal dysfunction, skin
rash, and fever. Hepatotoxicity is a potentially fatal adverse effect
that is usually associated with chronic use and overdose and is
related to direct toxic effects on the liver.
Nursing Precaution:
*Administer with food if GI occurs.
U2onitor for adverse effects: CNS changes, rash, GI upset, CHF,
liver dysfunction, asthma.
UEvaluate drug effects
UEvaluate effectiveness of patient teaching program.
Name of Drug: FEYYOUS SULFATE
Date Ordered: August 20 , 2010
Classification: IYON PYEPAYATION
Dose/Fequency/Youte:1 tab OD
2echanism of Action: Iron preparation elevate the serum iron
concentration. They are then either converted to hemoglobin
or trapped in reticuloendothelial cells for storage and eventual
release for conversion into a useable form of iron for YBC
production.
Specific indication (why drug is ordered): Treatment of iron deficiency
anemia
Adverse effects:
*GI irritation
*anorexia
*nausea
*vomiting
*diarrhea
*dark stools
*constipation
Nursing Precaution:
*Confirm iron defiency anemia before administering drugs to
ensure proper use of the drug.
*Consult with the physician to arrange for treatment of the
underlying cause of anemiaif possible, as iron replacement will not
correct the cause of the iron loss.
*Caution the patient that stool may be dark or green to prevent
undue alarm if this occurs.
*Arrange for hematocrit and hemoglobin levels before
administration and periodically during therapy to monitor drug
effectiveness.
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facial grimaces
changes in vital signs, baseline:
V
1. Obtained full description of pain from Pain is a subjective experience and must
patient including location, intensity (0- be described by the pt. Assist pt. to
10), duration, quality and radiation. quantify pain by comparing it to other
experiences.
2. Positioned patient comfortably, in
moderate high back rest
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Ê ³mura ko ug gakalumos and lipong NG AKONG
Paminaw´
facial grimaces
changes in vital signs, baseline:
HGB nd HCT result
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http://biology.clc.uc.edu/courses/bio105/circulat.htm
wwwmedlib.med.utah.edu\webpath\TUTOYIAL\ECTPY
EG.com
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