Nursing Management of a Patient with an Ectopic Pregnancy Pineda, Jenina Rose S.D. Platil, Maria Isabel J.

Razon, Jennifer R. Sola, Zendee-Marie E. Suarez, Suzaine Marie F. Tajuna, Jerome R.

BSN 2Y2 - 4

Our Lady of Fatima University

Nursing Management of a Patient with an Ectopic Pregnancy A gravida 3; para 2, Mrs. Jessica Soriano Mamaril was admitted to Dr. Jose Fabella Memorial Hospital with a chief complain of hypogastric pain (vagina). She was diagnosed as Ectopic pregnancy probably ruptured by Dra. Bernadette A. Cabaldon. Her initial vital signs were: BP 100/70mmHg; PR 86 bpm; RR 21 cpm; T 37 degrees Celcius; Wt 45 kg; Ht 157 cm. She is 28 years of age and she lives at Dagat-dagatan, Caloocan City. She was born on February 22, 1982 at Malabon City. She was able to finish her college and she is now a HR assistant. Her husband is Jefferson Pineda, 27 years of age.

Pathophysiology Tubal Ectopic Pregnancy Because most ectopic pregnancies initially implant in a fallopian tube, the pathophysiology will focus on tubal ectopic pregnancies. The blastocyst burrows into the epithelium of the tubal wall, tapping blood vessels, by the same process as normal implantation into the uterine endometrium. However, the environment of the tube is quite different because of the following factors:

1. 2. 3.

There is a decreased resistance to the invading trophoblastic tissue by the fallopian tube. There is a decreased muscle mass lining the fallopian tubes; therefore their dispensability The blood pressure is much higher in the tubal arteries than in the uterine arteries is greatly

limited. 4. There is limited decidual reaction; therefore human chorionic gonadotropin (hCG) is

decreased and the signs and symptoms of pregnancy are limited.

It is because of these characteristic factors the termination of a tubal pregnancy occurs gestationally early by an abortion, spontaneous regression, or rupture, depending on the gestational age and the location of the implantation. If the embryo dies early in gestation, spontaneous regression often occurs. If spontaneous regression fails to occur, then usually an ampullar or fimbriated tubal pregnancy ends in an abortion and an isthmic or interstitial pregnancy ends in a rupture

A tubal abortion primarily occurs because of separation of all or part of the placenta. This separation is caused by the pressure exerted by the tapped blood vessels or tubal contractions.

With complete separation, The products of conception are expelled into the abdominal cavity by way of the fimbriated end of the fallopian tube

With an incomplete separation, bleeding continues until complete separation takes place, and the blood flows into the abdominal cavity collecting in the rectouterine cul-de-sac of Douglas.

Tubal rupture results from the uninterrupted invasion of the trophoblastic tissue or tearing of the extremely stretched tissue. In either case the products of conception are completely or incompletely expelled into the abdominal cavity or between the folds of the broad ligaments by way of the torn tube.

The duration of the tubal pregnancy depends on the location of the implanted embryo or fetus and the distensibility of that part of the fallopian tube. For instance, if the implantation is located in the narrow isthmic portion of the tube, it will rupture very early, within 6 to 8 weeks; the distensible interstitial portion may be able to retain the pregnancy up to 14 weeks of gestation.

History CHIEF COMPLAINT: (Vaginal) Hypogastric Pain

ADMITTING DIAGNOSIS: Ectopic pregnancy, ruptured Gravida 3 Para 2 (2002) previous CS 2x

FINAL DIAGNOSIS: Tubal pregnancy ampullary, left, ruptured, previous CS 2x Gravida 3 Para 2 (2002)

OPERATION/PROCEDURE: Emergency exploratory laparotomy followed by left salphingotomy under spiral anesthesia

PAST MEDICAL HISTORY: Unremarkable

FAMILY MEDICAL HISTORY: Unremarkable

PERSONAL HISTORY: (-) Cigarette Smoking (-) Alcohol (-) Substance Abuse

GYNECOLOGIC HISTORY: Menarche 14y/o (+) Dysmenorrhea 28-30

OBSTETRIC HISTORY: G3P2 (2002)

Year G1 G2 G3 2003 2007 PP

Hospital Martinez Memorial Hospital Martinez Memorial Hospital

AOG FT FT

Manner of Delivery CS CS

Gender Girl Boy

Weight 7.3lbs 6.0 lbs Alive Alive

Nursing Physical Assessment The patients temperature was 37 C, pulse rate was 86 beats per minute, respirations was 21 breaths per minute, blood pressure was 100/70 mmhg. She has a normal sound rhythm of heart and breathing and the patient stated her pain level was 9. Her height is 157 cm and her weight is 45 kg. The color of the eyes is black with good vision and the eyelids are skin intact, no discharge, absence of edema or tearing and discoloration. The patient is conscious and has quantity, clarity, relevance and organization of thoughts and speech with good memory. She has no difficulty in breathing and has fine sense of smell. The patient has an IV hep lock in her left hand and also has an IV line in her right hand. The patients skin has a pallor color with minimal papule on the upper extremities, no masses and dont have any bone deformities. She has dry lips with a moderate bilateral hand grip. The patients surgical incision was from the umbilicus to suprapubic. The patient was on a soft diet starting 12/12/2010. She appeared frail and thin with some general weakness. The patient was not able to perform independent activities of daily living and must be assisted properly to decrease the pain she experienced on the site of her incision.

Recommendations Health Teachings The best way to take care of yourself is to pay close attention to your health, pay attention to changes related to your menstrual cycle. Always practice safe sex by using a latex or polyurethane condom to reduce your chances of infection. Tell your health care provider about any abnormal bleeding or unusual pain between menstrual periods. Call the provider as soon as you think you are pregnant, especially if you have an increased risk for ectopic pregnancy Encourage to done ultrasound or sonogram prior, for viewing fetus

Dysfunctional grieving Encourage the client to talk about what the client chooses and do not to try to force the client to face facts Permits verbalization of anger with acknowledgement of feelings and setting of limits regarding destructive behavior. Acute pain Take therapeutic treatment as ordered by physician Encourage verbalization of feelings about pain Encourage diversional activities Encourage to walk for proper flow of blood and oxygen Encourage to use of relaxation exercises , such as focused breathing , commercialized or individualized tapes (white noise, music, )

Discharge consideration Diet encourage to drink fluids as tolerated (water, fruit juices) encourage to eat fruits and vegetables, and other nutrient-dense foods Encourage to walk exercise for proper flow of blood and oxygen Encourage adequate rest periods to prevent fatigue. Advise for medical follow up if theres sign and symptoms and changes in pain requirement Advise to follow scheduled checkups (if there are any) Advice to give maintenance drugs such as vitamin supplements (if there are any)

Spirituality allow verbalizing about personal matters about faith