Beruflich Dokumente
Kultur Dokumente
College of Nursing
Tapuac District, Dagupan City
A
Case Study
On
Ruptured Ectopic Pregnancy
CONTENTS
I.
II.
Introduction
Objectives
III.
IV.
Patients Profile
V.
VI.
VII.
VIII.
IX.
Patients History
a. History of Present Illness
b. History of Past Illness
c. Family History
Assessment
Laboratory/ Diagnostic
Disease Identity
a. Anatomy and Physiology
b. Pathophysiology
Management Medical Surgical Nursing
a. Drug Study
b. Surgical Treatment
c. Nursing Care Plans
X.
ACKNOWLEDGEMENT
The advocates of this case study would like to extend their warmest
appreciation to all the people who made the success for the making of this work.
First of all, to the Almighty God, for His everlasting love and blessings; for
giving us enough power and determination to face all the hardships in the making of
this work. Praise and honor to You, our God!
To Mrs. Maria Moppet Q. Araa, RN, our clinical instructor for her priceless
time, knowledge and effort rendered to us.
To the staff of Pangasinan Provincial Hospital, especially in the Obstetric
Ward, for giving us the opportunity to complete this work.
To our dear families and friends, for their endless support and understanding;
for always being there to guide us and care for us after the long days of duties; for
being our inspiration to finish this seemingly impossible task.
To the patients and their families for challenging us to do more and for giving
us strength to give our best in rendering care to maintain their normal vital signs
and giving them enough knowledge in our health teachings.
To the group, we would like to recognize each other for our own radical efforts
in order to complete this case study; for sticking together through hardships and for
simply being there.
Lastly, to each and every one who helped realize this job into completion,
may it be direct or indirect, no matter how minimal, the gratitude and pleasure for
the achievement of this task is ours to share.
I.
Introduction:
interstitium
(or
cornual
region
of
the uterus).
Some
ectopic
II. Objectives
General Objective:
The foremost objective of the group is to be able to present the case
study of our chosen client that would provide a broad discussion of the
pathological mechanism of the disease to give significant information for the
case study.
Specific Objectives:
In order to meet the general objective, the group aims to:
Explain the related data gathered from the patient and her significant
others,
state past, present and family health history of the patient,
outline
Nursing Education
There is a need for us to study Ectopic Pregnancy because this
presents a major health problem for women of childbearing age
especially now that is one of the major causes of bleeding in pregnancy
during the first trimester. It is the result of a flaw in human
reproductive physiology that allows the conceptus to implant and
mature outside the endometrial cavity, which ultimately ends in death
of the fetus. Without
Nursing Practice
Studying this case is necessary to be able to develop and improve
nursing practice by determining interventions that are effective and
important compared to those that are not important and not helpful for
the client. Interventions may include: Providing a quiet and relaxing
environment; Monitoring vital signs to check for changes of respirations,
pulse rate, temperature and blood pressure--increased or decreased of
vital signs may indicate an abnormality; Assessing for pain is also
important knowing what pain scale she feels wherein 10 is the painful;
Assessing the vaginal bleeding including the amount and characteristics
to know if shes suffering from hemorrhage. If so, there is a need of
emergency surgery; blood transfusion and analgesics should be
administer as prescribed by the doctor. Providing emotional support
may help the patient express feelings of grief and fear.
Nursing Research
Women
with
ectopic
pregnancy
may
experience
several
complications that requires not only medical attention but also nursing
guidance. In this light, this study may be helpful in determining
interventions that will also help nursing research.
IV. Patients Profile
Patients Name: Luningning
Age: 24
Gender: Female
Birth date: March 22, 1987
Birth Place: Bayambang, Pangasinan
Civil Status: Married
Nationality: Filipino
Religion [Denomination]: Christianity [Roman Catholic]
Husband: Lunongnong
City Address: Bayambang, Pangasinan
Nationality: Filipino
Religion [Denomination]: Christianity [Roman Catholic]
V.
Patients History
a. History of Past Illness
G4P1
First Pregnancy
o Abortion @ 2months (8weeks)
o Missed miscarriage/ Early Pregnancy failure
Second Pregnancy
o Post Maturestill birth @ 43weeks.
Third Pregnancy
o NSD
o Child 11 months old @ present
No consultation done.
Referred to PPH.
c. Family History
VI.
DISEASE
MOTHER
FATHER
Cardiac Problem
Diabetes Mellitus
Meningitis
Asthma
Tuberculosis
Otitis Media
Hypertension
Cancer
Assessment
Body System
Methods of
assessment
FINDINGS
SIGNIFICANCE/RE
Pa
Pe
MARKS
General Appearance
Inspect physical
appearance.
Assess behaviour.
Assess overall
development and
speech.
Conscious and
coherent
Cooperative ;
interacts well
with others
Moderate
speech, clear
voice with
moderate pace
Assess interactions
with parents and
nurse.
Vital Signs
Measure blood
pressure.
Measure pulse rate
Measure respiratory
rate.
Measure
temperature.
Skin , Hair and Nails
Appears weak
nails(texture, shape,
color, condition)
Head, neck and Cervical Lymph nodes
Inspect and palpate
the head(symmetry,
condition of
fontanelles)
Inspect and palpate
the face
Inspect head control,
head posture and
Expected weakness
related to the postop status
Normal
Normal
Normal
110/70 mmHg
Normal
66 beats/ min
Normal
22 breaths/min
Normal
36.8C
Normal
No
swelling/lesions
noted; skin warm
to touch with
good turgor
Evenly
distributed; fine
and silky
Smooth, convex
in shape, light
pink in color
Normocephalic,
no lesions are
visible.
Symmetric with
an oval
appearance, no
abnormal
movements
noted.
Full range of
motion- up and
Normal
Normal
Normal
Normal
Normal
Normal
down and
sideways
range of motion.
Inspect and palpate
the neck
( suppleness, lymph
nodes for swelling,
mobility,
temperature and
tenderness)
Mouth, throat, nose and sinuses
Inspect mouth and
throat( tooth
eruption, condition of
tenderness.
Turbinates[color,swel
ling])
Eyes
Inspect external eye.
Observe for redness,
swelling or discharge
or lesions
No nodules or
swelling noted,
(+) pain in the
nape.
Abnormal
Improper oral
hygiene
Smooth and
symmetrical;
client reports no
tenderness
Normal
Bilaterally equal
in size
Skin on both
eyelids is without
redness, swelling
or lesion.
Normal
Normal
Ears
Equal in size
bilaterally; skin is
smooth with no
lesions, lumps or
nodules. Color is
consistent with
facial color
Scapulae are
symmetric and
non-protruding.
Shoulders and
scapulae are at
equal horizontal
position.
Respirations are
within normal
range, relaxed,
effortless, and
Normal
Normal
quiet
Resonance,
elicits flat tone
over the scapula
Breath sounds
clear; No
adventitious
sounds
auscultated.
Normal
Symmetrical, no
discharge or
lesions are noted
Normal
S1 and S2. No S3
and S4 noted.
Normal
Symmetry
Abdominal skin is
paler than the
general skin
tone.
Normal
Normal
Normal
Muskuloskeletal
Assess feet and legs
Assess gait
Assess joints
Assess muscles
VII.
(+) edema
Clients appear to
be relaxed with
shoulders
Gait is steady:
opposite arm
swings
Client reports no
pain in her joints
No muscle
weakness noted
Laboratory/ Diagnostic
Hematology Report (March 14, 2011)
Lab Test
Performed
N.V.
A.V.
Significance
1.
Hgb
F: 120 160
60
2.
WBC
5 10 x 10/1
15.5
3.
Hematocrit
F: 37 47
18
4.
Segmenters
.50 .70
.78
5.
Lymphocytes
.20 .40
.15
* A segmenters count is
usually a part of a
peripheral complete
blood cell count and is
expressed as percentage
of segmenters to total
white
blood
cells
counted.
Low. Chronic Infection;
Viral Infection
* A lymphocyte count is
usually a part of a
peripheral complete
blood cell count and is
expressed as percentage
of lymphocytes to total
white
blood
cells
counted.
Normal
6.
Monocytes
7.
Platelet
Count
.02 .08
.07
150 300 x
10/1
289 x 10/1
* A monocyte count is
usually a part of a
peripheral complete
blood cell count and is
expressed as percentage
of monocytes to total
white
blood
cells
counted.
Normal
*It is used to diagnose
bleeding disorders
1. Hgb
2. Hematocrit
N.V.
A.V.
F: 120 160
94
F: 37 47
28
Significance
N.V.
A.V.
Significance
1.
2.
Hgb
Hematocrit
F: 120 160
83
F: 37 47
26
1.
Hgb
2.
Hematocrit
N.V.
A.V.
F: 120 160
103
F: 37 47
31
Significance
N.V.
A.V.
Urea
2.5 6.1
3.7 mmol/L
Creatinine
62. 106.
61. umol/L
Significance
Normal
*often requested to monitor
kidney function before
starting to take certain
drugs and while taking
them.
Slightly Low
*Creatinine levels are
generally lower in
pregnancy
Diagnostics:
Ultrasound:
Significance: Abnormal
Findings: No
Gestational Sac Noted
VIII.
Disease Identity
a. Anatomy and Physiology
Female Reproductive System
Labia
majora: The
labia
majora
enclose
and
protect
the
other
external
reproductive organs. Literally translated as "large lips," the labia majora are
relatively large and fleshy, and are comparable to the scrotum in males.
Labia minora: Literally translated as "small lips," the labia minora can be very
small or up to 2 inches wide.
Bartholins glands: These glands are located next to 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. Like the penis, the clitoris is very sensitive
to stimulation and can become erect
Perineum A stretch of hairless, sensitive skin that extends from the bottom of
the vaginal opening back to the anus
Internal Organs
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.
Ovaries A woman normally has a pair of ovaries that resemble almonds in size
and shape. They are home to the female sex cells, called eggs, and they also
produce estrogen, the female sex hormone. Womens ovaries already contain
several hundred thousand undeveloped eggs at birth, but the eggs are not called
into action until puberty. Roughly once a month, starting at puberty and lasting until
menopause, the ovaries release an egg into the fallopian tubes; this is called
ovulation. When fertilization does not occur, the egg leaves the body as part of the
menstrual cycle.
Uterus The uterus is located in the pelvis of a womans body and is made up of
smooth muscle tissue. Commonly referred to as the womb, the uterus is hollow and
holds the fetus during pregnancy.
Cervix The lower part of the uterus, which connects to the vagina, is
known as the cervix. Often called the neck or entrance to the womb, the
cervix lets menstrual blood out and semen into the uterus. The cervix
remains
closed
during childbirth.
during
pregnancy
but
can
expand
dramatically
Ovulation
The ovulation process is important if subsequent fertilization is to take place.
This is an exquisitely timed phenomenon dependent on a host of hormonal
interactions involving a variety of endocrine glands. Tubal function must also
be adequate or the ovum will not be picked up by the fallopian tube to be
fertilized within the ampulla.
Fertilization
Following ovulation, the ovum with its cumulus oophorus cells are picked up
by the fimbria of the fallopian tube. The ovum has now formed the first polar
body. It remains in the ampulla portion of the tube and is viable for about 18
to 24 hours. If fertilization does not occur, the ovum disintegrates and is
destroyed by the tube. Sperm will remain viable in the female reproductive
tract for about 48 hours, although this can be quite variable. Sperm present
in the ampulla meet the cumulus oophorus mass and penetrate by chemical
and mechanical means to reach the zona pellucida. One sperm penetrates
the zona pellucida, the second polar body is formed, and the nuclear material
of the sperm enters the vitelline membrane. The diploid chromosome number
is re-established, and mitotic cell division can now occur.
Implantation
After fertilization occurs, the ovum remains in the fallopian tube for about 72
hours. During this time there are several cellular division, but the size of the
fertilized ovum does not increase. Around 72 hours the zona pellucida
fragments and falls away. The ovum enters the uterine cavity for 60 to 72
more hours, and the central cavity begins to form. A definite cell mass is
formed on one side of the blastocyst by the time implantation occurs. The
trophoblast
cells
burrow
into
the
endometrial
stroma
to
form
b. Pathophysiology
Precipitating
Factors:
Predisposing
Factors:
24yrs
old
Femal
e
Previous
abortion
Tubal
scarring or
scars in the
uterus from
previous
operations
Abdominal
utlrasound findings:
No gestational sac
identified
Abnormal
bleeding in the
vagina
Smoki
ng
Presence of
a protein
PROKR1
travelling
long
distances
without
resting
Sharp stabbing
pain radiating to
neck and
shoulders
No
Prenatal
Checkups
Inability
to know
condition
of
pregnanc
y
Inability
to
prevent
complica
-tions
Tubal
rupture
Ectopic Pregnancy
hemorrhag
e
IX.
a. Drug Study
Name of Drug
Generic Name:
Clindamycin
Brand Names:
Dalacin C
Dosage:
300mg TID
Route:
Per orem (P.O.)
Generic Name:
Mefenamic Acid
Brand Names:
Ponstel
Dosage and Route:
Mechanism of Action
Category:
Anti-bacterial
Mechanism of action:
Adverse Reactions:
It inhibits protein synthesis in CNS: convulsions (over dosage)
susceptible bacteria, causing GI:
Severe
colitis,
including
cell death
pseudomembranous
colitis,
diarrhea,
abdominal
pain,
esophagitis,
anorexia,
jaundice,
hepatic function changes
Hema:
Neutropenia,
Leukopenia,
agranulocytosis, eosinophilia
Hypersensitivity: Rashes, utricarial to
anaphylactoid reaction
Category:
Non-Steroidal
inflammatory
(NSAID), antipyretic
Nursing Interventions
regard
meals
severe
colitis
Mechanism of action:
Adverse Reactions:
Audiometric, ophthalmic exam
It
inhibits
prostaglandin GU: nephrotoxicity, renal failure
before, during, after treatment; for
synthesis
by
decreasing Hema: Leukopenia, thrombocytopenia,
eye, ear problems: blurred vision,
enzyme
needed
for
agranulocytosis,
anemia,
tinnitus; may indicate toxicity
biosynthesis; analgesic, antineutropenia,
inflammatory, antipyretic
lymphocytosis, eosinophilia,
Fever: temp before and 1 hr after
pancytopenia, hemolytic
administration
anemia
Misc: Anaphylaxis, serum sickness
Cardiac
status:
edema
(peripheral),
tachycardia,
Contraindications:
palpitations; monitor B/P, pulse for
Hypersensitivity to cephalosporins
character,
quality,
rhythm
especially in patients with cardiac
disease/ elderly
Implementation:
Administer With food, milk, or
antacid
to
decrease
GI
symptoms; however, taking on
empty stomach best facilitates
absorption;
if
nausea
and
vomiting occur/persist, notify
prescriber
Evaluation:
Therapeutic
response:
decreased pain, stiffness in joints;
decreased swelling in joints; ability
to move more easily; reduction in
fever or menstrual cramping
Side Effects/ Adverse Effect:
Substitution of one iron salt for
another
without
Constipation,
gastric
irritation,
proper
adjustment
may
result
in
nausea,
serious
over
or
abdominal
cramps,
anorexia,
under dosing.
diarrhea,
Eggs, milk, coffee, or tea
Generic Name:
Classifications:
Brand Names:
Action of Drug:
Iron is absorbed from the
duodenum and upper jejunum
Ferrous Sulfate
(FeSO4)
Anti-anemic, Iron
200mg 1cap OD
by an active
through
mucosal
cells
combines
with
transferrin.
mechanism
the
where
it
theprotein
Generic Name:
KETOROLAC
Brand Names:
TORADOL
Dosage and Route:
30mg/1amp IV q 8 x
4dose
Classifications:
Non-steroidal
anti- - CNS: drowsiness, abnormal thinking,
inflammatory
agents, dizziness, euphoria, headache.
nonopioid analgesics
- RESP: asthma, dyspnea
- CV: edema, pallor, vasodilation
Action of Drug:
- DERM: pruritis, purpura, sweating,
Inhibits
prostaglandin urticaria
synthesis,
producing - HEMAT: prolonged bleeding time
peripherally
mediated - LOCAL: injection site pain
- NEURO: paresthesia
analgesia.
- Also have anti-pyretic and - MISC: allergic reaction, anaphylaxis
anti-inflammatory properties. Contraindications:
- Therapeutic effect:Decreased
pain.
- Hypersensitivity
- Cross-sensitivity with other NSAIDs
may existPre- or perioperative use
- Known alcohol intolerance
Use cautiously in:
1) History of GI bleeding
2) Cardio vascular disease
Generic name:
cefuroxime
Brand name:
Ceftin
Dosage:
750mg.
IVq8h
Route:
Oral (P.O)
Classification:
Antibiotic
Action of the Drug:
Bactericidal; inhibits synthesis
of bacterial cell wall, causing
cell death.
Side Effects:
CNS: headache, dizziness,lethargy,
paresthesias,
GI: n/v, diarrhea, anorexia, abd.pain,
flatulence, hepatotoxicity
GU: nephrotoxicity
Hypersensitivity: serum sickness
reaction
Local: pain, abscess at injection site,
phlebitis
Other: disulfiram-like reaction with
alcohol
Adverse Effects:
GI: pseudomembranous colitis
Hematologic: bone marrow depression
Hypersensitivity: anaphylaxis
Other: superinfections,
Contraindications:
Contraindicated with allergies to
sulfonamides, celecoxib, NSAIDs, or
aspirin, significant renal impairment;
perioperative pain post CABG surgery;
pregnancy (3rd trimester), lactation.
Use cautiously with impaired hearing,
hepatic and CV conditions.
Brand name:
Zantac
Generic name:
ranitidine
Dosage:
50mg q8h
Route:
Intravenous (IV)
Side Effects:
CNS: h/a,
CV: tachycardia, bradycardia, PVCs
(rapid IV administration)
Dermatologic: alopecia
GI: Constipation, diarrhea, Nausea &
vomiting, abdominal pain
GU: gynecomastia, impotence or
decreased libido
Local: pain at IM site, local burning or
itching at IV site
Adverse reaction
CNS: malaise, dizziness, drowsiness,
somnolence, insomnia, vertigo
Dermatologic: Rash
GI: hepatitis, increased ALT levels.
Hematologic: leukopenia,
granulocytopenia,
thrombocytopenia,pancytopenia
Other: arthralgias
Contraindications:
Contraindicated with allergy to
Ranitidine, lactation
Use cautiously with impaired
renal or hepatic function,
pregnancy
GENERIC NAME:
metronidazole
BRAND NAMES:
Flagyl
DOSAGES & ROUTE:
500mg
I.V. q 8
CLASSIFICATIONS:
Amoebicides &
Antiprotozoals
ACTION OF DRUG:
Bactericidal; Inhibits DNA
synthesis
Generic Name:
BISACODYL
Brand Name:
BUSCOPAN
Dosage:
10mg ( 1 suppository
daily rectally)
Route:
Rectal (suppository)
Classification:
Laxatives
Action of the Drug:
It works by stimulating enteric
nerves to cause colonic mass
movements. It is also a
contact laxative; it increases
fluid and NaCl secretion.
Action of Bisacodyl on small
intestine
is
negligible;
stimulant
laxatives
mainly
promote evacuation of the
colon.
Side effects:
Upset stomach, diarrhea, intestinal
irritation
Adverse effects:
Abdominal pain, cramping, perineal
irritation, excessive bowel activity
Contraindications:
Hypersensitivity rectal fissures,
abdominal pain, nausea, vomiting,
appendicitis, acute surgical abdomen,
ulcerated haemorrhoids, acute
hepatitis, fecal impaction, intestinal,
bilary tract obstruction
b. Surgical Management
i. Exploratory Laparotomy
ii. Salphingectomy
Exploratory Laparotomy
-this was done to the patient because she suffered from ectopic pregnancy
-since the patient had an ectopic pregnancy in her abdomen they used
laparotomy to explore the cause of preoperative symptoms
-using this surgical treatment there are normal results in reasons why
exploratory laparotomy is performed. The procedure may indicate further
treatment if necessary.
-various diagnostic tests maybe perform to determine if exploratory laparotomy
is necessary. Example of this is CT Scan, X-ray, MRI. Also the presence of
intraperitoneal fluid maybe an indication that laparotomy is necessary.
Salphingectomy
INFERENCE
Surgical incision
Broken skin
Open wound,
possibility of
microorganisms
to enter.
Risk for
infection
PLANNING
STO:
After
30
mins
health teaching,
patient will be
able to identify 3
out of 5 ways to
reduce risk for
infection
NURSING
INTERVENTIONS
Independent:
assess
patients
perception, level of
understanding
and
needs
- assess v/s especially
temperature
emphasize
importance of hand
washing
maintain
aseptic
technique
when
changing dressing /
wound care
RATIONALE
EVALUATION
STO:
Goal met. Patient
was
able
to
identify 3 out of 5
ways to reduce
risk for infection.
LTO:
Goal met. Patient
did not manifest
any
signs
of
infection
during
the
course
of
confinement.
Problem:
Post-op pain
Subjective:
medyo masakit
pa yung sa may
tahi ko
As verbalized by
the patient.
Objective:
- pale and weak
in appearance
(+)
facial
grimace
- pain scale of 5
(10
as
the
highest)
Nursing
Diagnosis:
Acute
pain
related
to
surgical incision
as manifested by
pain
scale
of
5/10.
Surgical incision
Complex
responses of
nerve endings
due to trauma
Hypersensitivity
of central
nervous system
Unpleasant
physical and
emotional
responses
pain
STO:
After 4 hours of
nursing
intervention,
patients
perception of pain
will be lessen as
evidence by pain
scale of 3/10.
Independent:
assess
patients
perception, level of
understanding
and
needs
obtain
clients
baseline v/s including
pain scale
STO:
Goal partially met.
Patients perception
of pain was lessen
but with a pain
scale of 4/10.
LTO:
Goal met.
Patient
did
not
complain of pain
higher than pain
scale of 3/10
Problem:
Inadequate sleep
Subjective:
hindi
ako
makatulog
masyado sa iyak
ng mga baby at
mayat-maya
minomonitor ako
as verbalized by
the patient.
Objective:
weak
in
appearance
- yawning
-presence of eye
bags
-restless
Nursing
Diagnosis:
Disturbed
sleeping patterns
related
to
therapeutic
purposes
and
other generated
awakening
as
manifested
by
restlessness and
presence of eye
bags
Environmental
factors
(government
hospital setting:
2patients per
bed)
External factors
(crying babies
and nurses
frequent
monitoring of
vital signs)
Inability to sleep
Inadequate
sleep
STO:
Within the shift,
patient will have
an improvement
in sleep pattern
as evidence by
verbalization
of
enhancement in
sleep pattern and
rested
appearance
Independent:
- assess sleep pattern
disturbances that are
associated
with
environment
- observe and obtain
feedback
regarding
sleeping
pattern,
bedtime routine and
hours of sleep
-do as much care as
possible
without
waking the patient and
do as much care as
possible when patient
is awake
-explain
the
importance
of
monitoring v/s and
care when hospitalized
STO:
Goal met. Patient
verbalized
enhancement
of
sleep pattern and
-to determined usual appeared
rested
sleeping patterns and within the shift.
if
there
are
any
changes/improvement
s
- sleep disturbances
can affect the recovery
of patient
-to
minimize
complaints and for
patient to understand
the care being done to
her
Problem:
Anemia
Ruptured
ectopic
pregnancy
Objective:
- (+) pale & weak
in appearance
- Hgb Count of
103
- edema present
on the legs and
feet
Emergency
laparotomy and
salpingectomy
Profuse blood
loss
Anemia
Nursing
Diagnosis:
Inadequate
Tissue Perfusion
related
to
decreased
hemoglobin
concentration in
the
blood
as
manifested
by
paleness
and
weakness
Short
term Independent:
objective:
-Monitor
vitalsigns,
After 1 hour of heart
sounds,
and
nursing
cardiac rhythm
Interventions, the
capillary
client
will -measure
refill then palpate for
verbalize
understanding of presence or absence
and quality of pulses
conditions,
therapy regimens, -Perform assistive or
and
when
to active ROM exercises
contact
health
care provider.
-encourage
early
ambulation
when
possible
STO:
-to evaluate degree of Goal met.
inadequacy of tissue
After 1 hour of
perfusion
nursing
-to note degree of interventions, the
impairment
client
verbalized
understanding of
conditions, therapy
regimens,
and
when to contact
care
-to maximize tissue health
provider.
perfusion
-enhances
return
Long
term -discourage sitting or
Objective:
standing
for
long
-to maximize
After 8 hours of periods,wearing
constrictive
clothing
or
perfusion
nursing
crossing
legs
intervention, the
client
will
demonstrate
increased
perfusion
as
evidenced
by
absence of edema
venous
LTO:
Goal not met.
tissue
After 8 hours of
nursing
intervention,
the
client still exhibits
decreased
tissue
perfusion
as
evidenced
by
of
tissue presence
edema.
X.
Medications
Instruct client to continue take her prescribed medications
Orient the client about the name of drugs, their actions, the exact
dosage, the frequency and the route of administration.
Instruct client to follow the instruction when administering medication.
Advice the significant others not to leave the client during medication
Explain to the client the side effects and adverse effects of the drugs she
takes by
prescribing its manifestations.
Advice client not to stop intake of prescribed medications, unless
approved by the
physician.
Exercise
Instruct client to balance activities with adequate rest periods.
Educate client on proper body mechanics to prevent muscle strain and
enable client to
relax.
Encourage client to ambulate and assume normal activities
Encourage deep breathing exercise
Treatment
Educate client the importance of drug compliance.
Diet
To promote healing, eat a balanced diet rich in fresh fruits and
vegetables. Depending on
how much blood loss occurred during surgery, you may require a daily
iron supplement.
Eat high-fiber foods, drink plenty of water, and if necessary, use stool
softeners.
Instruct client to eat foods that are high in protein and vitamins and
minerals.
Bibliography
Pillitteri, Adele. 2007. Maternal and Child Health Nursing: Care for the
Childbearing
and Childbearing Family, ed. 5. Philippines: Lippincott Williams and Wilkins.
Abarquez, et. al. (2006) A Case Study on Ectopic Pregnancy . Ateneo de Davao
University College of Nursing.
Weber and Kelley (2007) Health assessment
Doenges, Moorhouse, Geissler-Murr (2004) Nurses Pocket Guide 9 th edition
Palma, Oseda (2009) G&A notes
Lippincott and Williams 2011 Drug Guide
http://www.scribd.com
http://www.smokersworld.info
http://www.nursingcrib.com
http://www.americanpregnancy.org/pregnancycomplications/ectopicpregnancy.html
http://www.wrongdiagnosis.com/e/ectopic_pregnancy/statscountry.htm#extrapwarning
http://www.medterms.com/script/main/art.asp?articlekey=9809
http://www.medcompare.com/jump/750/ectopic_pregnancy.html
http://en.wikipedia.org/wiki/Ectopic_pregnancy
http://www.ectopicpregnancy.net/resources_physicians.html
http://www.pregnancy.com.ph/ectopic_pregnancy.htm