INTRODUCTION PATIENT’S PROFILE
An ectopic pregnancy happens when a fertilized egg Name: Rosalinda Del Rosario (RDR)
implants and grows outside of the uterus's main cavity.
Ectopic pregnancy is most commonly found in a fallopian
tube, which transports eggs from the ovaries to the uterus.
A tubal pregnancy is a form of ectopic pregnancy. Ectopic
pregnancy can develop in other parts of the body, such as
the ovary, abdominal cavity, or the lower section of the
uterus (cervix) that links to the vagina. An ectopic
pregnancy cannot be carried out normally. If left untreated,
the fertilized egg cannot survive, and the developing tissue
may cause life-threatening hemorrhage.
. January 25, 2023/ 10:45am
OBJECTIVES
 Identify symptoms of ectopic pregnancy.
 Explain the correct ectopic pregnancy evaluation.
 Ectopic pregnancy (EP) is a serious condition.
Delayed diagnosis could lead to life-threatening
outcomes. The study aimed to develop a diagnostic
predictive model for EP to approach suspected
cases with prompt intervention before the rupture
occurred.
 The goal of the evaluation is to ensure that
maternal blood loss is replaced and the bleeding
would stop.
CASE DESCRIPTION
A 35-year-old female G2P1 reported to the Emergency
Room after experiencing a pre-syncopal episode at work.
Next morning, the patient had severe stomach cramps,
nausea, and vaginal bleeding with clots, followed by an
episode of light-headedness while seated at her work. The
patient denied experiencing any loss of consciousness,
dyspnea, chest discomfort, palpitations, or fevers/chills.
HISTORY OF PRESENT ILLNESS
The patient had unusually heavy and protracted menstruation five
Age: 35 years old
Address: BRGY II, Mataasnakahoy,
Batangas
Status: Married
Occupation: Real Estate Agent
Date and Time of Admission:
ECTOPIC
PREGNANCY
d
CHIEF COMPLAINT
Severe stomach cramps, nausea, and
vaginal bleeding with clots, followed
by an episode of light-headedness
while seated at her work
PHARMACOLOGIC
MANAGEMENT/DRUG STUDY
If an ectopic pregnancy is diagnosed
early but active monitoring isn't
suitable, treatment with a medicine
called “methotrexate” may be
recommended. This works by
stopping the pregnancy from growing.
It's given as a single injection into
your buttocks.
days before admission. Her last regular menstrual cycle occurred on
November 7, 2022. The current menstrual flow began on December
20, 2022, and lasted until the day of the first clinic visit. As she
suffered little flow during the first three days of this cycle, the
patient sought therapy from another clinic to "boost" the flow of her
menstrual. Her menstruation grew thick and protracted after
therapy. As a result, she sought a second opinion.
PAST MEDICAL HISTORY
At the age of 15, the patient experienced her first menstrual cycle.
She has had Asthma since she was three years old and had her flu
vaccine in January 2022. In 2016, she acquired a widespread rash
after a kidney infection that was treated with ampicillin. Despite
having no known food allergies, the patient was sensitive to dust
mites.
FAMILY HEALTH HISTORY
Mrs. RDR is the only daughter of the S family. Her father died in a
vehicle accident when she was 43, and her mother died at the age of
67 from varicose veins, headaches, and hypertension. Her eldest
brother, on the other hand, has high blood pressure but is generally
healthy at the age of 56, and her other brother is equally healthy
save for moderate arthritis at the age of 51.
PERSONAL, SOCIAL, LIFESTYLE
Mrs. RDR, the patient, has never experimented with illicit
substances or alternative remedies. She smokes one pack of
cigarettes every day at the age of 18. She also seldom consumes
alcohol and has no history of abuse. The patient's diet is poor in
calcium, with minimal milk or cheese and a low salt intake. She
routinely consumes high-fat mid-morning and night-time snacks.
Her sleep is generally decent, with an average of 7 hours each day.
She remarked that she does not have time to work-out.
 LABORATORY AND
DIAGNOSTICS REVIEW
 Transvaginal Ultrasound
 Hematology
 Complete Blood Count (CBC)
 Urinalysis
PATHOPHYSIOLOGY
The trophoblast grows in the
fertilized ovum and invades the
tubal wall profoundly.
↓ 
After implantation, the trophoblast
generates hCG, which keeps the
corpus luteum in place.
↓ 
The corpus luteum secretes
oestrogen and progesterone,
transforming the secretory
endometrium into decidua. The
uterus expands and softens for up to
8 weeks.
PHYSICAL ASSESSMENT AND
REVIEW OF SYSTEM
 Signs of rupture include
tachycardia, orthostasis,
rebound tenderness and
guarding
 Abdominal tenderness is
present
 Cervical motion tenderness is
present
 A palpable mass is present
MEDICAL DIAGNOSIS  Describe the side effects of medical therapy and symptoms to
monitor (eg severe abdominal pain, lightheadedness)
 Risk for “Deficient Fluid Volume” related to  Patients should be advised regarding their risk of future
bleeding from a ruptured ectopic pregnancy ectopic pregnancy
 “Powerlessness” related to early loss of  In patients with no history of subfertility or tubal pathology, no
pregnancy secondary to ectopic pregnancy difference in the risk of future tubal ectopic pregnancy or tubal
patency rates is seen between the different management
approaches
DISCHARGE PLAN
OPD
MEDICATION:  Return if patient has increasing abdominal or pelvic pain or
heave vaginal bleeding
 Vasopressin
 Have chest problems or shoulder pain
Methotrexate
 Return to emergency department if patient feels like they are
 Mifepristone
going to faint
 Dextrose 5% Lactated Ringer’s (D5LR)
DIET
ENVIRONMENT:
 Fiber supplements It is very important to include fiber in your
Clean, Quiet, and Dim Environment
diet while you are recovering from surgery for an ectopic
pregnancy
TREATMENT:
 Eat fresh fish Fish is a food rich in protein, low in fat and
 Expectant management – your condition is
offers many health benefits. In particular, white fish has a
carefully monitored to see whether treatment
lower fat content than any other animal protein source
is necessary
 Medicine – a medicine called methotrexate
 Milk Women after an ectopic pregnancy need to supplement
is used to stop the pregnancy growing
milk because milk is full of substances such as protein, sugar,
 Surgery – surgery is used to remove the
lipids, potassium, and multivitamins
pregnancy, usually along with the affected
fallopian tube
SEXUALITY AND SPIRUTUALITY
HEALTH EDUCATION:  Limiting the number of sexual partners and using a condom
during sex helps to prevent sexually transmitted infections and
 Advise the patient on the advantages and
may reduce the risk of pelvic inflammatory disease
disadvantages of each treatment option
 Women may grieve at the loss of pregnancy
 Excessive physical exertion or sexual activity might cause the
and may need appropriate support
ectopic pregnancy to rupture. Inquire with your doctor about
 Patient with confirmed ectopic pregnancy when it is safe to have sex.
should avoid using intrauterine device as
contraception since this can increase the
chance of ectopic pregnancy
 ETHICAL-MORAL CONSIDERATION

Any practice of intentionally delaying treatment of a reliably diagnosed ectopic pregnancy on non-clinical grounds
until rupture of the fallopian tube has occurred or is imminent, in order to justify terminating the ectopic pregnancy
on the grounds of saving the patient's life, is unethical and illegal. Catholic hospitals may utilize salpingectomy based
on the principle of twofold impact because it permits embryo death to be considered as an unintentional outcome of
therapy. With a salpingostomy, the lady can save her reproductive functions. In some respects, this is more ethical
because it encourages future procreation.

NURSING
CARE PLAN
 ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
SUBJECTIVE: INDEPENDENT:
- Anxiety related to the LONG TERM:
“Hindi ko talaga unfamiliarity of the - Monitor physiological - It could be an indicator - The client is well-
naiintindihan ang condition andthe - After completing the responses like dizziness, of the level of fear the informed about her
kundisyon ko, akala ko perceived threat to the nursing interventions, headaches, and tingling client is feeling—the condition and its actual
normal lang lahat ng mother's and fetus's the patient should be sensations, as well as client might feel out of effects, and she was
nararamdaman ko” as biologic integrity as a able to: behavioral cues like control or panic. able to devise coping
verbalized the patient result of a pregnancy restlessness and Symptoms, on the other mechanisms, making
complication. irritability. hand, may be linked to her appear calmer.
OBJECTIVE: physical condition or
- Appear relaxed and shock. - Client was able to use
T-36.8 °C, report anxiety reduced relaxationtechniques
HR-99/minute to a manageable level. -Create a relaxing and - Removing the client such as deep breathing
RR-25/minute calm environment from outside stressors exercises to help her
BP-90/60mmHg encourages relaxation relax.
- Verbalize and may improve
Pain Scale- 9/10Facial understanding of copingabilities. - Client is able to
Grimace- Wincing and condition, prognosis, participate in and follow
in a guarding position. and potential - Provide accurate, - Patients and families through with her
complications. concrete information who are informed are therapeutic regimen
about the effects of her more likely to follow without any confusion
- Participate in her condition on her theprescribed therapy or fear of the procedures
therapeutic regimen by pregnancy, delivery, and and participate in the and medications that
accurately monitoring maternal and fetal well- therapeutic regimen. will be administered.
and weight, blood being, as well as the Informing the client
pressure, urine protein, procedures and about the plan of care
edema,fetal activity, medications that will be reduces unnecessary
signs of improving or performed and anxiety about
worsening administered. unknowns.
preeclampsia, and side
effectsor effectiveness - Encourage people to - Creating a therapeutic
of medications.reporting express their worries by relationship.
speaking them out loud.
Actively listen to the
client as they express
their feelings.
 ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
SUBJECTIVE: INDEPENDENT:
- Acute pain related to SHORT TERM:
“Masakit ang aking distention or rupture of -Monitor maternal vital - To determine presence - After 1 hour of
tiyan” as verbalized by fallopian tube. - After 1 hour of nursing signs. of hypotension and nursing interventions,
patient. interventions the patient tachycardia caused by the patient’s pain has
will be relieved or rupture or hemorrhage. been ease as evidence
OBJECTIVE: controlled. by 5/10 from 9/10 using
-Monitor for presence -To further assess the pain scale.
T-36.8 °C, and amount of vaginal present situation
HR-99/minute bleeding. indicating hemorrhage.
RR-25/minute
BP-90/60mmHg - Monitor for increase - Increased pain and
and pain and abdominal abdominal distention
Pain Scale- 9/10Facial distention and rigidity. indicates rupture and
Grimace- Wincing and possible intra-
in a guarding position abdominalhemorrhage.

-Monitor complete -To determine the

blood count (CBC). amount of blood loss.

- Provide comfort -Promotes relaxation

measure like back rubs, and may enhance
deep breathing. patient’s coping
abilitiesby refocusing
attention.

COLLABORATIVE:

-Administer analgesics -To maintain acceptable

as indicated. level of pain.
 ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
SUBJECTIVE: INDEPENDENT:
- Risk for deficient fluid SHORT TERM: -Tachycardia may occur -At the end of our 2-
“Palagi akong nahihilo volume related to - Monitor Vital Signs. with hypovolemia to day, the patient
at biglanalang ako bleeding from a Within our 2-day care, maintain an effective maintained adequate
dinugo” as verbalized ruptured ectopic the patient will maintain - Assess capillary refill cardiac output. Usually fluid volume and
by the patient. pregnancy. adequate fluid volume skin turgor, and the pulse is weak and normal vital signs, moist
as evidenced by: mucousmembranes. maybe irregular if mucous membranes,
OBJECTIVE: electrolyte imbalance skin is slightly dry, has
-Vital Signs - Assess color and also occurs poor skin turgor,
T-36.8 °C, HR- amount of urine. capillary refill is less
80/minute,RR- -Moist mucous Reporturine output for 2 - To assess the signs of than 3 seconds and
25/minute, BP- Membranes consecutive hours adequacy of hydration Urinated 3 times.
110/90mmHg or development of
-Skin not dry and has - Monitor Input and dehydration.
good mobility and Output balance.
turgor: can belifted -Concentrated urine
easily and snaps COLLABORATIVE: denotes fluid deficit.
backimmediately to its polyuria can be present,
resting position. -Administer parenteral requiring more fluid
fluid: D5LR 1 L replacement.
-Capillary refillless gtts/min
than 3 seconds - -To ensure accurate
picture of fluid status.
-Adequate urinary Intake and output
output should be approximately
equal, dependent on
degree of hydration.

Capuchino, Lawrence Jay M.

CAMCAR Activity 1