TABLE OF CONTENTS

CHAPTER I: INTRODUCTION 2
CHAPTER II: ASSESSMENT
A. HEALTH HISTORY
 VITAL INFORMATION 4
 HISTORY OF PRESENT ILLNESS 4
 PAST MEDICAL HISTORY 4
 FAMILY HISTORY 5
 PSYCHOSOCIAL PROFILE 6
B. PAROS 8
C. LABORATORY AND DIAGNOSTIC TESTS 15
CHAPTER III: REVIEW OF ANATOMY AND PHYSIOLOGY
A. ANATOMY AND PHYSIOLOGY OF THE FEMALE REPRODUCTIVE SYSTEM 16
B. ANATOMY AND PHYSIOLOGY OF CIRCULATORY SYSTEM 18
C. ANATOMY AND PHYSIOLOGY OF ENDOCRINE SYSTEM 20
D. NORMAL PREGANANCY 21
CHAPTER IV: PATHOPHYSIOLOGY
 CONCEPT MAP
 DOCUMENTED ANALYSIS OF THE RISK FACTORS 25
CHAPTER V: NURSING PROCESS RECORD 27
CHAPTER VI: REFERENCES 36
CHAPTER VII: APPENDIX
A. DRUG STUDY 44
B. NURSING JOURNALS 52

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 Chapter I
INTRODUCTION

Pregnancy or gestation is the physiologic process of a developing fetus inside a

woman’s womb or uterus (Bernstein & VanBuren, 2022). Fertilization also referred to as
conception and impregnation, is the union of an ovum and a spermatozoon. This usually occurs
in the outer third of a fallopian tube, termed the ampullar portion which links an ovary to the
uterus. If the fertilized egg successfully travels down the fallopian tube and implants in the
uterus, an embryo starts growing (Silbert-Flag & Pillitteri, 2017).
The gestational age or menstrual age is the time elapsed since the first day of the last
normal menstrual period (LNMP), which actually precedes the time of oocyte fertilization. The
gestational age is expressed in completed weeks. The start of the gestation (based on the LNMP)
is usually 2 weeks before ovulation, assuming a 28-day regular menstrual cycle. The
developmental or fetal age is the age of the conception calculated from the time of implantation,
which is 4 to 6 days after ovulation is completed. The menstrual gestational age of pregnancy is
calculated at 280 days or 40 completed weeks (Bernstein & VanBuren, 2022).
On the other hand, Ectopic Pregnancy is an early embryo (fertilized egg) that has
implanted outside of the uterus (womb), the normal place for implantation (ASRM, 2022). The
term "ectopic" comes from the Greek "ektopis" meaning "displacement" ("ek", out of + "topos",
place = out of place). The first person to use "ectopic" in a medical context was the English
obstetrician Robert Barnes (1817-1907) who applied it to an extrauterine pregnancy: an ectopic
pregnancy (Marks, 2021).
Ectopic Pregnancy is where the sperm inside the fallopian tube fertilizes the egg in a
normal conception. The embryo then moves through the tube, arriving in the uterus 3 to 4 days
later. If the fallopian tube is obstructed or damaged, and the embryo is unable to reach the uterus,
the embryo may implant in the tube's lining, resulting in an ectopic pregnancy. The growing
embryo cannot be supported by the fallopian tube. The tube can rupture and hemorrhage after a
few weeks, resulting in a potentially dangerous situation (ASRM, 2022).
The most common site for ectopic pregnancy adherence is in the ampullary region of the
fallopian tube. Reportedly 95% of ectopic pregnancies develop in the ampulla, infundibular, and
isthmic portions of the fallopian tubes (Gnugnoli & Mummer, 2021). Any woman capable of
child-bearing age and is sexually active is at risk of an ectopic pregnancy (Bravand, 2022).
According to Danielsson (2021), ectopic pregnancy affects about one in every 50
pregnancies in the United States. An ectopic pregnancy affects between 6% and 16% of pregnant
women who visit an emergency room in the first trimester for bleeding, discomfort, or both.
Bleeding from ectopic pregnancy causes 10% of all pregnancy-related deaths, and it's the leading
cause of first-trimester maternal death. Women have a 15% chance of another ectopic pregnancy
after the first one. Treatment with medication rather than surgery has a lower risk of recurrent
ectopic pregnancy. In western world, the prevalence of ectopic pregnancy is approximately 2%
in the general population, but as high as 20% in patients who have undergo tubal surgery and
previous ectopic pregnancy. The prevalence of ectopic pregnancy has an increasing trend during
the last three decades throughout the world especially in developing countries where early

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diagnosis is low (Alemayehu, Desta, Diriba et al., 2021). In the Philippines, the incidence of
ovarian ectopic pregnancy is one in 7000 to 40 000, but most rupture in the first trimester and
only a few survive to term (Caguiat & Suarez, 2020).
Previous ectopic pregnancy, prior fallopian tube surgery, prior pelvic or abdominal
surgery, certain sexually transmitted infections (STIs), Pelvic inflammatory disease, and
endometriosis are all risk factors for ectopic pregnancy. Cigarette smoking, being over 35 years
old, having a history of infertility, and using assisted reproductive technologies, such as in vitro
fertilization, are other factors that may raise a woman's risk of ectopic pregnancy (IVF). Women
who are sexually active should be aware of changes in their bodies, particularly if they have
signs of an ectopic pregnancy (American College of Obstetricians and Gynecologists, 2018).
The purpose of this study is to appraise all the cases of Ectopic Pregnancy and to
determine the incidence, risk factors, clinical presentation, management and morbidity associated
with Ectopic Pregnancy.

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 Chapter II
HEALTH HISTORY

Vital Information
Name: Patient Cherry
Address: Saving-side village, Población, Pangantucan, Bukidnon
Contact person: Mother
Religion: Thanks to Commission
Sex: Female
Age: 23
Birthdate: January 18, 1999
Place of Birth: Saving-side village, Población, Pangantucan, Bukidnon
Ethnicity: Bisaya
Nationality: Filipino
Race: Asian
Date of admission: 3-26-2022
Marital Status: Married
Home phone:09702852606
Work phone:09702852606
Education: 1st year college, Agriculture
Occupation: Housewife
Health Insurance: Philhealth
Room number: SP6
Attending Physician: Doctor Jenni Mundin
Final Diagnosis: Ruptured left ampullary pregnancy hypovolemic shock and severe anemia
secondary to acute blood loss.
Reasons for seeking healthcare:
Ectopic pregnancy probably ruptured, hypovolemic shock and anemia secondary to acute blood
loss.

History of Present Illness:

Patient cherry is 23 years old, a housewife, primigravida, no term pregnancy, no preterm
pregnancy, no abortions, no living children and has no multiple gestations, LMP was on
February 6, 2022, amenorrhea as sign of pregnancy, 6 pm onset of pain on March 26, 2022,
stabbing pain in the left lower quadrant prompted admission.
Primary Dx:
Ectopic pregnancy probably ruptured, hypovolemic shock + anemia secondary to acute blood
loss
Final Dx:
Ruptured ampullary pregnancy, hypovolemic shock +severe anemia secondary to acute blood
loss

Past Medical History:

2 weeks PTA onset of on & off pain on the left lower quadrant radiating to hypogastric region to
left iliac region, pain scale of 5.

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5
Psychosocial Profile:
1. HEALTH PERCEPTION-HEALTH MAINTENANCE PATTERN
The patient does not have a yearly physical examination neither she visits hospital to seek health
care because she is physically healthy and no past illness history. Moreover, she does not
perform self-examinations and other self-care measures. Most of the foods that she intake are
vegetables and fruits, but does not drink enough water. She does not smoke nor drink alcohol and
caffeine. She used to eat salty foods like junk foods and also chocolates. During her free time,
she goes to sleep or walk around near in their house. The patient knows about the fire prevention,
water safety and poison control for the family. However, she assured the clean surroundings and
safety inside and outside of their home. She doesn’t have enough knowledge about infant care
because the baby is about a month only in her womb.
2. NUTRITIONAL-METABOLIC PATTERN
Junk foods and chocolates are the favorite foods of the patient. Sometimes she eats meat, but
most of the time she eats vegetables and fruits. She wakes up late in the morning so she eats late
too. She doesn’t have any food allergies and history of eating disorders. She likes to cook and
loves eating soup rather than fried foods. However, she doesn’t limit when she eats and she never
take any vitamins or herbal supplements. She takes drugs if the health care provider says so. Her
appetite is good, no nausea and vomiting or even sore mouth.
3. ELIMINATION PATTERN
The patient has problem in urinating or Dysuria because of her surgery, she has a catheter instead
and no Hematuria or Glucosuria. Her bowel movement usual time is unpredictable, she defecates
twice or thrice in a week, it is firm and its color is normal which is brown. No laxatives or
suppositories given.
4. ACTIVITY-EXERCISE PATTERN
The patient is a housewife, she never applies for job because her husband did it for her. Their
home is not near for pesticides, asbestos, plastics, anesthetics radiation or solvents. The
surroundings in their house does affect her health. Walking around sometimes and doing
household chores is what the patient considers as exercise. She makes some time doing
gardening and sweeping inside and outside of their house. The patient does not participate in any
sports and routine exercise. However, she maintains her health physically and mentally. The
patient has a pet which is the chicken that she loves. This serves as her hobby while she is the
one left alone in their home most of the day. She has no recreational activities aside from caring
her loving pet.
5. SLEEP-REST PATTERN
There are no medications taken by the patient. She sleeps at night around 8 or 9pm then she
wakes up 10am, because she wakes up late, she eats late also. She doesn’t have any interruptions
while sleeping, no problems in sleeping also.
6. COGNITIVE-PERCEPTUAL PATTERN

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The patient has no hearing aid and no glasses used. She doesn’t have any insensitivity to cold or
heat and also no insensitivity to superficial pain. Moreover, she can able to read and write
accordingly.
7. SELF-PERCEPTION PATTERN
The most concerned about of the patient is her health. The present health goals of the are to
achieve the normal blood pressure due to acute blood loss that turns to severe anemia and to
relieve the abdominal pain that she feels. Also, she helps herself to intake more water for her not
to become risk for dehydration. Her life change because of the loss of the baby that they are
waiting for 3 years. Moreover, she accepts it, knowing that there’s so much great things lie
ahead.
8. ROLE-RELATIONSHIP PATTERN
The patient is always having a positive self-image while asking her feelings. She possesses
positivity even how dark the past experiences that she had. Good relationship with the people
around her especially with her husband. She said that sometimes, they argue with her husband
for some small things, but she has control and she believes that love will never separate their
relationship. She always assumes the responsibility of others and self-concept are not a threat for
her. There’s no language barrier or any cultural plan and beliefs between the patient and her
husband. They are both Bisaya, same religion and same perspectives in life so there’s no conflict
arise in them. They both plan and decide in everything that needs to be, no individualizing and
ownership for them. No difficulties with relative and in-laws or parents. The patient is a member
of Philippine Health Insurance Incorporation and it has a big help for them especially her
husband had limited income and this insurance company help them a lot for her surgery and
other medical finances. The husband is the head of the family, and the patient which is the wife
budgets for the food and other finances. They both do their individual tasks and roles. Moreover,
they have a good relationship with each other because they are helping and understand each
other.
9. SEXUALITY-REPRODUCTIVE PATTERN
The patient is sexually active and she is satisfied with her sexual role, performance and
relationship. There’s no effects on her physical and psychological. She never used any
contraceptive. There’s pain and discomfort with intercourse at first back then but later on, not
that much.
10. COPING-STRESS PATTERN
The patient and her husband decide or plan things together, because they know that when they
both decide, it may end up into a great result. The loss of their first baby that they’re waiting too
long is painful and fresh for them especially for the patient. But she’s moving forward for what is
the good purpose of the things that happened. Knowing that she entrusts it to God. When the
patient is stress, she always sleeps. Sometimes she feels upset, she will talk to somebody
especially to her husband to ease the feeling that she had.
11. VALUE-BELIEF SYSTEM

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Due to the loss of suppose to be their first baby, the patient finds source of strength from her
family especially from her husband. It may not be easy for them, but they know that God has a
better plan. The support and comfort of loved ones and friends also find strength for her.

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 TABLE 1: Physical Assessment and Review of Systems
SYSTEMS REVIEW OF INSPECTI PALPATI PERCUSSI AUSCULTATI
SYSTEMS ON ON ON ON
INTEGUMENTA *incision on *no changes *smooth
RY left lower in skin color and fine hair
quadrant *5 cm *Smooth
*itching incision on nails
present on left lower *warm skin
forehead, quadrant
right arm,
right calf and
mid axillary
area
*sweating as
reaction to
warm weather
*cutis anserin
as reaction to
cold weather
*usual pattern
of haircare
includes
shampooing
and
conditioning
hair
*usual
patterns of
nail care
include
trimming
nails and nail
polish.
Head & Neck *Headaches *No wounds *No lumps
occur three to *No scars *No masses
four times a *No local *No swollen
year erythema nodes
*no recent * No stiff
head trauma neck
no head * No pain
injuries upon head
*no surgeries and neck
*no movements
concussion or
loss of
consciousness

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 *dizzy spells
prompted
admission
*no fainting
Eyes *No itching, *Constriction * No lumps
no tearing to colored *No masses
*No drainage light, bright
*No pain lights and
*No floaters flashing
*No halos. lights
*No blurring *No
of vision twitching
*No double *No Visual
vision deficit
*No
hypersensitivi
ty to light
Nose & Sinuses *No allergies *No * No lumps *No pain
*No use of nosebleeds upon
recreational *No broken percussion of
drugs nose sinuses
*No difficulty *Even
breathing septum
through nose *No snoring
*No
postnasal
drip
*No runny
nose
*No
sneezing
*No
lacerations
Ears *No ear pain * No * No lumps
*No ringing drainage
*No fullness * No ear
*No earwax infection
problems *No
*No use or lacerations
hearing aids, *positive
ear care watch tic test
patterns
include use of
cotton buds to
clean the ear
weekly.

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 *Ear care
patterns
include use of
cotton buds to
clean the ear
weekly.
Mouth & Throat *No sore *No mouth *No lumps
throats sores and masses
*No changes *No oral
on voice herpes
quality *No bleeding
*No difficulty gums
chewing or *No
swallowing hoarseness
*No changes *No mouth
in sense of sores
taste *No oral
herpes
*No bleeding
gums
*No
hoarseness
Respiratory *No breathing *No SOB * No Cough *Tympanic *No adventitious
problems with activity *No sputum sound sounds
*No noisy
respirations

Cardiovascular *No HTN *No swelling *No lumps *Dullness *No adventitious
*No of sounds
awakening extremities
with SOB, *No hair loss
*Dizzy spells on legs
*Cold and *No
numb hands unhealing
prompted sores
admission
*No pain in
legs while
walking
Breast *No breast *No pain *No breast
surgeries *No lumps
*Wasn’t able discharge *No mass
to perform *No swelling
BSE *No changes
in breast or
nipples

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 *No
dimpling
Gastrointestinal *No loss of
appetite
*No
indigestion
*No heartburn
*No GERD
*No nausea
*No vomiting
*No liver or
gallbladder
disease
*No jaundice
*No
abdominal
swealing,
*Regular
bowel pattern:
defacates
twice or thrice
a week,
*Yellowish
brown stools
*No diarrhea
*No
constipation
*No
hemorrhoids
*No changes
in weight*No
use of
laxatives or
antacids.
Genitourinary *No diarrhea
*No
constipation
*No
hemorrhoids
*No changes
in weight
*No use of
laxatives or
antacids
*No frequent
night time

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 urination.

Female *Menarche
Reproductive unrecalled
System *Normal
cycle *LMP:
February 6,
2022
*No painful
menstruations
, *No hx of
excessive
bleedings
*No irregular
menses
*No bleeding
between
periods
*Last pap
smear exam
date
unrecalled,
result:
catcher,
*Satisfied
with sexual
performance,
*No pain
upon
intercourse
*No use of
contraceptives
Musculoskeletal *No fractures *No joint *No masses *Dullness
*No sprains swelling *No lumps
*No muscle *No
cramps erythema
*Pain on left *No
pelvis limitation
prompted with ranges
admission of motion
*No use of *No joint
calcium deformity
supplements. *No noise
with
movement
*No spinal

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 deformity
*No low
back pain
*No loss of
height
Neurological *No loss of
consciousness
*No fainting
*No seizures
*No head
injury
*No changes
in cognition
or memory
*No
hallucination
*No
disorientation
s
*No speech
disturbances
*No motor
problems
*No problems
with gait,
balance and
coordination.

Endocrine *No
endocrine
disorders
*No
unexplained
hunger or
thirst
*No changes
in weight or
height
*No heat and
cold
intolerances
*No goiter
*No hx or
hormone
therapy
*No changes

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 in hair or skin.
Immune / *No bleeding *No bruising
Hematologic disorders *No
*With severe unexplained
anemia swollen
*No recurrent glands.
infections
*No hx of any
type of cancer
*No fatigue,
had blood
transfusion
*No allergies

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