ECTOPIC

PREGNANCY

Prepared by group 6
 Introduction
An ectopic pregnancy is a complication of
pregnancy in which the implantation occurs
outside the uterine cavity.
Most ectopic pregnancies occur in the
Fallopian tube (so-called tubal
pregnancies), but implantation can also
occur in the cervix, ovaries, and abdomen.
Risk factors
Pelvic inflammatory disease
Congenital malformations
Scars from tubal surgery
Uterine tumor pressing on the proximal end of the
tube
Infertility
Smoking
Previous ectopic pregnancy
Tubal ligation
causes
assessment
History of missed periods & “spotting”
Early signs of pregnancy
Anemia – fatigue and pale mucous membranes
Enlarged uterus due to hormonal influence
Slight abdoinal pain or sudden excruciating pain in
lower abdomen – often first indication of ruptured tube
Fainting & lightheadedness (occurs in 35-50%)
assessment
Early signs include:
Pain in the lower abdomen, (Pain may be confused with a strong
stomach pain, it may also feel like a strong cramp)
Pain while urinating
Pain and discomfort, usually mild. A corpus luteum on the ovary in a
normal pregnancy may give very similar symptoms.
Vaginal bleeding, usually mild. An ectopic pregnancy is usually a
failing pregnancy and falling levels of progesterone from the
corpus luteum on the ovary cause withdrawal bleeding. This can be
indistinguishable from an early miscarriage or the 'implantation
bleed' of a normal early pregnancy.
Pain while having a bowel movement
If the tube is unruptured, slow, chronic bleeding usually
occurs, and the abdomen gradually becomes rigid and
very tender
If a tube ruptures, sudden excruciating pain is felt in
the lower abdomen, usually over the mass; referred
shoulder pain is possible as the abdomen fills with
blood; vaginal bleeding and shock may also occur.
assessment
Patients with a late ectopic pregnancy typically
experience pain and bleeding. This bleeding will be
both vaginal and internal and has two discrete
pathophysiologic mechanisms:
External bleeding is due to the falling progesterone
levels.
Internal bleeding (hematoperitoneum) is due to
hemorrhage from the affected tube.
assessment
More severe internal bleeding may cause:
Lower back, abdominal, or pelvic pain.
Shoulder pain. This is caused by free blood tracking up
the abdominal cavity and irritating the diaphragm, and
is an ominous sign.
There may be cramping or even tenderness on one side
of the pelvis.
The pain is of recent onset, meaning it must be
differentiated from cyclical pelvic pain, and is often
getting worse.
Pregnancy usually terminates during the 1st three months
by:
1. Spontaneous tubal abortion
2. Tubal rupture
3. Death & disintegration of products of conception
within the tube
diagnosis
Quantitative hCG test
Ultrasound examination
Culdocentesis – assesses intraperitoneal bleeding by
needle puncture of the cul-de-sac of Douglas
Blood samples of Hgb and Hct; blood type and group
Laparoscope: an instrument that provides visualization
of the pelvic organs via a small incision on the
abdomen; if afected tube is found, a laparotomy can be
performed for treatment
Therapeutic management
Monitor amount of bleeding
Assess vital signs
Assess abdominal pain
Blood transfusion
Surgical: Laparoscopy, Laparotomy, Salpingostomy,
Salpingectomy
Medical: methotrexate used to dissolve residual tissue or as a
one-time treatment for unruptured pregnancies

COMPLICATION: Hemorrhagic Shock

implementation
Institute same care as for postsurgical client
Observe for signs of shock and institute treatment for
shock as necessary
Protect client against undue fatigue and infection
(energy level & resistance may be low because of
severe blood loss)
Provide emotional support: client may be frightened
and feel the loss of the pregnancy
 Patient’s
Assessment
Patient’s Profile
NAME: A. R. L.
AGE: 25 y/o
GENDER: Female
STATUS: Married
ADDRESS: Sitio Tagpi, Isaub, Aborlan
Palawan
EDUCATIONAL ATTAINMENT: High
School Graduate
OCCUPATION: Housewife
RELIGION: Roman Catholic
DATE AND TIME ADMITTED: August 3,
2010/2:45 am
CHIEF COMPLAINTS:
ATTENDING PHYSICIAN: Dr. Dexter D.
Feliciano/ Dr. Torres/ Dra. Funelas
DIAGNOSIS: Ectopic pregnancy L ruptured
severe anemia
 II. HEALTH HISTORY

Present illness
July 31, 2010 three days prior to admission, AR
experienced irregular pain at epigastric region. She rated
the pain 7 out of 10; the pain has 1 hour interval and it last
for ½ hour. She also stated that there was slight pain in all
quadrants. Her husband helped her to ambulate to ease
the pain she experienced. Claimed to have 2 episodes of
abortion(approximately 1 & 2 months of AOG) exact date
unrecalled .Three days PTA patient complained of
epigastric pain accompanied by nausea, body weakness
and patient has (-) consultation, (+) indication. A day
PTA still with above signs and symptoms and now with
fever as the “albularyo” seen her.
Two days before the admission, August
1, 2010, AR signs and symptoms have
worsened so her husband sought a
medical advice to the doctor and
brought her to the emergency room of
ONP on August 3, 2010.
B. Past health history
The patient had no history of chicken pox, mumps,
measles and rheumatic fever. She had no any
immunizations received. She has no known
allergies. The client verbalized that she uses honey
as her daily suplemmetary vitamins during her
pregnancy.
 
C. Family History
They have no history of hypertension, diabetes,
tuberculosis, arthritis, anemia, mental illness and
cancer to both side of her family.

 
D. Birth and Obstetrical History
 
She began to menarche at the age of 15. It
usually lasts for 4 days with regular and
normal flow. Her last menstrual period was
May 09, 2010 with obstetrical score of G5P3.
According to her, she is not completed her
scheduled prenatal check-ups. She stated
that she has no any complications during
pregnancy and after birth. According to her,
her 3 children are all in homebirth.
Prenatal- During her pregnancy she didn’t
experience any illness or complications. She
is very healthy as she rated herself 8 out of
10 and 10 is very healthy.

Natal- she delivered her three babies in NSVD

in cephalic presentation. Her babies are
normal and they in good condition.

Neonatal- her babies didn’t experience

respiratory distress or any complications.
E. Feeding history
 
She was breastfed by her mother until she is
4 months. The formula milk she took was
Alaska. She is also ate “lugaw” to substitute
milk during her 4 Months.
 F. Growth and Development History
According to Erik Erikson’s theory AR is now on the
Intimacy VS Isolation. In this stage, love is the primary
virtue. The start of this stage, identity vs. role confusion is
coming to an end, and it still lingers at the foundation of the
stage. Young adults are still eager to blend their identities
with friends. They want to fit in. Erikson believes we are
sometimes isolated due to intimacy. We are afraid of
rejections such as being turned down or our partners
breaking up with us. We are familiar with pain, and to some
of us, rejection is painful; our egos cannot bear the pain.
Erikson also argues that "Intimacy has a counterpart:
Distantiation: the readiness to isolate and if necessary, to
destroy those forces and people whose essence seems
dangerous to our own, and whose territory seems to
encroach on the extent of one's intimate relations"
Once people have established their identities, they
are ready to make long-term commitments to
others. They become capable of forming intimate,
reciprocal relationships (e.g. through close
friendships or marriage) and willingly make the
sacrifices and compromises that such relationships
require. If people cannot form these intimate
relationships--(perhaps because of their own
needs)--a sense of isolation may result.
  
III.PATTERNS OF FUNCTIONING
AND CLINICAL EXAMINATION
(PHYSICAL ASSESSMENT)
GUIDE
 PATTERNS OF FUNCTIONING CLINICAL EXAMINATION OTHER SOURCES
1.RESPIRATORY RR of 22 cpm. Not Used
She is not experiencing using accessory stethoscope
cough. No history of muscle for breathing. upon
asthma and PTB. She is Her cough doesn’t auscultation
not using cigarettes interfere with her rest. of the chest.

2. CIRCULATORY BP of 110/70 mmHg Hematology

She has no history of Heart rate of 18
hypertension dizziness Pulse rate of 65
or even faiting No parts of her baby is
palpitations, and chest swollen or discolored,
pain no edema. Nails are
pink but dry mucus.
 PATTERNS OF FUNCTIONING CLINICAL EXAMINATION OTHER SOURCES

3 FOOD AND FLUID Her skin is dry, no

INTAKE lesions, mucus
She usually eats rice, membranes are pale
vegetable and pork. She her lips are dry, while
eats three times a day her gums are pink. No
6:00 am for breakfast NGT.
12:00 nn for lunch and
8:oo pm for dinner. She
drinks 6-9 glasses of
water a day and soft
drinks during snacks.
She`s not drinking
alcohol.
 PATTERNS OF FUNCTIONING CLINICAL EXAMINATION OTHER SOURCES

4. ELIMINATION She moves her last Urinalysis

She usually voids for 3- bowel on August 2 @
4 times a day with clear 10:00am with formed
and yellow urine. She and soft and brown
normally moves her stool. Her abdomen is
bowel every morning round and has yellow
with soft and brown urine.
stools. She has no
history of constipation
and diarrhea.
 PATTERNS OF FUNCTIONING CLINICAL EXAMINATION OTHER SOURCES

5. REGULATORY Temp of 36.2 ºC

MECHANISM She has warm and dry
She was 15 years old skin with brown
when she began her complexion she has no
menarche. It usually flushed rashes on face
lasts for four days with and twitching paralysis.
normal and regular flow.
Her last menstrual
period was May 09,
2010. Before she is
using pills as
contraceptive.
 PATTERNS OF FUNCTIONING CLINICAL EXAMINATION OTHER SOURCES

6.HYGIENE Her hair are evenly

She takes a bath once a distributed, no lesions
day 10:00 in the and secretions on her
morning. She uses scalp. Nails are slightly
“sunsilk” to clean her dirty and short. Mouth
hair and scalp. She is clean without
changed clothes 2 times unpleasant odor
a day. She is not taking
a bath every time she is
sick. She has no
allergies in soap and
shampoo.
 PATTERNS OF FUNCTIONING CLINICAL EXAMINATION OTHER SOURCES

7. ACTIVITY AND She can`t walk

EXERCISE without assistance
She scrubbed their but not using any
floor every other day walking aids. No
as her exercise at swelling, abnormal
home. No history of mass and
gout, arthritis even enlargement of
paralysis.She is thyroid gland on her
always doing the neck.
household chores.
 PATTERNS OF FUNCTIONING CLINICAL EXAMINATION OTHER SOURCES

8.REST AND SLEEP She looks tired and

She wake up at 5:00 sleepy but no eye
am and sleep at bags. Her sleeping
8:00 pm. During pattern was
daytime naps she disturbed due to
sleeps at 1-2 pm pain on her suture.
and uses two
pillows. She used to
pray before
sleeping.
 PATTERNS OF FUNCTIONING CLINICAL EXAMINATION OTHER SOURCES

9.COMMUNICATION Her eye lashes are

AND SPECIAL SENSES evenly distributed. With
She uses her right hand pale conjunctiva. Her
for writing. No pupils are round with
eyeglasses and hearing regular border, is
aid .Can speak centered in size of iris.
“Tagalog” and No swelling on her ears
“Cuyunon.” and non tender. She
can hear well and talk
appropriately.
 PATTERNS OF FUNCTIONING CLINICAL EXAMINATION OTHER SOURCES

10 COGNITION AND She is well oriented

PERCEPTION about the time,
She is not place where she is
experiencing and about herself.
convulsion and loss During interview
of consciousness she is awake and
since she was a aware about the
child. surrounding.
 PATTERNS OF FUNCTIONING CLINICAL EXAMINATION OTHER SOURCES

11. PAIN AND Her pain is manifested

DISCOMFORT by guarding behavior
She is experiencing pain and facial grimace. Her
on her R lumbar region. sleeping pattern is
It is manifested by her disturbed due to pain.
guarding behavior and
facial grimace. To relieve
pain she is taking
analgesics as prescribed
the doctor.
 PATTERNS OF FUNCTIONING CLINICAL EXAMINATION OTHER SOURCES

12. RECREATION The patient cannot

AND DIVERSION ambulate. She feel
She loves to do their fainted when she
household chores like to seat.
every day.
 PATTERNS OF FUNCTIONING CLINICAL EXAMINATION OTHER SOURCES

13 RELIGIOUS LIFE The patient verbalized

She is a Roman that she often prays.
Catholic; she often going
to church. Doesn’t have
any beliefs and practices
that may affect health
care,
 PATTERNS OF FUNCTIONING CLINICAL EXAMINATION OTHER SOURCES

14. COPING She stated that she is

MECHANISMS moody and if angry it is
To release her hatred obviously seen. And
and angriness she she considers crying as
chooses not to talk but her coping mechanism.
to cry. When she`s angry
she is not talking. She is
not seeking for any
advice from others
except from her father.
 PATTERNS OF FUNCTIONING CLINICAL EXAMINATION OTHER SOURCES

15 ROLE AND She is well supported by her

RELATIONSHIP family and her friends. Since
She is a plain housewife. She she was in hospital her
believes that being a mother mother is the one who’s
is the most fulfilling role. taking care of her daughter.
Sending her daughter to
school and taking care of her.
There are five members in
their house. The most special
person she wants to see is
her children.
ANATOMY AND
PHYSIOLOGY
Pathophysiolgy
Laboratory Study
Drug Study
Nursing Care Plan
Discharge Plan