Ectopic Pregnancy Ob Ward 2022

Evolve.
Adapt.
Overcome.
CEFI is now ready
ECTOPIC PREGNANCY
Case Study
Presented to:
Clinical Instructors
College of Nursing
Calayan Educational Foundation Inc.
Alvarez, Ariane
Collette Group Presenters
Pacis, Cyris
Nicolas, Kaye Anne Mae
Buñales, Guillen, John Marasigan, Bea Tarrega
Elaijah Bernal Kobe
De La Cruz, Mendoza, Portea,

Guinto, Camille Odero, Paula
Mary Joyce Katherine John Lester
Dequito, Jan Merjudio, Niña

Manalo, Jenise
Marc Sassie Orijuela,
Precious Villasin,
Haynierhy
Dimasin,
Sinfrosa
2nd year student of Bachelor of Science in Nursing
NCM 109 RLE OBSTETRIC WARD
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
FORWORD
We as nurses has a very huge responsibility to care for the patients that are sick and
very ill. It is our responsibility to take good care of the patient and ensure their
safety. The environment that we are working on requires us to be quick, ready at all
cost, with hands that are gentle, all while maintaining a genuine concern about what
we do to our patients. In this case the 36 years old G6P4 diagnosed Ectopic
pregnancy. The emphasis of this study is on statistics, studies, and books produced
and published by a variety of medical experts.
The discussions in this study have shown that it would aid in the knowledge and
understanding to my co-nursing student as well as future researchers who will do
the same study.
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DEDICATION

This study is dedicated to our cherished families, friends, clinical instructor, and
also to our Almighty God, this study will gave them some important facts that
regarding the study of Ectopic Pregnancy.
And also we dedicated this study to our fellow nursing students, to those future
researchers who will take the same case. This study serve as related literature for
other researcher to have also a wider knowledge and facts regarding the study of
Ectopic Pregnancy, and to our Alma Mater, the Calayan Educational Foundation
Inc.
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OBJECTIVES
General Objectives
• This case study will serve as a guide for nursing students to provide information about patient with Ectopic
Pregnancy.
• Specific Objectives:
• To identify the pathophysiology and etiology of Ectopic pregnancy.
• Apply nursing interventions necessary to the need of the patient.
• Make plans and goal on the problem.
• To learn new clinical skills as well as sharpen our current clinical skills required in the management of Ectopic
pregnancy.
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INTRODUCTION
Normal pregnancies develop inside the uterus, after a fertilized egg travels through the fallopian tube and
attaches to the uterine lining. Ectopic pregnancy is when a fertilized egg attaches somewhere else in the belly,
usually in the fallopian tube that’s why it’s sometimes called “tubal pregnancy.” Ectopic pregnancies can also
happen on the ovary, or somewhere else in the belly. This condition are rare and it happens in about 2 out of
every 100 pregnancies. But they’re very dangerous if not treated. Fallopian tubes can break if stretched too
much by the growing pregnancy this is sometimes called a ruptured ectopic pregnancy. This can cause internal
bleeding, infection, and in some cases lead to death. However, most people who have an ectopic pregnancy can
have healthy pregnancies in the future, depending on the treatment that they had and the condition of their
fallopian tubes. If one of their fallopian tubes was removed or they tubes are scarred, it may be more difficult to
get pregnant. If they have an ectopic pregnancy, they are more likely to get another one in the future.
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PATIENTS DATA
Patient’s Name : Mother M Place of Birth : Polillo Quezon
Age : 35 yrs old Date of Birth : June 27, 1985
Sex : Female Father’s Name : Rogelio Antonio

Civil Status : Single Mother’s Name : Rosalinda Baseño
Address : Brgy. Pamatdan, Polillo Quezon Temp : 36.2 °C

Nationality : Filipino BP : 80/60 mmHg
Religion : Roman Catholic Weight : 45 kgs
Admission Date : April 18, 2022

Admission Time : 2:52 pm
Attending Dr. : Dra. Jessabeth Mercado
Chief Complaint : Abdominal Pain
Admitting Diagnosis : Ectopic Pregnancy
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PHYSICAL ASSESSMENT
Vitals:
G:6 P:4
BP: 80/60 mmHg
HR: 110 bpm
RR: 22 cpm
TEMP: 36.6°c
02 SAT: 97%
WEIGHT: 45kg (105.8 lbs)
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BODY PART EXAMINED FINDINGS

SKIN • THE SKIN IS PALE AND WRINKLED
HAIR • BLACK IN COLOR

• FLAKY SCALP
• UNEVEN HAIR IS SEEN
NAILS • LONG FINGER NAILS AND TOENAILS

• NAILS ARE BITTLE AND SOFT
FACE • NO INVOLUNTARY MOVEMENT

• FACE IS ROUND
EYES • BOTH EYES ARE ALIGNED AND PARALLEL

• THERE IS A PUFFINESS OF THE BOTH EYELIDS
• SCLERA IS WHITE.
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NOSE • THE NOSE APPEARS SYMMETRICAL AND MIDLINE
MOUTH • LIPS ARE PALE AND CRACKS
NECK • UPON CHECKING THE NECK RANGE OF MOTION THE CLIENT FEELS A
LITTLE BIT PAIN
BREAST • BOTH BREAST ARE SAGGY

• AREOLA AND NIPPLE ARE DARK
• VEINS ARE VISIBLE
ABDOMEN • THE BELLY IS LARGE

• NAVEL IS PROTUDE AND THE LOWER FUNDUS IS SOFT AND FLOPPY
UPON PALPATION
EXTERNAL • PUBIC ARE TRIMMED AND HAS A VAGINAL BLEEDING

GENITALIA
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LABORATORY/DIAGNOSTIC
RESULTS
Last Name: ANTONIO First Name: MARY JANE Date: 04-18-2022

Age: 36 years old Gender: FEMALE Birthday: 06-27-1985
Sample ID: 0414422-170 Dept: ER OB
Pregnancy Test Positive

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Test Result Result Unit Ref. Range
WBC H 12.95 x10^3/uL 4.00 – 10.00
Neu% H 81.0% 50.0 – 60.0
Lym% L 14.0% 35.0 – 45.0
Mon% 4.0% 2.0 – 4.0
Eos% L 1.0% 2.5 – 5.0
Bas% 0.0% 0.0 – 1.0
RBC L 41.34 x10^6/uL 3.50 – 5.20
HGB L 3.9 g/dL 11.0 – 15.0
HCT L 11.4% 35.0 – 49.0
MVC 85.0 fL 80.0 – 100.0
MCH P8.9 pg 27.0 – 34.0
MCHC 34.0 g/dL 32.0 – 36.0
RDW-CV 12.1% 11.0 – 16.0
RDW-SD 43.6 fL 35.0 – 56.0
PLT 232 x10^3/uL 150 - 450
MPV 7.3 fL 6.5 – 12.0
PDW 15.2 9.0 – 17.0
PCT 0.168% 0.108 – 0.282

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ANATOMY AND PHYSIOLOGY
Ectopic pregnancy, also called extrauterine

pregnancy, condition in which the
fertilized ovum has become imbedded outside
the uterine cavity. The site of implantation
most commonly is a fallopian tube; however,
implantation can occur in the abdomen,
the ovary, or the uterine cervix. Ectopic
pregnancy occurs in an estimated 1 to 2 percent
of women worldwide and is a major cause of
sickness and death among women in the first
trimester (first 12 weeks) of pregnancy.
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 There are several local factors, such as toxic, infectious, immunologic, and hormonal, that can induce
inflammation. There is upregulation of pro-inflammatory cytokines following tubal damage; this
subsequently promotes embryo implantation, invasion, and angiogenesis within the fallopian
tube. Chlamydia trachomatis infection results in the production of interleukin 1 by tubal epithelial cells;
this happens to be a vital indicator for embryo implantation within the endometrium Interleukin 1 also
has a role in downstream neutrophil recruitment which would further contribute to fallopian tubal
damage. Cilia beat frequency is negatively affected by smoking and infection. Hormonal variations
throughout the menstrual cycle additionally have demonstrated effects on cilia beat frequency.
 Ectopic implantation can occur in the cervix, uterine cornea, myometrium, ovaries, abdominal cavity,
etc. Women with tubal ligation or other post-surgical alterations to their fallopian tubes are at risk for
ectopic pregnancies as the native function of the fallopian tube would be altered. The patient additionally
can have an ectopic pregnancy with a concurrent intrauterine pregnancy, as known as a heterotopic
pregnancy.
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 Symptoms of ectopic pregnancy often begin with those typical of pregnancy, such
as breast tenderness, missed menstrual period, and nausea. As the condition
progresses, many women experience lower back pain, lower abdominal pain, cramping
on one side of the pelvic area, or light vaginal bleeding. If the tissue surrounding the
abnormally implanted ovum ruptures, internal bleeding may become severe. Pooling
of blood in the abdomen can place pressure on the rectum or on certain nerves,
producing symptoms such as shoulder pain and sharp abdominal pain. Bleeding is
accompanied by light-headedness and fainting, which may be followed by shock. As
the blood supply supporting the ovum decreases, hormonal support for the pregnancy
declines, and the decidua (endometrial tissue modified for pregnancy) begins
to slough off and is excreted vaginally. The embryo, however, remains and frequently
must be removed by surgery. Treatment with the drug methotrexate may be effective in
less-severe cases or for cases that are detected early.
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Tubal pregnancy
 in which the ovum becomes implanted in one of
the fallopian tubes, may be brought about by factors that
interfere with the propulsion of the fertilized ovum from the
fallopian tube toward the uterine cavity.
 Examples include inflammation of the fallopian tube,
developmental malformation of the sacs within its canal, or
kinking of the tube. If transport to the uterus is sufficiently
delayed, the ovum becomes too large for easy passage and
becomes imbedded in the wall of the fallopian tubule.
 Depending on the part of the tube in which the ovum has
become implanted, the tubal pregnancy can abort, through
tubal rupture, any time from 6 to 18 weeks after cessation of
menstrual periods (on occasion there will be no history of
missed periods). Surgical exploration of the abdomen and
removal of the affected tube and replacement of lost blood
may be essential to prevent death.
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Ovarian ectopic pregnancy and Cervical ectopic

pregnancy are relatively rare conditions. In ovarian
pregnancy, the ovum is fertilized before its discharge from
the follicle, resulting in the ovum’s implantation in or on
the ovary. Ovarian pregnancies typically abort early, and
the most common symptom is abdominal pain, with minor
vaginal bleeding. Although risk of ovarian pregnancy is
thought to be increased by history
of endometriosis or pelvic inflammatory disease or by the
use of assisted reproductive technologies or an intrauterine
device (IUD), none of these factors has been shown
definitively to cause the condition. In cervical pregnancy,
the ovum implants in the uterine cervix or in the isthmus
(the opening into the cervix). Cervical pregnancy may be
associated with significant vaginal bleeding, and, in severe
cases, hysterectomy is required. Risk for the condition
may be associated with previous operations such
as Cesarean section or dilation and cutterage, with in vitro
fertilization, or with IUD use.
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Abdominal ectopic pregnancy occurs when

the placenta is attached to some part of the
peritoneal cavity other than the uterus, ovary, or
fallopian tube. Although a few of these
pregnancies are a result of implantation in the
abdominal lining, most are the result of expulsion
of a tubal pregnancy. The condition can be
suspected in the first three months of pregnancy if
pain and bleeding are experienced. Abdominal
pregnancy can reach term. Prompt surgical
removal of the fetus is necessary, because an
unrecognized and untreated abdominal pregnancy
can result in infection or calcification leading to
the formation of a lithopedion (calcified dead
fetus) and death of the mother.
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PATHOPYSIOLOGY
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MEDICAL MANAGEMENT
TREATMENT:
Outside of the uterus, a fertilized egg cannot develop properly. The ectopic tissue must be removed to avoid life-threatening consequences.
This may be accomplished by the medication, laparoscopic surgery, or abdominal surgery, depending on your symptoms and when the
ectopic pregnancy is detected.
PROCEDURE DONE TO THE PATIENT:

• The surgery specifically, Explore Laparotomy Bilateral Salpingectomy. To further understand below are the explanation about the procedure.
Explore Laparoscopy- is a procedure that opens up the abdomen. This procedure is performed to determine the origin of symptoms ( such as
abdominal discomfort or bleeding) that testing has not been able to identify. It is also used when an abdominal injury necessitates immediate
medical attention. One major cut is used in this procedure (incision).
Bilateral Salpingectomy - is a surgical operation in which both Fallopian tubes are removed. Women who have undergone this treatment are
no longer able to conceive naturally. Some women choose this treatment for long-term birth control. In vitro fertilization, on the other
hand, can still result in pregnancy.
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MEDICATION:
• Doxycycline – a kind of antibiotic that is used to treat a variety of bacterial infections.
Dosage: 1000 mg/1 capsule ; BID for 2 weeks
• Celecoxib – a nonsteroidal anti-inflammatory drug (NSAID) used to treat mild to moderate pain
and help relieve inflammation and swelling
Dosage: 200mg /1 capsule ; BID
• Ferrous Sulfate – iron supplement used to treat or prevent low blood levels of iron
Dosage: 1 tab ; BID
The doctor may also recommend that you include more animal foods in your diet, such as:
• Meat • Eggs
• Dairy products • Increase Fluid Intake
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COURSE IN THE WARD

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April 18, 2022 A 36 years old G6P4 was admitted to OB with the diagnosed of Ectopic pregnancy at 3 weeks AOG
ruptured, anemia secondary to acute blood loss. PR: 110 bpm, BP: 80/60 mmHg, T: 36.6°C . RR: 22 cpm.
April 18, 2022 Medical Management Nursing Intervention Rationale
• Admit to Obstetrics • Admitted the patient as ordered • For monitoring , management, ang
ward under the serv evaluation of the patient's condition in
ice of Dr Mercado relation to OB ward and incision pain
and Dr. Limjoco. complain.
• Prepare and filled out necessary
documents.
• Obtain initial vital signs and • It measures how much the blood is made
record. up of red blood cells.
• Laboratory test
1. Hematology • Informed the patient about the
2. Serology diagnostic
• Informed laboratory department • To inform the client of the purpose of the
about the tests. procedure.
• Fallowed up results and attached • To ensure compatibility.
it to the patient's chart.
• Blood • Verify Doctor's order.

Crossmatching • Check for cross matching and • To prevent adverse effects.
typing.
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April 18, 2022 Medical Management Nursing Intervention Rationale

• Blood Transfusion • Warm blood at room temperature
before transfusion..
• Identify the client properly.
• Monitor vital signs . • To obtain baseline data.
• Do not mix medication with blood
transfusion .
• Observe for potential complications.
• IV Fluid • Continually monitor the patient's • For hydration and to provide

fluid and electrolyte status to replacement fluid sugars, electrolytes,
evaluate the effectiveness of the and nutrients and serves as an access
infusion and to avoid potential for IV medication.
complication of fluid overload and
electrolyte imbalance.
April 19, 2022 • IV Fluid • Continually monitor the • For hydration and to
patient's fluid and electrolyte status provide replacement fluid sugars,
to evaluate the effectiveness of electrolytes, and nutrients and serves as
the infusion and to avoid an access for IV medication.
potential complication of fluid
overload and electrolyte imbalance.
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NURSING CARE PLAN

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ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Subjective data: Risk for Deficient After 8 hours of nursing INDEPENDENT After 8 hours of nursing
“Madalang lang po ang Fluid Volume related intervention, the patient • Monitor and • A decrease intervention, the patient
pag ihi ko” as verbalized
to bleeding from a should be able to: document vital in circulating have:
by the patient blood volume can
ruptured ectopic • Have normovolemic signs, especially BP cause hypotension • Normovolemic as
Objective data: pregnancy as as evidenced by: and HR. and tachycardia. evidenced by: , HR
• Dry mucous evidenced by systolic BP greater Usually, the pulse is 60 to 100 beats/min,
• Sunken eyeballs decreased urine than or equal to 90 weak and irregular if and normal skin
• Decreased skin turgor output. mm HG (or patient’s electrolyte imbalance turgor.
• Decreased blood baseline), absence of also occurs. • BP: 120/80 mmHg
pressure orthostasis, PR 60 to • Assess skin turgor and • Signs of dehydration • HR 35
• Tachycardia 100 beats/min, urine oral mucous are also detected • Normal presentation
• Orthostasis output greater than 30 membranes for signs of through the skin. of eyeballs and
mL/hr and normal dehydration. mucous
Vital Signs are taken as skin turgor. • absence of orthostasis
follows: • Assess alteration in • Alteration in • urine output greater
• Urine output greater mentation/sensorium mentation/sensorium than 30 mL/hr
T: 36.5 than 30mL/hr (confusion, agitation, may be caused by • 40mL/hr
PR: 52 bpm slowed responses). abnormally high or • normal skin turgor.
RR: 22 bpm low glucose,
BP: 82/44 mmHg electrolyte
O2sat: 95 abnormalities,
acidosis, decreased
cerebral perfusion, or
developing11
hypoxia.
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INDEPENDENT • Normovolemic as evi
denced by: , HR 60
• Assess color • Normal urine to 100 beats/min, and
and amount of urine. output is considered normal skin turgor.
Report urine output less normal, not less
than 30 ml/hr for two than 30ml/hour. Conc • Vital signs taken
(2) consecutive hours entrated as follow:
urine denotes fluid T: 36.5
deficit. BP: 120/80 mmHg
• Weigh daily with PR: 80 bpm
the same scale, • Weight is the RR: 22 bpm
and preferably at the best assessment data O2sat: 95
same time of day. for possible fluid
volume imbalance. • absence of orthostasis
• Urge the patient • urine output
to drink the • Oral greater than 30 mL/hr
prescribed amount of hydrating solutions • normal skin turgor.
fluid. (e.g., Rehydralyte)
can be considered as
needed
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INDEPENDENT
• Emphasize the • A fluid deficit can
importance of oral cause a dry, sticky
hygiene. mouth. Attention to
mouth care promotes
interest in drinking
and reduces the
discomfort of dry
mucous membranes.
DEPENDENT
• Administer medication • Medication needs
as prescribe by the prescription before
assigned physician the administration to
secure the patient’s
safety.
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Subjective data: Acute Pain may be After 8 hours of nursing INDEPENDENT After 8 hours of nursing
“Nurse sumasakit po yung related to physical intervention, the patient intervention, the patient
tahi ko” as verbalized by injury agent should be able to: • Assess vital signs • For baseline data have:
the patient
(distention/rupture of • The patient will • To monitor the • The patient
fallopian tube) • Assess the
Objective data: demonstrate relief of characteristics of pain effectiveness of demonstrated relief of
• Pain intensity 8 out of possibly evidenced by pain as evidenced by at least 30 minutes after medical treatment for pain as evidenced by
10 verbal reports a pain score of 0 out administration of relief of pain. The a pain score of 0 out
• Abdominal rigidity of 10 medication time of monitoring of of 10
• Restlessness vital signs may
• Unstable vital signs • Stable vital depend on the peak • Stable vital signs
• Dizziness or weakness signs time of the drug T: 36.5
• Light vaginal bleeding T: 36.5 administered. PR: 80 bpm
PR: 80 bpm RR: 22 bpm
Vital Signs are taken as RR: 22 bpm • Assessed the Post-op • Acts as a baseline BP: 120/80 mmHg
follows: BP: 120/80 mmHg site. against which the O2sat: 95%
O2sat: 95% patient's condition
T: 37.6 can be assessed at a
PR: 110 bpm later date and
RR: 22 bpm identifies any
BP: 140/90 mmHg problems that may
O2sat: 90 have occurred on
transfer from the
operating department.
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Post-Op Site: • Elevated the head of • To increase the
Redness around wound_/_ the bed and position the oxygen level by
Edema/swelling None patient in semi allowing optimal
Ecchymosis None fowler’s lung expansion
Discharge None
Approximation of edges • Place the patient in • To provide comfort to
Closed complete bed rest the patient.
during severe episodes
of pain. Perform
relaxation techniques
such as deep breathing
exercises, guided
imagery, and provision
of distractions such as
TV or radio.
• Post-surgery, advise the • To reduce post-

patient to: Have no surgical pain and
strenous activity for a allow reovery and
few weeks. Apply healing.
support on the
abdomen when
coughing, laughing or
moving by placing a
pillow over the
abdominal area.
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• Inform the healthcare • For proper
team if the pain intervention.
medications are not
working.
DEPENDENT
• Administer prescribed • To alleviate the
pain medications symptoms of acute
abdominal pain.
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Subjective data: Powerlessness related After 8 hours of nursing INDEPENDENT After 8 hours of nursing
“Di nya kami kinakausap to early loss of intervention, the patient intervention, the patient
at tahimik lang” as pregnancy secondary should be able to: • Assess for feelings of • These moods may be have:
verbalized by the patient’s apathy, hopelessness, an element of
mother. to ectopic pregnancy • The patient will powerlessness. • The patient will
possibly evidenced by and depression.
demonstrate mental demonstrate mental
Objective data: anxiety stability and will start • Determined the • Patients are usually stability and
• Fragility regaining herself by patient’s power needs able to recognize startedregaining
• Passivity showing signs of or need for control. those perspectives of herself by showing
• Frequent changes in positivity such as self-governance that signs of positivity
mood smiling they miss most and such as smiling.
• Violent behavior that are relevant to
them. • And started talking
and bonding to other
• Evaluate the patient’s • Powerlessness is the people.
decision-making feeling that one has
competence. lost the implicit
power to control their
own interests.
• Know • It is necessary for

situations/interactions healthcare providers
that may add to the to recognize the
patient’s sense of patient’s right to
powerlessness refuse to certain
procedures.
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• Encourage • This approach creates
verbalization of a supportive
feelings, thoughts, and environment and
concerns about making sends a message of
decisions. caring.
• Help the patient in • The patient may have

reexamining negative his or her own
perceptions of the perceptions that are
situation. unrealistic for the
situation.
• Give the patient control • This approach

over his or her enhances patient’s
environment. independence.
• Rendered positive • Success promotes

feedback for making confidence in
decisions and engaging abilities and a sense
in self-care of control.
Recognition and
positive
reinforcement
for heightening self-
esteem and feelings
of self-governance.
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DEPENDENT
• Recommending the • These professionals
case to a psychiatrist are medical doctors
who specialize in the
treatment of mental,
emotional, or
behavioral problems.
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DRUG STUDY
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THERAPUTIC ACTION CONTRAINDICATION TOXIC/SIDE EFFECTS INTERVENTIONS SAFE DOSE

CLASSIFICATION
Generic Name: Doxycycline is a • Contraindicated in More common • Tell patient to take Route: Oral
Doxycycline broad spectrum patients the entire amount of
antibiotic that is used hypersensitive to • nausea, drug exactly as Dosage: 100mg/1capsule
drug or other • vomiting, prescribed, even if
Brand Name: to treat a variety of tetracyclines. • upset stomach, feeling better. Frequency: BID
Doryx bacterial infections. • loss of appetite,
These include • Contraindicated to • mild diarrhea, • Instruct patient to Take Note: This
Therapeutic Class: respiratory infections, those patient woman • skin rash, report adverse medication is given to the
Antibiotics sexually transmitted in her 2nd and 3rd • itching, reactions promptly, patient for 2 weeks.
diseases, eye trimesters, • darkened skin color, especially the signs
infections, skin and and symptoms of
• Pregnancy or • vaginal itching or hypersensitivity.
infections such as breastfeeding due to discharge
those caused by teratogenicity and • Advise patient to
rosacea, gum disease, permanent teeth Serious side effects increase fluid intake
urinary tract discoloration after in and not to take oral
infections, and utero exposure. • severe stomach pain, tablets or capsule
intestinal infections. It • diarrhea that is watery within 1 hours of bed
• Allergy to or bloody, time because of the
is also used to prevent tetracycline throat irritation, possible esophageal
•
malaria and treat antibiotics • trouble swallowing, irritation or
infections caused by • chest pain, ulceration.
mice, lice, and ticks. • Use with penicillin or • irregular heart rhythm
isotretinoin • shortness of breath,
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CLASSIFICATION
• Relative • little or no urination, • Check or considered

Contraindications • fever, the history of the
• chills, patient (allergies or
- Liver disease due to • swollen glands, toxic effects)
rare fatal hepatotoxicity • body aches,
- History of yeast • weakness, • Rationalize the 10R’s
infections • pale skin, before administering
- Recent colitis • easy bruising or this kind of drugs.
caused by antibiotic use bleeding,
- Kidney disease • severe headaches,
diarrhea from C. Dificile • ringing in your ears, • Assess carefully the
- History of lupus • dizziness, vital signs before
(autoimmune) • nausea, administering the
- Porphyria (a blood • vision problems, drug.
disease) • pain behind your eyes,
- Myasthenia gravis • loss of appetite,
• upper stomach pain,
• tiredness,
• vomiting,
• fast heartrate,
• dark urine, and
• yellowing of the skin or
eyes (jaundice)
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CLASSIFICATION
Generic Name: Celecoxib is a • Contraindicated for the More common • Assess carefully the Route: Oral
Celecoxib nonsteroidal anti- treatment of vital signs before
inflammatory drug perioperative pain after • stomach pain administering the Dosage: 200mg / 1
coronary artery bypass • constipation drug. capsule
Brand Name: (NSAID) used to treat graft surgery (CABG). • diarrhea
Celebrex mild to moderate pain • gas • Rationalize the 10R’s Frequency: BID
and help relieve • Contraindicated in • heartburn before administering
Therapeutic Class: symptoms of arthritis patients hypersensitive • nausea this kind of drugs.
NSAIDs (COX-2 (eg, osteoarthritis, to drug, sulfonamides, • vomiting
inhibitors) rheumatoid arthritis, or aspirin, or other • dizziness • Check or considered
juvenile rheumatoid NSAIDs • headache the history of the
• respiratory tract patient (allergies or
arthritis), such as • Contraindicated in infection toxic effects)
inflammation, patients who
swelling, stiffness, and experienced asthma, Serious side effects • Take the medication
joint pain. urticarial, or allergic on an empty stomach,
type reactions after • Chest pain or heart at least 1 hour before
taking aspirin or other attack or 2 hours after a
NSAIDs and in those • Stroke meal.
who have demonstrated • High blood pressure
allergic type reactions • Edema
to sulfonamides. • Bleeding and ulcers in
your stomach and
intestine
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CLASSIFICATION
• Drug is not • Skin reactions, • Seek emergency

recommended with including rash or medical attention if
any those of a non- blisters you think you have
aspirin NSAIDs. • Allergic reactions. used too much of this
• Liver problems. medicine, or if
• Serious skin reactions Symptoms may include anyone has
(toxic epidermal yellowing of your skin accidentally
necrolysis). or whites of your eyes. swallowed it.
• Asthma attacks
• Use Celecoxib
exactly as directed on
the label, or as
prescribed by your
doctor.
• Ask the patient for

any toxic effects of
the drug given.
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CLASSIFICATION
Generic Name: Ferrous Sulfate • A high amount of More common: • Rationalize the 10R’s Route: Oral
Ferrous Sulfate (Feosol) replaces iron, oxalic acid in urine before administering
and essential • Constipation this kind of drugs. Dosage: 1 tab
• Iron metabolism • diarrhea
Brand Name: component in disorder causing • Assess carefully the Frequency: BID
Feosol formation of • stomach cramps
increased iron storage • upset stomach vital signs before
hemoglobin administering the
Therapeutic Class: • Sickle cell anemia drug.
Serious side effects
Iron Products Iron supplement used
to treat or prevent low • Anemia from • Check or considered
pyruvate kinase and • allergic reaction the history of the
blood levels of iron. including the:
G6PD deficiencies an patient (allergies or
overload of iron in - rash toxic effects)
the blood. - itching
- swelling (face, • Take ferrous sulfate
• A type of blood throat, tongue) on an empty stomach,
disorder where the - severe dizziness at least 1 hour before
red blood cells burst - trouble breathing or 2 hours after a
called, “hemolytic meal.
anemia”
• Tell patient that this
• An ulcer from too medication is iron-
much stomach acid. deficiency anemia
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CLASSIFICATION
• Ulcerative colitis • Avoid taking antacids

or antibiotics within
• An inflammatory 2 hours after taking
conditions of the ferrous sulfate.
intestines.
• Seek emergency
• Diverticular disease medical attention if
you think you have
• Excess iron due to used too much of this
repeated blood medicine, or if
transfusions anyone has
accidentally
• Problems with food swallowed it.
passing through the
esophagus • Use ferrous sulfate
exactly as directed on
the label, or as
prescribed by your
doctor.
• Ask the patient for

any toxic effects of
the drug given.
COLLEGE OF NURSING
DISCHARGE PLAN
The Do’s and Don’ts

 Rest for a week after your surgery
 Ask your family or friends to help with chores and errands while you recover.
 Don't exercise or do other strenuous activities until the healthcare provider approved.
 Climb stairs slowly and pause after every few steps.
 Walk as often as you feel able.
Medication
• Give medications religiously and on time.
• Educate them about the drugs as well as its effects, indications and the adverse effects and what to do
when it occurs.
COLLEGE OF NURSING
Home care
 Continue with the coughing and deep breathing exercises that you learned in the
hospital.
 To prevent constipation:
- Eat fruits, vegetables, and whole grains.
- Drink 6 to 8 glasses of water every day, unless directed otherwise.
 Wash your incision with mild soap and water. Pat it dry. Don’t use oils, powders, or
lotions on your incision.
 Shower as normal
COLLEGE OF NURSING
When to call your healthcare provider:

 Redness, swelling, or drainage at your incision site
 Fever of 38.0°C or higher, or as directed by your provider
 Pain that does not go away with medicine
 Stomach pain and swelling that get worse
 Vaginal discharge or bleeding
 Dizziness or fainting
 Upset stomach (nausea) and vomiting
Follow-up care:
 Make a follow-up appointment as directed by your healthcare provider.
 You may need follow-up blood tests to make sure that the ectopic pregnancy has been completely
removed.
COLLEGE OF NURSING
PROGNOSIS
The mother with the diagnosis of ectopic pregnancy can be safely treated as they could
seek medical attention and not wait for the condition to worsen. Quick treatment for an
ectopic pregnancy is important to protect the mother’s life. Most women who
experience ectopic pregnancy and treatment will achieve a successful pregnancy in the
future, even if they’ve lost one fallopian tube as part of the therapy.
After applying nursing interventions, giving the right medications, and health teaching
to the mother, the mother was stable and the general condition of the mother was good
with clear laboratory results and have stable vital signs; T= 36.6˚C, PR= 52bpm, RR=
19 cpm, O2S= 98%.
Clear laboratory result is included also as evidence to a stable and general good
condition of the patient.
COLLEGE OF NURSING
Last Name: ANTONIO First Name: MARY JANE Date: 04-20-2022

Age: 36 years old Gender: FEMALE Birthday: 06-27-1985
Sample ID: 041922PM-82 Dept: OB
COLLEGE OF NURSING
Test Result Result Unit Ref. Range
WBC H 16.17 x10^3/uL 4.00 – 10.00
Neu% H 78.0% 50.0 – 60.0
Lym% L 17.0% 35.0 – 45.0
Mon% H 5.0% 2.0 – 4.0
Eos% L 0.0% 2.5 – 5.0
Bas% 0.0% 0.0 – 1.0
RBC 4.04 x10^6/uL 3.50 – 5.20
HGB 12.4 g/dL 11.0 – 15.0
HCT L 36.5% 35.0 – 49.0
MVC 90.3 fL 80.0 – 100.0
MCH 30.8 pg 27.0 – 34.0
MCHC 34.1 g/dL 32.0 – 36.0
RDW-CV 12.8% 11.0 – 16.0
RDW-SD 48.2 fL 35.0 – 56.0
PLT 242 x10^3/uL 150 - 450
MPV 8.0 fL 6.5 – 12.0
PDW 16.1 9.0 – 17.0
PCT 0.194% 0.108 – 0.282

COLLEGE OF NURSING
REFERENCES
https://www.healthline.com/health/celecoxib-oral-capsule
https://www.ncbi.nlm.nih.gov/books/NBK555888/
https://www.rxlist.com/doryx-drug.htm#description
COLLEGE OF NURSING
Thank you and God bless!

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Evolve.

De La Cruz, Mendoza, Portea,

Dequito, Jan Merjudio, Niña

• To identify the pathophysiology and etiology of Ectopic pregnancy.

• Apply nursing interventions necessary to the need of the patient.

• Make plans and goal on the problem.

Age : 35 yrs old Date of Birth : June 27, 1985

Sex : Female Father’s Name : Rogelio Antonio

Address : Brgy. Pamatdan, Polillo Quezon Temp : 36.2 °C

Admission Date : April 18, 2022

BODY PART EXAMINED FINDINGS

HAIR • BLACK IN COLOR

NAILS • LONG FINGER NAILS AND TOENAILS

FACE • NO INVOLUNTARY MOVEMENT

EYES • BOTH EYES ARE ALIGNED AND PARALLEL

NOSE • THE NOSE APPEARS SYMMETRICAL AND MIDLINE

MOUTH • LIPS ARE PALE AND CRACKS

BREAST • BOTH BREAST ARE SAGGY

ABDOMEN • THE BELLY IS LARGE

EXTERNAL • PUBIC ARE TRIMMED AND HAS A VAGINAL BLEEDING

Last Name: ANTONIO First Name: MARY JANE Date: 04-18-2022

Pregnancy Test Positive

Test Result Result Unit Ref. Range

WBC H 12.95 x10^3/uL 4.00 – 10.00

Neu% H 81.0% 50.0 – 60.0

Lym% L 14.0% 35.0 – 45.0

Mon% 4.0% 2.0 – 4.0

Eos% L 1.0% 2.5 – 5.0

Bas% 0.0% 0.0 – 1.0

RBC L 41.34 x10^6/uL 3.50 – 5.20

HGB L 3.9 g/dL 11.0 – 15.0

HCT L 11.4% 35.0 – 49.0

MVC 85.0 fL 80.0 – 100.0

MCH P8.9 pg 27.0 – 34.0

MCHC 34.0 g/dL 32.0 – 36.0

RDW-CV 12.1% 11.0 – 16.0

RDW-SD 43.6 fL 35.0 – 56.0

PLT 232 x10^3/uL 150 - 450

MPV 7.3 fL 6.5 – 12.0

PDW 15.2 9.0 – 17.0

PCT 0.168% 0.108 – 0.282

ANATOMY AND PHYSIOLOGY

Ectopic pregnancy, also called extrauterine

Ovarian ectopic pregnancy and Cervical ectopic

Abdominal ectopic pregnancy occurs when

PROCEDURE DONE TO THE PATIENT:

COURSE IN THE WARD

• Blood • Verify Doctor's order.

April 18, 2022 Medical Management Nursing Intervention Rationale

• IV Fluid • Continually monitor the patient's • For hydration and to provide

NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

• Post-surgery, advise the • To reduce post-

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION