ectopic pregnancy status post left salpingectomy
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By:Oronce, Aiza F.
Cruz, Kryzia MargaretMacaranas, Bien
Balanon, Mark PauloChong, Mike Neilsen
Edrada, JoneilNgking, Amado II.
BSN 3
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An ectopic pregnancy, or eccyesis, is a complication ofpregnancy in which the pregnancy implants outside the uterine
cavity. With rare exceptions, ectopic pregnancies are not viable.Furthermore, they are dangerous for the mother, internal bleedingbeing a common complication. Most ectopic pregnancies occur inthe Fallopian tube (so-called tubal pregnancies), but implantationcan also occur in the cervix, ovaries, and abdomen. An ectopicpregnancy is a potential medical emergency, and, if not treatedproperly, can lead to death.
Ectopic pregnancy can be difficult to diagnose becausesymptoms often mirror those of a normal early pregnancy. Thesecan include missed periods, breast tenderness, nausea, vomiting,or frequent urination.
The first warning signs of an ectopic pregnancy are often painor vaginal bleeding. You might feel pain in your pelvis, abdomen,or, in extreme cases, even your shoulder or neck (if blood from aruptured ectopic pregnancy builds up and irritates certain nerves).Most women describe the pain as sharp and stabbing. It mayconcentrate on one side of the pelvis and come and go or vary in
intensity.
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An ectopic pregnancy results from a fertilized egg's
inability to work its way quickly enough down the fallopiantube into the uterus. An infection or inflammation of thetube might have partially or entirely blocked it. Pelvicinflammatory disease (PID), which can be caused bygonorrhea or chlamydia, is a common cause of blockage of
the fallopian tube.Endometriosis (when cells from the lining of the uterusimplant and grow elsewhere in the body) or scar tissue fromprevious abdominal or fallopian surgeries can also causeblockages. More rarely, birth defects or abnormal growths
can alter the shape of the tube and disrupt the egg'sprogress.
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The significance of the study is for us third year students toapply the principles and concepts that we have learned inthe NCM 101 (Maternal and Child Nursing) in our rotationat St. Mattheus Hospital, with the following specific learningobjectives:
1. Cognitive To be able to review concepts and theories in maternal and
child nursing. To be able to describe the development, pathophysiology,
medical-surgical management, and nursing care of a clientwho had undergone an ectopic pregnancy. To be able to design a Nursing Care Plan for the patient. To be able to provide information and heath teachings to the
patient in the postpartum period.
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2. Psychomotor
To be able carry-out hospital routines and thetreatment prescribed to the patient.
To be able to perform nursing procedures andnursing considerations for a client in the
preoperative and postoperative stages To be able to implement the nursing care plan
3. Affective
To be able to establish a good workingrelationship with the patient and hospital staff.
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The "Core, Care, andCure" theory wasdeveloped in the late
1960's. She postulated that
individuals could beconceptualized in three
separate domains: thebody (care), the illness,(cure), and the person(core).
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Nursing functions in all three of the circles (core, care, andcure) but shares them to different degrees with otherdisciplines. For example, the nurse's function in the curecircle is limited to helping patients/families deal with themeasures instituted by the physician. She felt that the carecircle was exclusive to nursing. The core circle was sharedwith social workers, psychologists, clergy, etc.
For the care aspect which goal is to comfort the patient, weshould complete such basic daily biological functions as
eating, bathing, elimination, and dressing. By this we areproviding opportunity for closeness, and as this develops,the patient can share and explore feelings with the nurse,which in this case the chance for having another baby. Ourpatient experience an ectopic pregnancy which deeplyaffects her reproductive system, so for the “care” or the
body we as nurses function as a support for her, so weshould explain deeply and carefully that there are stillpossible ways to have another baby and that she should alsoface the reality.
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Patient once verbalized that she didn’t know that she ispregnant until she experienced abdominal pain. The
goal of the core or the person is to discuss with thepatient her condition which may help her with thenurse find a way for a fast recovery, with the use oftherapeutic communication we somehow develop aninterpersonal relationship with the patient, by this weshould help the patient verbally express feelingsregarding the disease process and its effects, as well asdiscuss the patient’s role in recovery.
Cure or the illness, we are the one who are givingthe medications, monitor the patient, and the onewhich is in close contact with the patient, so any
confusion with the prescription or orders of thedoctors, we are the one that will act as their advocate,we are the one that will help the patient and family tounderstand it.
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Patient’s Profile
Name: MC Address: San Mateo, Montalban Sex: Female Age: 22 years old. Date of Birth: September 03, 1988 Educational Attainment: High School Graduate Nationality: Filipino Religion: Catholic
Civil Status: Single Date of admission: September 19, 2010 Time admitted: 5:40pm Chief Complaint: Abdominal Pain
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E. Social History
Patient MC is currently living with her step mother and live-in partners atNovaliches. She claims to have experienced engaging in smoking and alcohol at theage of 18 because of grieving from the loss of her first baby but claims to haveceased 6 months after death. She denies to have engaged in drugs. She loves to eatlongganisa and other meat products but also includes vegetables on her daily foodintake. She sometimes skips meals.
F. Developmental Data
According to Erik Erikson’s Psychosocial Theory, the patient developmental
task at her age (22) is Intimacy versus Isolation. At this stage it involves theaffiliation or the ability to give and receive love, commitments and mutuality withothers, collaboration in work and affiliations, sacrificing for others and responsiblesexual behavior. Intimacy is achieved when an individual has developed thecapacity for giving oneself to another and is learned when one has been therecipient of this type of giving within the family.
In relation to the patient, the patient has been able to receive and learn love fromher family members however, achieving intimacy might be at a struggle lately asshe has no plan of marriage or commitment and her child from her live-in-partnerresulted into a loss. In addition to that, she confirms that she does not enjoy sexualencounter with her live-in partner and her dad is currently at her province. On theother hand the patient has is with her step-mother and live-in-partner who gives
emotional support and love at her stay at the hospital
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FamilyGenogram
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Family History
According to the patient, her grandmother on her mother’s sidedied with a disease related to a heart problem, Moreover hermother died also with a cardiac related problem upongiving birth to her.
According to the patient, her first baby died on October 22,2006, 11 months after birth because of inability to admit her
baby at Philippine Heart Center as recommended by doctorsbecause her first born had a uncorrected ventricular septaldefect. Her Gravida 3 was unexpected and has resulted toan ectopic pregnancy.
No other illness on the father’s side was traced by her. No othernoted disease like Asthma, Diabetes, Tuberculosis, Cancer,or Liver diseases is in their family except for a cardiacrelated problem.
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Anatomy of female reproductive system The female reproductive system is designed to carry out severalfunctions. It produces the female egg cells necessary forreproduction, called the ova or oocytes. The system is designed totransport the ova to the site of fertilization. Conception, thefertilization of an egg by a sperm, normally occurs in the fallopiantubes. The next step for the fertilized egg is to implant into thewalls of the uterus, beginning the initial stages of pregnancy. Iffertilization and/or implantation do not take place, the system isdesigned to menstruate (the monthly shedding of the uterinelining). In addition, the female reproductive system producesfemale sex hormones that maintain the reproductive cycle.
During menopause the female reproductive system graduallystops making the female hormones necessary for the reproductivecycle to work. When the body no longer produces these hormonesa woman is considered to be menopausal.
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Parts of the FemaleReproductive Anatomy:
The female reproductive
anatomy includes partsinside and outside thebody.
The function of theexternal female
reproductive structures(the genitals) is twofold:To enable sperm to enterthe body and to protectthe internal genitalorgans from infectiousorganisms. The mainexternal structures of thefemale reproductivesystem include:
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Labia majora: The labia majora enclose and protect the otherexternal reproductive organs. Literally translated as "large lips,"the labia majora are relatively large and fleshy, and are comparableto the scrotum in males. The labia majora contain sweat and oil-secreting glands. After puberty, the labia majora are covered with
hair. Labia minora: Literally translated as "small lips," the labia minora
can be very small or up to 2 inches wide. They lie just inside thelabia majora, and surround the openings to the vagina (the canalthat joins the lower part of the uterus to the outside of the body)and urethra (the tube that carries urine from the bladder to the
outside of the body). Bartholin's glands: These glands are located besides 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. The clitoris iscovered by a fold of skin, called the prepuce, which is similar to the
foreskin at the end of the penis. Like the penis, the clitoris is verysensitive to stimulation and can become erect.
The internal reproductive organs in the female include: 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.
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Date/ Time Laboratory Results/
Vital Signs
Medications Treatment Nursing
Intervention
September 19, 2010
5:40pm
September 19, 2010
8:00pm
URINALYSIS
Color: yellow
Transparency: Clear
Reaction: 6.0
Specific Gravity:
1.020
RBC: 1-2 hpf
Pus Cells: 2-3 hpf
Albumin: Negative
Amorphous Urates:
++
Epithelium
Squamous Cells: ++
-Cefazolin 2 g IV as
Loading Dose
-Then shift to
Cefazolin 500mg IV
every 6 hours
-Tramadol 100mg
slow IV push every 8
hours at 3 doses
-Ketorolac 30 mg IV
push every 6 hours at
4 doses
-IVF Started
D5LR 1L at
20gtts/min
-Second line PNSS
1L at 20gtts/min
-To PACU
-Monitor Vial Signs
every 15 minutes and
record
-Regulate present
IVF:
1. D5LR 1L at30gtts/min
2. PNSS at KVO
rate
-Flat on bed for 6
hours
-O2 at 5LPM via
Facemask
-Monitor Urine
Output every hour
and record-Watch out for
hypotension and
bleeding
Assess patient to
know previous/
present status of the
patient.
Check the level of
pain. Base on the
pain scale. Check for
PQRST (
precipitating/predisp
osing factor, quality,
radiation, severity,
time )
Prepare the
medications anddouble check it.
Check for the
expiration date.
Make sure to apply
the 10Rights.
Check the O2 at
5lpm every q15
Regulate and check
the IVF fluid q15.
Monitor V.Sthoroughly every 15
minutes and record.
Monitor Urine
Output every hour
and record
Watch out for
hypotension and
bleeding
Reassess
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Date/ Time Laboratory
Results
Medications Treatment Nursing Intervention
September 20,
2010
2:30 am
7:45am
9:00am
-Cefalexin 500mg
capsule every 6
hours for 7 days
-Mefenamic Acid
500mg capsule
every 6 hours for
pain
-multivitamins 1
cap once a dat-Ferrous Sulfate 1
cap once a day
-Cefalexin 500mg
capsule every 6
hours for 7 days
-Mefenamic Acid
500mg capsule
every 6 hours for
pain
-multivitamins 1
cap once a dat
-Ferrous Sulfate 1
cap once a day
-May transfer to ward
-Continue VS monitoring
every hour for 6 hours
-Continue IVF to
complete IV antibiotics
for 24 hours then shift to
Oral
-May remove IFC at
6pm
-Encourage early
ambulation
-Continue VS monitoring
-Patient seen and
examined
-Monitor Input and
Output hourly and record
-Continue present
medications
Assess patient to know
previous/ present status of
the patient.
Patient’s Lab results, V.S,Chart.
Continue VS monitoring
every hour for 6 hours
Check the level of pain.
Base on the pain scale.
Check for PQRST (
precipitating/predisposing
factor, quality, radiation,
severity, time )Prepare the medications and
double check it. Check for
the expiration date. Make
sure to apply the 10Rights.
Teach on how to prevent
infection, proper hygiene,
and proper nutrition to
prevent infection and to
boost immunity.
Monitor Input and Output
hourly and record
Reassess patient
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Date/ Time Laboratory
Results/Vital
Signs
Medications Treatment Nursing
Intervention
September 23,
20106am
-Cefalexin
500mg capsuleevery 6 hours for
7 days
-Mefenamic Acid
500mg capsule
every 6 hours for
pain
-multivitamins 1
cap once a day
-Ferrous Sulfate
1 cap once a day
-follow up Labs
-continuemedications and
Vital Signs
Monitoring
Assess patient to
know previous/ present status of
the patient. Esp.
to follow up
Laboratory
results.
Continue Health
Teachings esp. to
encourage patient
full ambulation
Continue
medications and
VS monitoring, I
and O.Monitoring and
recording.
Reassess patient.
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Date/ Time Laboratory
Results/Vital
Signs
Medications Treatment Nursing
Intervention
September
25,20106:33am
BP 110/70mmHg
Temp 36.50
CPR 73bpm
RR 20cpm
Pain Scale: 2/10
-Cefalexin
500mg capsuleevery 6 hours for
7 days
-Mefenamic Acid
500mg capsule
every 6 hours for
pain
-Multivitamins 1cap once a day
-Ferrous Sulfate
1 cap once a day
-follow up all lab
results-continue ordered
medications and
Vital Signs
Monitoring
Assess patient to
know previous/ present status of
the patient.
Continue Health
Teachings esp. to
encourage patient
full ambulation
Continuemedications and
VS monitoring, I
and O.
Monitoring and
recording.
Reassess patient.
MGH.
BLOOD MORPHOLOGY September 19, 2010
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Exam Name Result Normal Findings Analysis Interpretation
Haemoglobin 112 110-150 g/L Normal
Hematocrit 0.35 0.37-0.45 Decreased Indicates anemia or massive blood
loss.
WBC Count 14.6 4.6 x 10^g/L Increased Associated with inflammatory
process from trauma acquired from
surgery.
RBC Count 3.75 4.0-5.5^3/L Decreased Indicate anemia, dilution due to
fluid overload or hemorrhagelasting more than 24 hours.
Platelet Count 360 150-400 x 10g/L Normal
Differential Count:
Segmenters
Lymphocytes
Monocytes
0.70 0.50-0.70 Normal
0.26 0.20-0.40 Normal
0.04 0-0.07 Normal
MCV 93.2 80.9-99.9 fL Normal
MCH 29.9 27.0-31.0 pg Normal
MCHC 320 330-370 g/L Normal
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Physical Result Normal Findings Analysis Interpretation
Color Yellow Amber-Yellow Normal
Transparency Clear Clear-Hazy Normal
pH 6.0 4.5-7.8 Normal
Specific Gravity 1.020 1.001-1.035 Normal
Cells
Red Blood Cells 1-2 hpf 0-5 hpf Normal
Pus Cells 2-3 hpf Negative Positive Indicates the presence of infection
Chemical
Albumin Negative Negative Normal
Sugar Negative Negative Normal
Epithelium
Squamous Cells +2 0-4/hpf Normal
BLOOD TYPING September 19, 2010 Type: O
Rh: +
URINALYSIS September 20, 2010
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Medication
Instruct the patient to take her medicines as prescribed by her physicians.
Do not buy medicines or other food supplements without the doctor’sorder.
Do not quit taking medicines until the physician said so.
Exercise
Advise the patient to continue to do exercises such as Deep breathing andcoughing exercises because these exercises can promote fasterrecovery.
After several weeks the client should have a routine exercise like walkingto remain physically fit.
Exercise helps blood move through the body and may help prevent blood
clots from forming.Treatment
1. Cefalexin 500mg capsule every 6 hours for 7 days
2. Mefenamic Acid 500mg capsule every 6 hours for pain
3. Multivitamins 1 cap once a day
4. Ferrous Sulfate 1 cap once a day
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Health Teaching Instruct the patient to do proper wound care.Teach patient and also her relatives to do aseptic technique while doing wound
care by washing his/her hands to minimize the spread of infection.
Proper wound care can help prevent the spread of infectious microorganisms.
Out- patient follow up The patient must have a regular check-up with her physician routinely. Instruct the client to write down any questions he may encounter during the
past days so that she can ask questions to her physicians if she has concerns forher conditions and how will she take care her health.
Diet Encourage the patient to eat nutritious foods such as vegetables and fruits. Try to lessen foods that are too salty and fatty. Ask the physician about her diet such as how many servings of fat,
carbohydrates, protein and sweets. In that way, she will know what dishes she will eat to promote good health.
Spiritual Advise the patient to continue to have faith in God in spite of losing two of her
babies. She must read the bible regularly to regain her trust to the Lord. Encourage the patient to have a one on one relationship with God so that she
can have a peaceful mind and a positive outlook in life.