Ectopic Pregnancy 101 - Copy

7/28/2019 Ectopic Pregnancy 101 - Copy

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Ectopic PregnancyPrepared by:Adrillano, E.J Nocos, SharmBernales, J.P Peria, PaoloCenteno, Lily Romero, CharmEbron, Don Silay , Anne
http://www.123rf.com/photo_10954772_shield-with-stethoscope-wrapped-round-it-medical-healthcare-concept.html


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Introduction

The BSN students were given theopportunity to have a hospital exposureat Ospital ng Cabuyao; and on thatday found a commendable case

reasonable to be presented for casestudy. The patient, to be mentioned inthis paper as Patient X, housewife,G2P1 (T1-P0-A0-L1), was one of the patients admitted to the EmergencyRoom. She was 34 years of age. HerLMP is July 30, 2012. She wasadmitted due to ectopic pregnancy.


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An ectopic pregnancy occurs when the baby starts todevelop outside the womb (uterus). The most common site for anectopic pregnancy is within one of the tubes through which the eggpasses from the ovary to the uterus (fallopian tube). However, in rarecases, ectopic pregnancies can occur in the ovary, stomach area, orcervix. Ectopic Pregnancy occurs in about 1 in 250 pregnanciesamounting to approximately 70 000 cases annually, 5,833 per month,1,346 per week, 191 per day, 7 per hour. In the Philippines,unpublished reports have estimated the incidence to be just about 22,

194 each year.An ectopic pregnancy is commonly referred to as a tubal

pregnancy because 95 percent occur in a fallopian tube. An ectopicpregnancy needs to be treated immediately to avoid fallopian tubedamage or life threatening blood loss. When identified early, ectopicpregnancies are treatable with medication that stops the pregnancy.If the pregnancy is further along, laparoscopy is usually performedto remove the ectopic tissue and repair the fallopian tube. Currently,laparotomy is the preferred technique when the patient ishemodynamically unstable, the surgeon has not been trained inlaparoscopy, physical facilities and supplies to perform laparoscopic

surgery are lacking or technical barriers to laparoscopy are present.


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Currently, laparotomy is the preferred techniquewhen the patient is hemodynamically unstable, the surgeonhas not been trained in laparoscopy, physical facilities andsupplies to perform laparoscopic surgery are lacking ortechnical barriers to laparoscopy are present.

If the ectopic pregnancy has ruptured or bleedingpersists, salpingectomy is a very common option. Thisprocedure involves excision of segment of the Fallopian

tube involved in the ectopic pregnancy. The tubal segment tobe removed is coagulated and cut off with bipolarforceps.The group chose J.S. as their subject primarilybecause her case posed as a very intricate case requiringdue understanding and knowledge. The group recognizestheir partial knowledge about ectopic pregnancy and thesurgical procedures involved in such condition, thus makingthis case a good avenue to broaden the proponentsknowledge about the disease and the surgical proceduresinvolved.


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The first warning signs of an ectopic pregnancyare often pain or vaginal bleeding. You might feelpain in your pelvis, abdomen, or, in extreme cases,even your shoulder or neck (if blood from aruptured ectopic pregnancy builds up and irritatescertain nerves). Most women describe the pain assharp and stabbing. It may concentrate on oneside of the pelvis and come and go or vary inintensity.Any of the following additional symptoms canalso suggest an ectopic pregnancy:vaginal spottingdizziness or fainting (caused by blood loss)low blood pressure (also caused by blood loss)lower back pain


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AbstractThis is a case of a patient who has been diagnosed with EctopicPregnancy. The patient was complaining from pain in right lowerquadrant of her abdomen. In an ectopic pregnancy, a fertilized egghas implanted outside the uterus. The egg settles in the fallopiantubes in more than 95% of ectopic pregnancies. This is why

ectopic pregnancies are commonly called "tubal pregnancies." Theegg can also implant in the ovary, abdomen, or the cervix, so youmay see these referred to as cervical or abdominal pregnancies.

None of these areas has as much space or nurturing tissue as auterus for a pregnancy to develop. As the fetus grows, it willeventually burst the organ that contains it. This can cause severe

bleeding and endanger the mother's life. A classical ectopicpregnancy does not develop into a live birth. Ectopic pregnancy canbe difficult to diagnose because symptoms often mirror those of anormal early pregnancy. These can include missed periods, breasttenderness, nausea, vomiting, or frequent urination.


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Patients Profile: Name: Patient X Address: Nia Road Sala, Cabuyao,

LagunaBirthdate: March.18,2012Age: 34Birthplace: Mindanao

Religion: Roman Catholic


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Nationality: FilipinoCivil Status: Single

Admission: Aug. 23,2012

Time: 12:15 amDischarge: Aug. 28, 2012Time: 8:00pmFinal Diagnosis: Tubal pregnancy, rightcompletely ruptured G2P1 (1001) right partialsalpingectomy


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Nursing Assessment


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Review of Reproductive SystemGynecologicalGravida\ paraObstruction

LMP(frequency,duration)Age of menarchyMenopauseDysmenorrhea

ContraceptionDischargeItchinessDysparunia


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HematologicalAnemiaBleeding

BruisingMalignancyTransfusion


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Physical ExaminationSkin-Pale skinChest- SCE no retractionHeart- AP no murmur nrrrAbdomen- flabby soft (+) hypogastrictendernessPelvic Exam- (+) wriggling tenderness

EyesPale palpebral conjuctiva

Nose(-) NAD


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Assessment findings :

Amenorrhea

Abnormal menses (after fallopian tubeimplantation)Slight vaginal bleeding

Unilateral pelvic pain over the massIf fallopian tube ruptures, sharp lowerabdominal pain, possibly radiating to theshoulders and neck.Possible extreme pain when cervix is movedand adnexa palpated.Boggy and tender urine

Possible enlargement of adnexa


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Chest- SCE no retractionHeart- AP no murmur nrrr

Abdomen- flabby soft (+) hypogastrictendernessPelvic Exam- (+) wriggling tenderness

EyesPale palpebral conjuctiva

Nose(-) NAD


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Drug Study


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DRUGNAME

ACTION ANDTHERAPEUTICEFFEC

T

CONTRAINDICATION

ADVERSEEFFECT

NURSING IMPLICATION

CEFAZOLINSODIUMCLASSIFIC

ATION: ANTIBIOTIC, FIRSTGENERATION

CEPHALO-SPORINROUTE,DOSAGE,FREQUENCY AND

ADMINISTR ATION:-ADULT:IV/IM250mg-2gQ8

SEMISYTHETIC,FIRSTGENER

ATIONCEPHALOSPORIN C

WITHLIMITED ACTIVITY

AGIANSTGRAM-NEGATIVEORGANISMS

HYPERSENSITIVITYTO

ANYCEPHALOSPORIN

ANDRELATED

ANTIBIOTICS

BODY: ANAPHYLAXIS,FEVER,EOSINOPHILIA,SUPERINFECTIONS,

SEIZURE,GI:DIARRHEA,

ANOREXIA, ABDOMINAL CRAMPSSKIN:MACULOPAPULARRASH,URTICARIA

-DETERMINE HISTORY OF HYPERSENSITIVITY TOCEPHALOSPORINS, PENICILINS, AND OTHER DRUGSBEFORE THERAPY IS INITIATED-LAB TEST: PERFORM CULTURE AND SENSITIVITYTESTING PRIOR TO AND DURING THERAPY. THERAPYMAY BE INITIALED PENDING RESULTS-MONITOR I & O RATES AND PATTERNS, BE ALERT TOCHANGES IN BUN, SERUM CREATINIRE

-PROMT ATTENTION SHOULD BE GIVEN ONSET SIGNSOF HYPERSENSITIVITYPROMPTLY REPORT THE ONSET OF DIARRHEA,PSEUDOMEMBRANOUS COLITIS, A POTENTIALLY LIFETHREATENNG CONDITION, STARTS WITH DIARRHEA


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DRUG ACTIONANDTHERAPEUTICEFFECT

CONTRAINDICATIONS

ADVERSE EFFECT NURSING IMPLICATION

TRAMA

DOLCLASSIFICATION:

ANALGESIC,NARCOTICROUTE,

DOSAGE,FREQUENCY

AND ADMINISTRATION:POIMMEDI

ATERELEASE:25mgDAILY,TITRATED UPTODOSEOF

CENTRAL

LY ACTINGOPIATERECEPTOR

AGONISTTHATINHIBITSTHE

UPTAKEOFNOREPINEPHRINE

ANDSEROTONIN,SUGGESTINGBOTHOPIOID-LIKEEFECTS,BUTCAUSELESSRESPIRATORYDEPRESSION THAN

HYPERSE

NSITIVITYTOTRAMADOL OROTHEROPIOID

ANALGESICS,SEVERE

RESPIRATORYDEPRESSION,SEVEREOR ACUTE

ASTHMAS,PATIENSON MAOINHIBITORS,SUBSTANCE ABUSE,

ALCOHOLINTOXICATION,LACTATION,CHILDRENYOUNGER

CNS:

DROWSINESS, DIZZINESS,VERTIGO, FATIGUE, HEADACHE,SOMNOLENCE,RESTLESSNESS, EUPHORIA,CONFUSION, ANXIETYCOORDINATION DISTURBANCE,SLEEP DISTURBANCES,SEIZURESCV:

PALPITATION, VASO-DILATIONGI:NAUSEA, CONSTIPATION,VOMITING, XEROSTOMIA,DYSPEPSIA, DIARRHEA,

ABDOMINAL PAIN, ANOREXIA,FLATULENCEBODY:SWEATING, ANAPHYLACTICRAECTION, WITHDRAWALSYDROME w/ ABRUPTDISCONTINUATIONSKIN:RASHSPECIAL SENSES:VISUAL DISTURBANCESUROGENITAL:URINARYRETENTION/FREQUENCY,MENOPAUSAL SYMPTOMS

-ASSESS FOR LEVEL OF

PAIN RELIEF AND ADMINISTER PRN DOSE ASNEEDED BUT NOT TOEXCEED THERECOMEMDED TOTALDAILY DOSE-MONITOR VITAL SIGNS

AND ASSESS FORORTHOSTATIC

HYPOTESION OR SIGNS OFCNS DEPRESSION-WITHHOLD DRUG ANDNOTIFY PHYSICIAN IF S/SOF HYPERSENSITIVITYOCCUR-ASSESS BOWEL ANDBLADDER FUNCTION;REPORT URINARYFREQEUNCY ORRETENTION-USE SEIZUREPRECAUTIONS FORPATIENTS WHO HAVE AHISTORY OF SEIZURES ORWHO ARE CURRENTLYUSING DRUGS THATLOWER THE SEIZURETHRESHOLD-MONITOR AMBULATION


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DRUG ACTION ANDTHERAPEUTIC EFFECT

CONTRAINDICATIONS

ADVERSE EFFECT NURSINGIMPLICATION

DieclofenacClassification:Nonsteroidalanalgesic,anti-inflammator y drugRoute,dose, frequencyandadministrati

on:adult-apply onepatch tomostpainful areaB.I.D.

Diclofenaccompetitivelyinhibits bothcyclooxygenaseisoenzyme, COX-1and COX-2, bybloking arachidonicacid conversion toother chemicals,thus leading to itsanalgesic,antipyreticand anti-inflammatory effect.It appear to be a

potent inhibitor of cyclooxygenase,thereby decreasing thesynthesis of prostaglandin

Hypersensitivitytodiclofenac,NSAIDS, or salicylate;patients inwhomasthma,urthicaria,angioedema,brochospasm,severerhinitis,historyof bleeding;hepatic

porhpyria;shockor other sensitivityreaction ispresipitated byaspirin or other NSAIDS, postoperative

CABG pain.

CNS : Dizziness, headache,drowsinessSpecial senses: TinnitusSkin: Rash, pruritusG I: Dyspepsia, nausea,vomting, abdominal pain,cramps, constipation,diarrhea, indigestion,abdominal distention,flatulence, peptic ulcer, liver enzyme,transaminases,increased liver test abnormalitiesCV : Fluid retention,

hypertention, CHF.RESPIRATORY : AsthmaBODY AS A WHOLE : Back,leg, or joint pain.ENDOCRINE : hyperglycemiaHEMATOLOGIC : prolongedbleeding time; inhibits plateletaggregation

-observe and reportsigns of beeding-Monitor bloodpressure for hypertension andblood sugar for hyperglycemia-Monitor diabeticsclosely for loss of diabetic control-monitor for increased serumsodium andpotassium in

patient receivingpotassuim sparingdiuretics- Monitor for S&Sof CHF, includingweight gain greater than 1kg-monitor for signs

and symptoms of GI irritation and


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DRUG ACTION ANDTHERAPEUTICEFFECT

CONTRAINDICATION

ADVERSEEFFECT

NURSINGIMPLICATION

OMEPRAZOLECLASSIFICATION: PROTONPUMPINHIBITOR,

ANTISECRETORYROUTE, DOSE,FREQUENCY

AND ADMINISTRATION:PO 20-40mgONCE ADAYFOR 4-5WEEKS

AN ANTISECRETORYCOMPOUNDTHAT IS AGASTRIC ACIDPUMPINHIBITOR.SUPPRESSES

GASTRIC ACIDSECRETIONBY INHIBITINGTHE H+, K+,

ATPaseENZYMESYSTEM ACIDIN THEPARIETALCELLS.SUPPRESSESGASTRIC ACIDSECRETIONRELIEVINGGASTROINTES

TINALDISTRESS AND

LONG TERMUSE FORGASTROESOPHAGEALREFLUXDISEASE,DOUDENALULCERS,PROTON

PUMPINHIBITORS,HYPERACTIVITY, BLEEDING,LACTATION,USE OFZEGERID INMETABLOLIC

ALKALOSIS,HYPOGLYCEMI

A, VOMITING

CNS:HEADACHE,DIZZINESS,FATIGUEGI:DIARRHEA,

ABDOMINALPAIN, NAUSEA,MILD

TRANSIENTINCREASES INLIVERFUNCTIONTESTSUROGENITAL:HEMATURIA,PROTEINURIASKIN:RASH

-LAB TESTS:MONITORURINALYSISFORHEMATURIA

ANDPROTEINURIA,PERIODICLFTS w/

PROLONGEDUSE-REPORT ANYCHANGES INURINARYELIMINATIONSUCH AS PAIN

ANDDISCOMFORT

ASSOCIATEDw/ URINATION-REPORTSEVEREDIARRHEA,DRUG MAY

NEED TO BEDISCONTINUE


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DRUG ACTIONANFTHERAPEUTICEFFECT

CONTRAINDICATION

ADVERSE EFFECTS NURSINGIMPLICATION

FERROUSSULFATE

CLASSIFICATION:IRONPREPARATIONROUTE,DOSAGE,FREQUENCY AND

ADMINISTRATION:POSULFATE750-

1500mgPER DAYIN 1-3DIVIDEDDOSES

STANDARD IRONPREPARATIONTHATCORRECTSERYTHROPOIETIC

ABNORM ALITIESINDUCEDBY IRONDEFICIENCY BUTDOESNOTSTIMULA

TEERYTHROPOIESIS

PEPTICULCER,REGIONALENTERITIS,ULCERATIVECOLITIS,HEMILYTIC

ANEMIAS,HEMOCHROMATOSIS,HEMOSIDEROSIS,PATIENTSRECEIVINGREAPETEDTRANSFUSIONS,PYRIDOXINE

-RESPONSIVE ANEMIA,CIRRHOSISOF LIVER

GI:NAUSEA, HEARTBURN,

ANOREXIA, CONSTIPATION,DIARRHEA, EPIGASTRIC PAIN,

ABDOMINAL DISTRESS, BLACKSTOOLSSPECIAL SENSES:YELLOW-BROWNDISCOLORATION OF EYES ANDTEETHLARGE CHRONIC DOSES ININFANTS:RICKETSMASSIVE OVERDOSAGE:LETHARGY, DROWSINESS,NAUSEA, VOMITING,

ABDOMINAL PAIN, DIARRHEA,LOCAL CORROSION OF

STOMACH ANF SMALLINTESTINE, PALLOR ORCYANOSIS, METABOLIC

ACIDOSIS, SHOCK,CARDIOVASCULAR COLLAPSE,CONVULSION, LIVERNECROSIS, RENAL FAILURE,DEATH

-LAB TEST: MONITORHIGH Hgb ANDRETICULOCYTEVALUES DURINGTHERAPY.INVESIGATE THE

ABSENCE OFSATISFACTORYRESPONSE AFTER 3WEEKS OF DRUGTREATMENT-CONTNUE IRONTHERAPY FOR 2-3MONTHS AFTER THEHEMOGLOBIN LEVELHAS RETURNED TONORMAL-MONITOR BOWEL

MOVEMENTS ASCONSTIPATION IS ACOMMON ADVERSEEFFECT


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DRUG ACTION ANDTHERAPEUTIC EFFECT

CONTRAINDICATION

ADVERSE EFFECT NURSINGIMPLICATIONS

CEFUROX

IMESODIUMCLASSIFICATION:

ANTIBIOTIC,SECONDGENERATIONCEPHALOSPORINROUTE,DOSAGE,FREQUENCY AND

ADMINISTRATION:

ADULT:PO 250-500mgQ12IV/IM 750-1.5g Q6-8

SEMISYNTH

ETICSECONDGENERATIONCEPHALOSPORIN BETA-LACTAM

ANTIBIOTIC.PREFERENTIALLY BINDSTO ONE ORMORE OFTHEPENICILINBONDING

PROTEINSLOCATEDON CELLWALLS OFSUSCEPTIBLEORGANISMS, THUSKILLING THEBACTERIUM

HYPERSE

NSITIVITYTOCEPHALOSPORINS

ANDRELATED

ANTIBIOTICS; VIRALINFECTIONS

BODY:

THROMBOPHLEBITIS,PAIN, BURNING,CELLULITIS,SUPERINFECTIONS,POSITIVE COOMBS

TESTGI:DIARRHEA, NAUSEA,

ANTIBIOTIC ASSOCIATEDCOLITISSKIN:RASH, PRURITUS,URTICARIAUROGENITAL:

INCREASED SERUMCREATININE ANDBUN, DECREASEDCRAETININECLEARANCE

-DETERMINE

HISTORY OFHYPERSENSITIVITY REACTIONS TOCEPHALOSPORINS, AND HISTORYOF ALLERGIES,PARTICULARLY TODRUGS, BEFORETHERAPY ISINITIATED-LAB TESTS:PERFORMCULTURE ANDSENSITIVITYTESTS BEFORE

INITIATION OFTHERAPY.THERAPY MAY BEINSTITUTEDPENDING TESTRESULTS.MONITORPERIODICALLYBUN ANDCREATININE


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DRUG ACTION ANDTHERAPEUTICEFFECT

CONTRAINDICATION

ADVERSEEFFECT

NURSINGIMPLICATION

FLANAXFORTE

CLASSIFICATION:

Analgesics, Antipyretics &MuscleRelaxants/

Analgesics,Non-Narcotic/Non-Steroidal

Anti-InflammatoryDrugs (NSAIDs)ROUTE,DOSAGE,

FREQEUNCY AND ADMINISTRATION:PO Non-Rx:Flanax 275mg;Rx: FlanaxForte BID

Relief of mild tomoderately

severe pain withor withoutaccompaniedinflammation.Relief of painassociated withpost-partumcramping anddysmenorrhea.

Hypersensitivity. Active peptic

ulcer. Children


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DRUG ACTION AND CONT ADVERSE NURSING IMPLICATION


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THERAPEUTICEFFECT

RAINDICATION

EFFECT

D5LRS(DEXTROSE 5% INLACTATEDRINGERS

SOLUTION)

CLASSIFICATION:HYPERTONIC,NON-

PYROGENIC,PARENTERALFLUID,ELECTROLYTE,NUTRIENTREPLENISHER

ROUTE,DOSAGE,FREQUENCY

AND ADMINISTRATION:IV SINGLEDOSE OF 500-

1000mL @ 30gtts/min OR AS

HYPERTONICSOLUTIONS

ARE THOSETHAT HAVE ANEFFECTIVEOSMOLARITYGREATERTHAN THEBODY FLUIDS.THIS PULLS

THE FLUIDINTO THEVASCULAR BYOSMOSISRESULTING IN

AN INCREASEVASCULARVOLUME. ITRAISESINTRAVASCULAR OSMOTICPRESSURE

ANDPROVIDESFLUID,

ELECTROLYTES AND

HYPERSENSITIVITY TO

ANYOFTHECOMPONENTS

The mostfrequently

reportedside effectsfor patientstaking D5Lrs are:hypotension,pneumoniarespiratorysyncytialviral,hypernatraemia. Theyare followedby: acute

respiratorydistresssyndrome,pneumonitis, bloodbilirubinincreased.

-DO NOT ADMINISTERUNLESS SOLUTION ISCLEAR AND CONTAINERIS UNDAMAGED-CAUTION MUST BEEXERCISED IN THE

ADMINISTRATION OFPARENTERAL FLUIDS,ESPECIALLY THOSECONTAINING SODIUM

IONS TO PATIENTSRECEIVINGCORTICOSTEROIDS ORCORTICOTROPHIN-SOLUTION CONTAINING

ACETATE SHOULD BEUSED WITH CAUTION ASEXCESS ADMINISTRATIONMAY RESULT INMETABOLIC ALKALOSIS-SOLUTION COINTAINGDEXTROSE SHOULD BEUSED WITH CAUTION INPATIENTS WITH KNOWNCUBCLINICAL OR OVERT

DIABETES MELLITUS

A t Di i i f Pl i I i R i l l i


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Assessment Diagnosis inference Planning Intervention Rationale evaluation

Subjective:Masakit angtiyan ko (

My tummyhurts) asverbalized

by patient .Objective: Facial mask of pain. Guarding

behavior

Acute painrelated todistention

or ruptureof fallopiantube

Ectopic pregnancy isgestation

locatedoutsidethe uterine

cavity.The

fertilizedovumimplantsoutside

of the uterus,usually in

the fallopiantube .

After 8 hoursof nursinginterventions,the patientwill berelievedor controlledIndependent:

Monitor maternal vitalsigns.

Monitor for presenceand amountof vaginal

bleeding.Monitor for increaseand pain andabdominaldistentionand rigidity.Monitor complete blood

count(CBC)

To determine

presence

of hypotension andtachycardiacaused byruptureor hemorrhage.

After 8hoursof nursinginterventions

, the patientwas relievedor controlled

Assessment Diagnosis inference Planning Intervention Rationale Evaluation


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PredisposingfactorsIncludeAdhesions

of the tube,salpingitis,congenitalanddevelopmentalanomaliesof the

fallopian tube, previousectopic

pregnancy,use of anintrauterinedevice for

more than2years,multipleinducedabortions,menstrualreflux , anddecreasedtuba lmotility

Providecomfortmeasure like

back rubs,

deep breathing.Instruct inrelaxation or visualizationexercises.Provideddiversionalactivities

Collaborative:

Administer analgesics asindicated

Tofurther assessthe presentsituationindicatinghemorrhageProvidecomfortmeasure like

back rubs, deep breathing.Instruct in

relaxation or visualizationexercises. Diversionalactivities aidsin refocusingattention andenhancingcoping withlimitations. To maintainacceptablelevel of pain

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Ectopic Pregnancy 101 - Copy