ectopic pregnancy
TRANSCRIPT
CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
Ectopic Pregnancy
In line with the partial fulfillment in Related Learning Experience
CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
IntroductionEctopic pregnancy is any pregnancy that occurs outside the uterus. The vastmajorities (95%) of these are in the fallopian tubes. Other possibilities are the ovary, cervix, or abdominal cavity. It occurs in about 1 out of 200
pregnancies. It is very serious because when the pregnancy grows in these abnormal areas, it can easily cause massive, rapid bleeding, which can result in a decrease in fertility and even death.
Usually, some sort of anatomical problem exists which traps the fertilizedegg in the tube. Pelvic Inflammatory Disease (PID), which leads to scarring ofthe tubes, is the most common cause, comprising about 30%-50% of allectopics. Pelvic infections include chlamydia and gonorrhea.
Common symptoms that a woman may experience early in an ectopicpregnancy:
a) Abdominal painb) Late or missed periodc) Vaginal bleedingd) Tissue passage from the vaginae) Pregnancy symptoms
Ectopic pregnancy is usually found in the first 5-10 weeks of pregnancy.
CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
Objectives
At the end of the case presentation, the researcher will
be able to have a deeper understanding aboutEctopic Pregnancy.
Specifically, students will be able to: • have an overview about the complication, Ectopic
Pregnancy• enumerate treatment and management of Ectopic
Pregnancy • formulate an appropriate nursing care plan for
patients undergoing Ectopic Pregnancy
CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
Personal Profile
Name: Patient LAGender: femaleBirthday: April 6, 1984Age: 25 years oldNationality: FilipinoReligion: CatholicCivil Status: Married
CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
Nursing Theory
Lydia Hall“Care, Core, Cure”
Theory
Care Core
Cure
CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
Care, Core, Cure TheoryCARDENAS,
JaymarCARPIO,
Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
The theory contains of three independent but interconnected circles—the core, the care and the cure.
According to the theory, the core is the person or patient to whom nursing care is directed and needed. It has been mentioned that the core has goals set by the patient herself and not by any other person, and that these goals need to be achieved. The core, in addition, behaved according to his feelings, and value system.
The cure, on the other hand is the attention given to patients by the medical professionals. It has been explicit in stating that the cure circle is shared by the nurse with other health professionals. These are the interventions or actions geared on treating or “curing” the patient from whatever illness or disease he may be suffering from. Some interventions in relation to this are prescribing pharmacologic therapies and performing diagnostic tests.
The highlight however is the care model. This is the part of the model reserved for nurses, and focused on performing that noble task of nurturing the patients, meaning the component of this model is the “motherly” care provided by nurses, which may include, but is not limited to provision of comfort measures, provision of patient teaching activities and helping the patient meet their needs where help is needed.
Care, Core, Cure TheoryCARDENAS,
JaymarCARPIO,
Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
That means that if all three circles exhibit harmony and balance, the patient will be the one to benefit from it all since his needs are being put into priority but the meeting of it depends on which circle of the model is responsible for meeting such activities. It was hard not to see that in all of the circles of the model, the nurse is always presents, but the bigger role she takes belongs to the care circle where she acts a professional in helping the patient meet his needs and attain a sense of balance.
In relation to Patient LA, the patient serves as the core together with the relatives whom nursing care is needed and must be given. The patient sets goal for the relief and this must be achieved according to what the patient feels. On the other hand, the attention the nurses give to the patient serve as the cure. The patient will achieve his goal with the help of all the medical team. Lastly, the care which is the task for the nurses. It focuses on performing the tasks. The nurses will give necessary interventions and actions that gears in treating and curing the patient (core). These three components, the patient, the attention and the care by the nurse should have balance and each one has benefit to one another not to the patient only.
History of Present Illness
• 2 days prior to admission she had experienced abdominal pain. As well as nausea and vomiting.
Consultation was done and advice her to do apregnancy test. Few hours before admission the patient has undergo to ultrasound and found out that the embryo was in the left fallopian tube and not in the uterine wall. The patient had decided to remove the embryo.
CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
Physical AssessmentCARDENAS,
JaymarCARPIO,
Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
Conjunctiva
1. Color, texture and presence of lesions in the bulbar conjunctiva
Pinkish or red in color; with presence of small capillaries; moist; no
foreign bodies; no ulcers
paleDue to fluid and blood
loss
2. Color, texture and presence of lesions in
the palpebral conjunctiva
Pinkish or red in color; with the presence of small
capillaries; moist; no foreign bodies; no ulcers
paleDue to fluid and blood
loss
AbdomenNo swelling, no warmth, no redness, no pain, no
tenderness when palpated
(+) painRuptured fallopian
tube
Definition of TermsCuldocentesisIncision made into the wall of vagina, usually the posterior wall,
close to cervix. This was formerly used to confirm diagnosis of ectopic pregnancy but has now replaced by laparoscopy
EndometriumThe mucous membrane lining the uterus, which becomes
progressively thicker and more glandular and has an increased blood supply in the latter part of the menstrual cycle.
BlastocystEarly stage of embryonic development that consists of hollow ball of
cells with a localized thickening (inner cell mass) that will develop into the actual embryo
Corpus luteumThe glandular tissue in the ovary that forms at the site of a ruptured
follicle after ovulation. It secretes the hormone progesterone, which prepares the uterus for implantation.
CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
Anatomy and Physiology
CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
Embryo
Uterus: The uterus (womb) is a hollow, pear-shaped organ located in a woman's lower abdomen between the bladder and the rectum. The narrow, lower portion of the uterus is the cervix; the broader,upper part is the corpus. The corpus is made up of two layers oftissue.
In women of childbearing age, the inner layer of the uterus(endometrium) goes through a series of monthly changes known asthe menstrual cycle.
Each month, endometrial tissue grows and thickens in preparationto receive a fertilized egg. Menstruation occurs when this tissue isnot used, disintegrates, and passes out through the vagina. Theouter layer of the corpus (myometrium) is muscular tissue thatexpands during pregnancy to hold the growing fetus and contractsduring labor to deliver the child.
CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
Pathophysiology
CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
BLOOD LOSSPeritoneal reaction to
blood escaping from the tube.
Nausea Vomiting
Transport of a blastocyst to the
uterus is delayed.
Irregular menses
Inflammation of fallopian tube
Uterine enlargement and contraction
PAIN
Fallopian tube is ruptured
Ovum is discharge in the abdominal cavity
Dizziness Faintness
The blastocyst implants at another available vascularized site, usually the
fallopian tube lining.
Laboratory Results
CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
UltrasoundCARDENAS,
JaymarCARPIO,
Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
Diagnosis: Normal right anteverted with slightly thickened endometrium, cystic to right ovary to consider corpus luteum, complex mass noted in the left
abdomen. To consider ectopic genitalia with HCG determinate s clinically.
HematologyCARDENAS,
JaymarCARPIO,
Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
Findings: Normal: Interpretation:
White blood cells 12.1 4.5-11 /dl It has a sign of infection.
Neutrophils 0.62 0.1-0.7/dl Normal
Lymphocytes 0.38 1-2.8/dlAnemic or
immunodeficient
Hemoglobin 12 12-16 gm/dl Normal
Hematocrit 35 38%-46%Because of the blood
loss
Drug Study
CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
DrugClassificatio
nAction Indication Contraindication Side Effects Nursing interventions
Ceferoxime750 mg
Anti-infectives Inhibit cell wall synthesis
Promoting cell wall instability
usually bactericidal
Pharyngitis, tonsillitis, infection of the urinary or lower respiratory tracts, and/or skin structure infection
caused by Streptococcus pneumonia and
Sypogenes.Serious lower
respiratory tract infection, UTI, skin or skin structures,
bone or joint infection,
septicemia, meningitis and
gonorrhea.Uncomplicated
UTIOtitis Media
Phrayngitis and Tonsillitits
Perioperative operative operationEarly lyme
disease
Hypersensitive to drug or other
cephalosporinsuse catiously in
patients hypertensive to penincillin because if possibility of cross-sensitivity with other beta-lactam antibiotic
use catiously in breast-feeding women and in
patients with history of colitis and renal
insufficiency.
Transient neutropeniaeosinophiliahemolytic anemia
Thrombopheniatemperature
elevation pain
Indurationsterile
abscesses tissue sloughing
Ask patient if allergic to penicillins or cephalosporins
Obtain specimen for culture and sensitivity test before giving first dose.R: This medication can cause you to have unusual results with certain lab tests to check for glucose (sugar) in the urine.
Tablets may be crushed, if absolutely necessary for patients who can’t swallow.
If large doses are given, therapy is prolonged, or patient is at high risk, monitor patient for s&s of superinfectionR: The combined infection has also been shown to reduce the overall effectiveness of the immune response
Medical Management
Medical Management
CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
Action: Rationale:
CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
Nursing Management
Procedures: Rationale:
Ultrasound
a test that can find a decreased proportion of red blood cell which reflect the body’s inability to produce enough red blood cells to replenish what has been out of blood stream. And it is use to find a reduced proportion of red blood cells or an elevation of white blood cells.
CBC
which can show whether the uterus contains a developing fetus or if masses are present elsewhere in the abdominal area. It reveals of a viable fetus.
catheter
Catheterization allows the patient's urine to drain freely from the bladder for collection, or to inject liquids used for treatment or diagnosis of bladder conditions.
CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
Other Procedures
Surgical Management
• Laparoscopy- to visually detect unruptured tubal pregnancy and thereby avoid the risk of its rupture. And reveal pregnancy outside the uterus.
• Salpingectomy-removal of the fallopian tube
Laparotomy and salpingectomy if culdocentesis showsblood in the peritoneum; possibly after laparoscopy toremove affected fallopian tube and control bleeding.
CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
Problem List
CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
Cues Nursing process
Rank Justification
Subjective: N/AObjective: Lab resultsHematocrit: 35Hemoglobin: 12 Pale skin
Deficient fluid volume related to
blood loss
1 Prolonged fluid loss may lead to severe dehydration and must be implemented every after surgical procedure done to the patient.
Subjective:“Medyo nananakit ang tiyan ko ngayon.” as verbalized by thepatient.Objective: Evidence of sutured
abdomen Facial expressions
seen expressing pain
Acute pain related to incised abdominal
area
2 Pain must be achieved because it can alter the normal function
of an individual thus altering her daily activity.
Subjective:”Sayang talaga, wala lang sa lugar yung pinagbubuntis ko kaya ko pinaoperahan na.”as verbalized by the patient.
Objective: feels down repetitive
verbalization of the past surgery
Grieving related to loss of child
3 Stress. If pregnancy is desired, loss may be expressed and the impact may not be fully realized until much later. For as long as there is loss, grief reaction will follow and would give persistent psychological distress
Concept Mapping
CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
Client who has undergone Exploratory Laparotomy with
underlying condition of Ectopic Pregnancy
Keep fluids within patients reach and encourage frequent fluid intake as
possible.
Maintain accurate I/O and weigh daily.
Administer IV fluids as possible
Discuss factors related to occurrence of dehydration.
Nursing Diagnosis
Risk for deficient
fluid volume
related to blood loss
Desired outcomesThe patient will be able to maintain fluid balance and understand its causative factors and find appropriate intervention for it.
Subjective:N/A
Objective:Hematocrit: 35
Hemoglobin: 12
Monitor Vital Sings regularly.
CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
Client who has undergone Exploratory Laparotomy with
underlying condition of Ectopic Pregnancy
Administer analgesics as indicated. Then notify if regimen is inadequate to meet
goal
Use pillows, cloth into the incised area to lessen impact whenever the patient
moves or touches it.
Instruct in usage of relaxation techniques like deep breathing
exercises to promote proper blood circulation.
Nursing DiagnosisAcute pain related to incised
abdominal area
Desired outcome(s): The patient will be able to control the pain and will also find ways to lessen its occurrence.
Subjective:“Medyo nananakit ang tiyan ko ngayon.” As verbalized by the patient.Objective:Evidence of sutured abdomenFacial expressions seen expressing pain
Encourage diversional activities like talking to others reading newspaper,
etc.
CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
Client who has undergone Exploratory Laparotomy
with underlying condition of Ectopic Pregnancy
Provide comfort and availability as well as caring for physical needs.
Encourage involvement in usual activities, exercise and social
activities within limits of physical activity.
Respect patient’s need for privacy or silence.
Nursing DiagnosisGrieving related to loss of child
Desired outcomes): The patient will be able to demonstrate progress in dealing with stages of grief at own pace.
Subjective:”Sayang talaga, wala lang sa lugar yung pinagbubuntis ko kaya ko pinaoperahan na.” as verbalized by the patient.Objective:deels downrepetitive verbalization of the past surgery
Acknowledge reality of feelings of guilt/blame
Discharge PlanningCARDENAS,
JaymarCARPIO,
Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
Thank you CARDENAS, Jaymar
CARPIO, Marco AngeloCASABUENA,
ChristiaCASTILLO,
Maria FeCELISPARA, Hanna MarielCENTENO,
JhuwenaCENTENO,
MierCILEK,Monika
COBARRUBIAS,Jedidiah Thomas
CONDE, Ma. Angela Francesca
CONG,Jan FerbeCONOL,
Jenine Ezra
Thank you
Thank you Thank you
Thank you Thank you
Thank you Thank you
Thank you