Lyceum Northwestern University

College of Nursing
Tapuac District, Dagupan City

A
Case Study
On
Ruptured Ectopic Pregnancy

Pangasinan Provincial Hospital

Obstetric Ward
2ND YEAR-Section 1 (Group 2):
Regodon, Rhemel John L.
Reyes, Kimberly M.
Romero, Bryan B.
Silan, Mary Claude Tiffany B.
Sison, Bianca Dominique F.
Solis, Irish Crystal U.
Soriano, John Krisnel P.
Soriano, Michelle R.
Suguitan, Susan A.
Tabucao, Angelica T.
Tagapulot, Maria Katrina
Tan, Kimberlee Anne A.

Mrs. Ma. Moppet Magnolia Q. Araña

Clinical Instructor

March 26, 2011

CONTENTS
 I. Introduction

II. Objectives

III. Significance of the study

IV. Patient’s Profile

V. Patient’s History
a. History of Present Illness
b. History of Past Illness
c. Family History

VI. Assessment

VII. Laboratory/ Diagnostic

VIII. Disease Identity

a. Anatomy and Physiology
b. Pathophysiology

IX. Management Medical Surgical Nursing

a. Drug Study
b. Surgical Treatment
c. Nursing Care Plans

X. Discharge Summary (METHODS)

ACKNOWLEDGEMENT

The advocates of this case study would like to extend their warmest
appreciation to all the people who made the success for the making of this work.
 First of all, to the Almighty God, for His everlasting love and blessings; for
giving us enough power and determination to face all the hardships in the making of
this work. Praise and honor to You, our God!

To Mrs. Maria Moppet Q. Araña, RN, our clinical instructor for her priceless
time, knowledge and effort rendered to us.

To the staff of Pangasinan Provincial Hospital, especially in the Obstetric

Ward, for giving us the opportunity to complete this work.

To our dear families and friends, for their endless support and understanding;
for always being there to guide us and care for us after the long days of duties; for
being our inspiration to finish this seemingly impossible task.

To the patients and their families for challenging us to do more and for giving
us strength to give our best in rendering care to maintain their normal vital signs
and giving them enough knowledge in our health teachings.

To the group, we would like to recognize each other for our own radical
efforts in order to complete this case study; for sticking together through hardships
and for simply being there.

Lastly, to each and every one who helped realize this job into completion,
may it be direct or indirect, no matter how minimal, the gratitude and pleasure for
the achievement of this task is ours to share.

I. Introduction:

In the developed world, Ectopic Pregnancy occurs in about 1 in 250

pregnancies amounting to approximately 70 000 cases annually, 5,833 per
month, 1,346 per week, 191 per day, 7 per hour. In the United States alone
64,000 women experience loss of pregnancy through ectopic pregnancy. In
the Philippines, unpublished reports have estimated the incidence to be just
about 22, 194 each year.

An ectopic pregnancy is a pregnancy in which implantation occurs

outside the uterine cavity. About 95% of ectopic pregnancies occur in the
fallopian tube — 70% in the ampulla; 12%, isthmus; 11.1%, fimbria; and
2.4%, interstitium (or cornual region of the uterus). Some ectopic
pregnancies implant in the cervix (<1%), in prior cesarean delivery scars, or
in a rudimentary uterine horn; although these may be technically in the
uterus, they are not considered normal intrauterine pregnancies. About 3.2%
of ectopic pregnancies occur in the ovary, and 1.3% occur in the abdomen.
In the absence of modern prenatal care, abdominal pregnancies can present
at an advanced stage (>28 wk) and have the potential for catastrophic
rupture and bleeding.

With ectopic pregnancy, fertilization occurs as usual in the distal third

of the uterine tube. Immediately after the union of the ovum and the
spermatozoon, the zygote begins to divide and grow normally. Unfortunately,
because an obstruction is present, such as adhesion of the uterine tube from
a previous infection (chronic salpingitis or pelvic inflammatory disease),
congenital malformations, scars from tubal surgery, or a uterine tumor
pressing the proximal end of the tube, the zygote cannot travel the length of
the tube. It lodges at the strictured site along the uterine tube and implants
there instead of in the uterus.

Approximately 2% of pregnancies are ectopic; ectopic pregnancy is the

second most frequent cause of bleeding in early pregnancy. The incidence is
increasing because of the increasing rate of pelvic inflammatory disease,
which leads to tubal scarring. Ectopic pregnancy occurs more frequently in
women who smoke compared to those who do not. There is some evidence
that intrauterine devices (IUDs) used for contraception may slow the
transport of the zygote and lead to an increased of tubal or ovarian
implantation. The incidence also increases following an in vitro fertilization.
Women who have one ectopic pregnancy have a 10% to 20% chance that a
subsequent pregnancy will also be ectopic. This is because salpingitis that
leaves scarring is usually bilateral. Congenital anomalies such as webbing
(fibrous bands) may also be bilateral. Surprisingly, oral contraceptives may
reduce the possibility of ectopic pregnancy.

Although a woman may experience typical signs and symptoms of

pregnancy, the following symptoms are used to help recognize a potential
ectopic pregnancy: Sharp or stabbing pain that may come and go and vary in
intensity. The pain may be in the pelvis, abdomen or even the shoulder and
neck (due to blood from a ruptured ectopic pregnancy gathering up under
the diaphragm); Vaginal bleeding, heavier or lighter than the normal period;
Gastrointestinal symptoms; Weakness, dizziness, or fainting.

At weeks 6 to 12 of pregnancy (2 to 8 weeks after a missed menstrual

period), the zygote grows large enough to rupture the slender uterine tube
or the trophoblast cells break through the narrow base. Tearing and
destruction of the blood vessels in the tube result. The extent of the bleeding
that occurs depends on the number and size of the ruptured vessels. If
implantation is in the interstitial portion of the tube (where the tube joins the
uterus), the rupture can cause severe intraperitoneal bleeding. Fortunately,
the incidence of tubal pregnancies is highest in the ampullar area (the distal
third), where the blood vessels are smaller and profuse hemorrhage is less
likely. However, continued bleeding from this area may in time result in a
large amount of blood loss. Therefore, a ruptured ectopic pregnancy is
serious regardless of the site of implantation.
In treating ectopic pregnancy, Methotrexate may be given, which
allows the body to absorb the pregnancy tissue and may save the fallopian
tube, depending on how far the pregnancy has developed. But if the tube
has become stretched or it has ruptured and started bleeding, all or part of
the fallopian tube may have to be removed. Bleeding needs to be stopped
promptly, and emergency surgery is needed. Laparoscopic surgery under
general anesthesia may be performed. If the ectopic pregnancy cannot be
removed by a laparoscope procedure, then surgical procedures like
laparotomy and salpingectomy may be done.

II. Objectives
General Objective:
The foremost objective of the group is to be able to present the case
study of our chosen client that would provide a broad discussion of the
pathological mechanism of the disease to give significant information for the
case study.

Specific Objectives:
In order to meet the general objective, the group aims to:
• Establish rapport to the patient and the patient’s significant others,
• Explain the related data gathered from the patient and her significant
others,
state past, present and family health history of the patient,
• Present the cephalocaudal assessment obtained from the patient,
• Interpret the laboratory test results of the patient,
• Define the complete diagnosis of the patient,
• Discuss the anatomy and physiology of the organ involved in the
patient’s disease,
• Trace the pathophysiology of the patient’s disease,
• Discuss the nature of the drugs given to the patient,
• Discuss the surgical procedure performed to the patient,
• Present a specific, measurable, attainable, realistic and time-bounded
nursing care plans for the client,
 • Provide the patient and family with proper discharge planning
(M.E.T.H.O.D), and outline
recommendations based on the case study’s findings.

III. Significance of the Study

 Nursing Education
There is a need for us to study Ectopic Pregnancy because this
presents a major health problem for women of childbearing age
especially now that is one of the major causes of bleeding in
pregnancy during the first trimester. It is the result of a flaw in human
reproductive physiology that allows the conceptus to implant and
mature outside the endometrial cavity, which ultimately ends in death
of the fetus. Without timely diagnosis and treatment, ectopic
pregnancy can become a life-threatening situation.

 Nursing Practice
Studying this case is necessary to be able to develop and improve
nursing practice by determining interventions that are effective and
important compared to those that are not important and not helpful for
the client. Interventions may include: Providing a quiet and relaxing
environment; Monitoring vital signs to check for changes of
respirations, pulse rate, temperature and blood pressure--increased or
decreased of vital signs may indicate an abnormality; Assessing for pain
is also important knowing what pain scale she feels wherein 10 is the
 painful; Assessing the vaginal bleeding including the amount and
characteristics to know if she’s suffering from hemorrhage. If so, there
is a need of emergency surgery; blood transfusion and analgesics
should be administer as prescribed by the doctor. Providing emotional
support may help the patient express feelings of grief and fear.

 Nursing Research
Women with ectopic pregnancy may experience several
complications that requires not only medical attention but also nursing
guidance. In this light, this study may be helpful in determining
interventions that will also help nursing research.

IV. Patient’s Profile

Patients Name: “Luningning”
Age: 24
Gender: Female
Birth date: March 22, 1987
Birth Place: Bayambang, Pangasinan
Civil Status: Married
Nationality: Filipino
Religion [Denomination]: Christianity [Roman Catholic]
Husband: “Lunongnong”
City Address: Bayambang, Pangasinan
Nationality: Filipino
Religion [Denomination]: Christianity [Roman Catholic]

V. Patient’s History
a. History of Past Illness

• G4P1
• First Pregnancy
 o Abortion @ 2months (8weeks)
o Missed miscarriage/ Early Pregnancy failure
• Second Pregnancy
o Post Mature—still birth @ 43weeks.
• Third Pregnancy
o NSD
o Child 11 months old @ present
• Fourth Pregnancy (Present pregnancy)
o Ectopic Pregnancy (to be discussed) 3WEEKS.
b. History of Present Illness
• Chief Complaint: Prolonged vaginal bleeding
• Started on January on & off vaginal bleeding
• No consultation done.
• 1 day, consulted at BDH, UTZ done.
• Result: Ruptured Ectopic Pregnancy Right fallopian tube.
• Referred to PPH.
• Abdominal assessment: globular, (+) tenderness all over
• Admission diagnosis: Ruptured Ectopic Pregnancy
• Principal Diagnosis: Ruptured Ectopic Pregnancy
• Principal Operaton: (March 14, 2011) Explore Laparatomy
• Operation Performed: Emergency Pelvic Laparotmy, Right
Salpingectomy
• Received plasma expander (Voluven) 500cc fast drip
• Received 2u properly typed: O+ fresh whole blood
• Received another 2u RBC

c. Family History
 DISEASE MOTHER FATHER

Cardiac Problem  

Diabetes Mellitus  

Meningitis  

Asthma  

Tuberculosis  

Otitis Media  

Hypertension  

Cancer  

VI. Assessment

Body System Methods of FINDINGS SIGNIFICANCE/RE

assessment
 I Pa Pe A MARKS

General Appearance
Expected weakness
Inspect physical
 Appears weak related to the post-
appearance.
op status
Conscious and
Assess behaviour. Normal
 coherent
Assess interactions Cooperative ;
with parents and  interacts well Normal
nurse. with others
Moderate
Assess overall
speech, clear
development and  Normal
voice with
speech.
moderate pace
Vital Signs
Measure blood
  110/70 mmHg Normal
pressure.
Measure pulse rate  66 beats/ min Normal
Measure respiratory
 22 breaths/min Normal
rate.
Measure
36.8⁰C Normal
temperature.
Skin , Hair and Nails
No
swelling/lesions
Inspect and palpate
  noted; skin warm Normal
skin.
to touch with
good turgor
Inspect and palpate Evenly
hair( distribution and   distributed; fine Normal
characteristics) and silky
Inspect and palpate Smooth, convex
nails(texture, shape,   in shape, light Normal
color, condition) pink in color
Head, neck and Cervical Lymph nodes
Inspect and palpate
Normocephalic,
the head(symmetry,
  no lesions are Normal
condition of
visible.
fontanelles)
Symmetric with
an oval
Inspect and palpate appearance, no
  Normal
the face abnormal
movements
noted.
Inspect head control, Full range of Normal
head posture and  motion- up and
 down and
range of motion.
sideways
Inspect and palpate
the neck
No nodules or
( suppleness, lymph
swelling noted,
nodes for swelling, Abnormal
  (+) pain in the
mobility,
nape.
temperature and
tenderness)
Mouth, throat, nose and sinuses
Inspect mouth and
throat( tooth
eruption, condition of
(+) Mouth lesion Improper oral
gums, lips, teeth,  
(gingivitis) hygiene
palpates, tonsils.
Tongue and buccal
mucosa)
Inspect nose and
Smooth and
sinuses (discharge,
symmetrical;
tenderness.  Normal
client reports no
Turbinates[color,swel
tenderness
ling])
Eyes
Bilaterally equal
Inspect external eye. Normal
 in size
Skin on both
Observe for redness,
eyelids is without
swelling or discharge  Normal
redness, swelling
or lesions
or lesion.
Ears
Equal in size
bilaterally; skin is
smooth with no
Inspect external ears  lesions, lumps or Normal
nodules. Color is
consistent with
facial color
Thorax and lungs
Inspect shape of Scapulae are Normal
thorax and symmetric and
respiratory effort  non-protruding.
Shoulders and
scapulae are at
equal horizontal
position.
Respirations are
within normal
range, relaxed,
effortless, and
 quiet
Resonance,
Percuss the lungs  elicits flat tone Normal
over the scapula
Breath sounds
Auscultate for breath clear; No
sounds and  adventitious Normal
adventitious sounds. sounds
auscultated.
Breasts
Inspect and palpate Symmetrical, no
breasts(shape,   discharge or Normal
discharge, lesions) lesions are noted
Heart
Auscultate heart S1 and S2. No S3
 Normal
sounds and S4 noted.
Abdomen
Inspect shape  Symmetry Normal
Abdominal skin is
Observe the paler than the
Normal
coloration of the skin  general skin
tone.
Muskuloskeletal
The edematous area
when held for a few
Assess feet and legs   (+) edema seconds, the
depression rapidly
refills.
Clients appear to
Assess spine and
 be relaxed with Normal
posture
shoulders
Gait is steady:
Assess gait  opposite arm Normal
swings
Client reports no
Assess joints  Normal
pain in her joints
No muscle
Assess muscles
 weakness noted Normal

VII. Laboratory/ Diagnostic

Hematology Report – (March 14, 2011)

Lab Test N.V. A.V. Significance

Performed
 Low. Chronic Blood loss
* This is used to evaluate
1. Hgb F: 120 – 160 60
the hemoglobin content
of erythrocytes.
High. Acute Infection
*The WBC is an indicator
of Immune function of the
2. WBC 5 – 10 x 10⁹/1 15.5
body. Elevation is seen
during the ongoing
infection of inflammation.
Low. Hemorhage;
3. Hematocrit F: 37 – 47 18 *This test is useful in the
diagnosis of anemia.
High. Infection
* A segmenters count is
usually a part of a
peripheral complete
4. Segmenters .50 – .70 .78 blood cell count and is
expressed as percentage
of segmenters to total
white blood cells
counted.
Low. Chronic Infection;
Viral Infection
* A lymphocyte count is
usually a part of a
5. Lymphocyte peripheral complete
.20 – .40 .15
s blood cell count and is
expressed as percentage
of lymphocytes to total
white blood cells
counted.
Normal
* A monocyte count is
usually a part of a
peripheral complete
6. Monocytes .02 – .08 .07 blood cell count and is
expressed as percentage
of monocytes to total
white blood cells
counted.
Normal
7. Platelet 150 – 300 x
289 x 10³/1 *It is used to diagnose
Count 10³/1 bleeding disorders
 Hematology Report – (March 15, 2011)

Lab Test
N.V. A.V. Significance
Performed

Low. Chronic Blood loss

* This is used to evaluate
1. Hgb F: 120 – 160 94
the hemoglobin content
of erythrocytes.
Low. Hemorhage;
2. Hemat
F: 37 – 47 28 *This test is useful in the
ocrit
diagnosis of anemia.

Hematology Report – (March 15, 2011)

Lab Test N.V. A.V. Significance

Performed
 Low. Chronic Blood loss
* This is used to evaluate
1. Hgb F: 120 – 160 83
the hemoglobin content
of erythrocytes.
2. Hematocrit F: 37 – 47 26 Low. Hemorhage;
*This test is useful in the
diagnosis of anemia.

Hematology Report – (March 16, 2011)

Lab Test
N.V. A.V. Significance
Performed

Low. Chronic Blood loss

* This is used to evaluate
1. Hgb F: 120 – 160 103
the hemoglobin content
of erythrocytes.
Low. Hemorhage;
2. Hematocrit F: 37 – 47 31 *This test is useful in the
diagnosis of anemia.

Vitros Clinical Patient Report – (March 15, 2011)

Lab Test
N.V. A.V. Significance
Performed

Normal
*often requested to monitor
kidney function before
Urea 2.5 – 6.1 3.7 mmol/L
starting to take certain
drugs and while taking
them.
Slightly Low
*Creatinine levels are
Creatinine 62. – 106. 61. umol/L
generally lower in
pregnancy

Diagnostics:
• Ultrasound:

Significance: Abnormal
Findings: No
Gestational Sac Noted
VIII. Disease Identity
a. Anatomy and Physiology

Female Reproductive System

The female reproductive system is designed to carry out several functions. It

produces the female egg cells necessary for reproduction, called the ova or oocytes.

Main External Structures

Labia majora: The labia majora enclose and protect the other external
reproductive organs. Literally translated as "large lips," the labia majora are
relatively large and fleshy, and are comparable to the scrotum in males.

Labia minora: Literally translated as "small lips," the labia minora can be very
small or up to 2 inches wide.

Bartholin’s glands: These glands are located next to 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. Like the penis, the clitoris is very sensitive
to stimulation and can become erect

Perineum — A stretch of hairless, sensitive skin that extends from the bottom of
the vaginal opening back to the anus
Internal Organs

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.

Ovaries — A woman normally has a pair of ovaries that resemble almonds in size
and shape. They are home to the female sex cells, called eggs, and they also
produce estrogen, the female sex hormone. Women’s ovaries already contain
several hundred thousand undeveloped eggs at birth, but the eggs are not called
into action until puberty. Roughly once a month, starting at puberty and lasting until
menopause, the ovaries release an egg into the fallopian tubes; this is called
ovulation. When fertilization does not occur, the egg leaves the body as part of the
menstrual cycle.

Uterus — The uterus is located in the pelvis of a woman’s body and is made up of
smooth muscle tissue. Commonly referred to as the womb, the uterus is hollow and
holds the fetus during pregnancy.

 Cervix — The lower part of the uterus, which connects to the vagina, is
known as the cervix. Often called the neck or entrance to the womb, the
cervix lets menstrual blood out and semen into the uterus. The cervix
remains closed during pregnancy but can expand dramatically
during childbirth.
 Ovulation
The ovulation process is important if subsequent fertilization is to take place.
This is an exquisitely timed phenomenon dependent on a host of hormonal
interactions involving a variety of endocrine glands. Tubal function must also
be adequate or the ovum will not be picked up by the fallopian tube to be
fertilized within the ampulla.
 Fertilization
Following ovulation, the ovum with its cumulus oophorus cells are picked up
by the fimbria of the fallopian tube. The ovum has now formed the first polar
body. It remains in the ampulla portion of the tube and is viable for about 18
to 24 hours. If fertilization does not occur, the ovum disintegrates and is
destroyed by the tube. Sperm will remain viable in the female reproductive
tract for about 48 hours, although this can be quite variable. Sperm present
in the ampulla meet the cumulus oophorus mass and penetrate by chemical
and mechanical means to reach the zona pellucida. One sperm penetrates
the zona pellucida, the second polar body is formed, and the nuclear material
of the sperm enters the vitelline membrane. The diploid chromosome number
is re-established, and mitotic cell division can now occur.
 Implantation
After fertilization occurs, the ovum remains in the fallopian tube for about 72
hours. During this time there are several cellular division, but the size of the
fertilized ovum does not increase. Around 72 hours the zona pellucida
fragments and falls away. The ovum enters the uterine cavity for 60 to 72
more hours, and the central cavity begins to form. A definite cell mass is
formed on one side of the blastocyst by the time implantation occurs. The
trophoblast cells burrow into the endometrial stroma to form
syncytiotrophoblast. Primitive amniotic and chorionic cavities begin to form,
and a germ disk is recognizable soon after implantation.
b. Pathophysiology
Precipitating
Predisposing Factors:
Factors:
travelling
24yrs Femal Previous Smoki long No
old e abortion ng Prenatal
distances
Check-
without ups
Presence of resting

Tubal a protein –
scarring or PROKR1 Inability
scars in the to know
uterus from prevents the muscles condition
previous in the walls of the of
operations fallopian tubes from pregnanc
contracting y

Abdominal Blocks or slows the movement of a fertilized Inability

utlrasound findings: egg through the fallopian tube to the uterus to
No gestational sac prevent
identified complica
Fertilized egg attaches to an -tions
Abnormal area outside the uterus
bleeding in the (ampullar region of the
vagina fallopian tube) where it
implants and grows
Sharp stabbing
pain radiating to Tubal
neck and rupture
shoulders

Ectopic Pregnancy hemorrhag

e
 IX. Medical Management, Surgical Management and Nursing Management

a. Drug Study

Side Effects, Adverse Reactions

Name of Drug Mechanism of Action Nursing Interventions
and Contraindications

Generic Name: Category: Side Effects: • Take each dose with a full
Clindamycin Anti-bacterial GI: nausea, vomiting glass of water (decreases
esophageal irritation)
Mechanism of action: Adverse Reactions:
Brand Names: It inhibits protein synthesis in CNS: convulsions (over dosage) • May be taken without regard
Dalacin C susceptible bacteria, causing GI: Severe colitis, including for meals
cell death pseudomembranous colitis, Report S&S of severe
Dosage: diarrhea, abdominal pain, diarrhea and colitis
300mg TID esophagitis, anorexia, jaundice,
hepatic function changes • Monitor BP and pulse after
Route: Hema: Neutropenia, Leukopenia, administration.
Per orem (P.O.) agranulocytosis, eosinophilia • Be alert for signs of
Hypersensitivity: Rashes, utricarial to superinfection and
anaphylactoid reaction anaphylactoid reactions that
require immediate attention.
Contraindications:
• Patient and Family Education:
Hypersensitivity to the drug or
• Complete full course of
lincomycin, tartrazine dye; ulcerative
therapy
colitis/ enteritis
• Report loose stool or diarrhea
(more than 5 loose stools
daily) promptly and do not
self-medicate with anti-
diarrheal preparations.
Generic Name: Category: Side Effects: Assessment:
Mefenamic Acid Non-Steroidal Anti- Upset stomach, nausea, heartburn,
inflammatory Drug dizziness, drowsiness, diarrhea, and • Renal, hepatic, blood studies:
Brand Names: (NSAID), antipyretic BUN, creatinine, Hgb, before
headache may occur. treatment, periodically thereafter
Ponstel
• Pain: note type, duration, location,
Dosage and Route: and intensity with ROM 1 hr after
5oomg 1cap TID Adverse Reactions:
Mechanism of action: GU: nephrotoxicity, renal failure administration
It inhibits prostaglandin Hema: Leukopenia, thrombocytopenia,
synthesis by decreasing agranulocytosis, anemia, • Audiometric, ophthalmic exam
enzyme needed for neutropenia, before, during, after treatment; for
biosynthesis; analgesic, anti- lymphocytosis, eosinophilia, eye, ear problems: blurred vision,
inflammatory, antipyretic pancytopenia, hemolytic tinnitus; may indicate toxicity
anemia
Misc: Anaphylaxis, serum sickness • Fever: temp before and 1 hr after
administration
Contraindications:
Hypersensitivity to cephalosporins • Cardiac status: edema
(peripheral), tachycardia,
palpitations; monitor B/P, pulse for
character, quality, rhythm
especially in patients with cardiac
disease/ elderly

• For history of peptic ulcer

disorder; asthma, aspirin,
hypersensitivity, check closely for
hypersensitivity reactions

Implementation:

• Administer With food, milk, or

antacid to decrease GI
symptoms; however, taking on
empty stomach best facilitates
absorption; if nausea and
vomiting occur/persist, notify
prescriber
Evaluation:

• Therapeutic response:
decreased pain, stiffness in joints;
decreased swelling in joints;
ability to move more easily;
reduction in fever or menstrual
cramping
Generic Name: Classifications: Side Effects/ Adverse Effect: • Substitution of one iron salt for
Ferrous Sulfate Anti-anemic, Iron Constipation, gastric irritation, another without
(FeSO4) nausea, proper adjustment may result in
Action of Drug: abdominal cramps, anorexia, serious over or
Brand Names: Iron is absorbed from the diarrhea, under dosing.
duodenum and upper jejunum • Eggs, milk, coffee, or tea
dark colored stools
by an active mechanism consumed with a meal or 1hr
through the
Contraindications:
Dosage and Route: after may significantly inhibit
mucosal cells where it Hemosiderosis, hemochromatosis, absorption of
200mg 1cap OD
combines with theprotein peptic dietary iron.
transferrin. ulcer, regional enteritis, and • Ingestion of calcium and iron
ulcerative colitis. Hemolytic supplements with
anemia, pyridoxine- food can decrease iron
responsive anemia, and cirrhosis of absorption by one-third;
the liver. Use in those with normal iron absorption is not decreased
iron balance. if calcium
carbonate is used and taken
between meals.
• Do not crush or chew sustained-
release product.
Generic Name: Classifications: Side Effects/ Adverse Effect: • Patients who have asthma,
KETOROLAC aspirin-induced allergy, and
Non-steroidal anti- - CNS: drowsiness, abnormal thinking, nasal polyps are at increased
Brand Names: inflammatory agents, dizziness, euphoria, headache. risk for developing
TORADOL nonopioid analgesics - RESP: asthma, dyspnea hypersensitivity reactions.
- CV: edema, pallor, vasodilation Assess for rhinitis, asthma,
Dosage and Route: Action of Drug: - DERM: pruritis, purpura, sweating, and urticaria.
30mg/1amp IV q 8 x
4dose - Inhibits prostaglandin urticaria • Assess pain (note type,
synthesis, producing - HEMAT: prolonged bleeding time location, and intensity) prior
peripherally mediated - LOCAL: injection site pain to and 1-2 hr following
analgesia. - NEURO: paresthesia administration.
- Also have anti-pyretic and - MISC: allergic reaction, anaphylaxis • Ketorolac therapy should
anti-inflammatory properties. Contraindications: always be given initially by
- Therapeutic effect:Decreased the IM or IV route. Oral
pain. - Hypersensitivity
therapy should be used only
as a continuation of
- Cross-sensitivity with other NSAIDs
parenteral therapy.
may exist¨Pre- or perioperative use
• Caution patient to avoid
- Known alcohol intolerance
concurrent use of alcohol,
 Use cautiously in: aspirin, NSAIDs,
1) History of GI bleeding acetaminophen, or other OTC
medications without
2) Cardio vascular disease consulting health care
professional.
• Advise patient to consult if
rash, itching, visual
disturbances, tinnitus, weight
gain, edema, black stools,
persistent headache, or
influenza-like syndromes
(chills, fever,muscles aches,
pain) occur.
• Effectiveness of therapy
can be demonstrated by
decrease in severity of pain.
Classification: Side Effects: • Report loose stools or
Generic name: Antibiotic CNS: headache, dizziness,lethargy, diarrhea promptly.
cefuroxime paresthesias, • Report any signs
Action of the Drug: GI: n/v, diarrhea, anorexia, abd.pain, or symptoms of hypersensitivity.
Brand name: Bactericidal; inhibits synthesis flatulence, hepatotoxicity • Do not breast feed while
Ceftin of bacterial cell wall, causing GU: nephrotoxicity taking this drug.
cell death. Hypersensitivity: serum sickness • Determine history of
reaction hypersensitivity reactions to
Dosage: Local: pain, abscess at injection site, cephalosporin, penicillin, and
750mg. phlebitis history of allergies, particularly
IVq8h Other: disulfiram-like reaction with to drugs, before therapy is
alcohol initiated.
Route:
• Monitor I&O rates and
Oral (P.O)
pattern.
Adverse Effects:
GI: pseudomembranous colitis
Hematologic: bone marrow depression
Hypersensitivity: anaphylaxis
Other: superinfections,

Contraindications:
Contraindicated with allergies to
sulfonamides, celecoxib, NSAID’s, or
aspirin, significant renal impairment;
 perioperative pain post CABG surgery;
pregnancy (3rd trimester), lactation.
Use cautiously with impaired hearing,
hepatic and CV conditions.

Brand name: Action of the Drug: Side Effects: • Assess patient for epigastric or
Zantac Inhibits the action of histamine CNS: h/a, abdominal pain and frank or occult
at the H2 receptor site located CV: tachycardia, bradycardia, PVCs blood in the stool, emesis, or gastric
Generic name: primarily in gastric parietal (rapid IV administration) aspirate.
ranitidine cells, resulting in inhibition of Dermatologic: alopecia • Nurse should know that it may
gastric acid secretion. GI: Constipation, diarrhea, Nausea & cause false-positive results for urine
Dosage: vomiting, abdominal pain protein; test with sulfosalicylic acid.
50mg q8h Classification: GU: gynecomastia, impotence or • Inform patient that it may cause
Anti-ulcer agents decreased libido drowsiness or dizziness.
Route: H2 antagonist Local: pain at IM site, local burning or • Inform patient that increased fluid
Intravenous (IV) itching at IV site and fiber intake may minimize
constipation.
Adverse reaction • Advise patient to report onset of
CNS: malaise, dizziness, drowsiness, black, tarry stools; fever, sore
somnolence, insomnia, vertigo throat; diarrhea; dizziness; rash;
Dermatologic: Rash confusion; or hallucinations to
GI: hepatitis, increased ALT levels. health care professional promptly.
Hematologic: leukopenia, • Inform patient that medication
granulocytopenia, may temporarily cause stools and
thrombocytopenia,pancytopenia tongue to appear gray black.
Other: arthralgias

Contraindications:
• Contraindicated with allergy to
Ranitidine, lactation
• Use cautiously with impaired
renal or hepatic function,
pregnancy

GENERIC NAME: CLASSIFICATIONS: SIDE EFFECTS/ADVERSE EFFECT: •Do not drink alcohol (beverages or
metronidazole Amoebicides & CNS: fever, vertigo, headache, ataxia, preparations containing
Antiprotozoals dizziness, syncope, incoordination, alcohol,cough syrups) for 24-72◦ of
BRAND NAMES: confusion, irritability, depression, drug use;severe reactions may
Flagyl ACTION OF DRUG: weakness, insomnia, seizures, occur.
Bactericidal; Inhibits DNA peripheral neuropathy
DOSAGES & ROUTE: synthesis CV: flattened T wave, edema, flushing, •Your urine may be a darker color
500mg thrombophlebitis after I.V. infusion than usual; this is expected.
I.V. q 8◦ GI: unpleasant metallic taste, anorexia,
nausea & vomiting, diarrhea, GI upset •Refrain from sexual intercourse
cramps during treatment for trichomoniasis,
GU: dysuria, incontinence, darkening of unless partner wears condom.
urine
LOCAL: thrombophlebitis (I.V.), •You may experience these side
redness, burning, dryness, and skin effects:dry mouth w/ strange
irritation metallic taste (frequent mouth care,
HEMATOLOGIC: transient leukopenia, sucking sugarless candies may
neutropenia help); nausea, vomiting,
MUSKULOSKELETAL: fleeting joint diarrhea(eat frequent small meals)
pains •Report severe GI upset, dizziness,
RESPIRATORY: upper respiratory tract unusual fatigue, or weakness, fever,
infection chills.
SKIN: rashes

CONTRAINDICATIONS:
•Contraindicated w/ hypersensitivity
to metronidazole, pregnancy, (do not
use for Trichomoniasis in first
trimester)
•Use cautiously w/ CNS diseases,
hepatic diseases, candidiasis
(moniliasis), blood dyschasias,
lactation
Generic Name: Classification: Side effects: • Assess usual bowel patterns.
BISACODYL Laxatives Upset stomach, diarrhea, intestinal
irritation • Don’t give if client has
abdominal pain.
Brand Name: Action of the Drug:
BUSCOPAN It works by stimulating enteric Adverse effects: • Use other methods to relieve
nerves to cause colonic mass Abdominal pain, cramping, perineal constipation where possible.
movements. It is also a irritation, excessive bowel activity
Dosage: contact laxative; it increases • Provide comfort measures.
10mg ( 1 suppository fluid and NaCl secretion.
daily rectally) Action of Bisacodyl on small Contraindications:
• Carefully monitor the I&O
intestine is negligible; Hypersensitivity rectal fissures,
when patient is receiving tube
stimulant laxatives mainly abdominal pain, nausea, vomiting,
feedings.
Route: promote evacuation of the appendicitis, acute surgical abdomen,
Rectal (suppository) colon. ulcerated haemorrhoids, acute
hepatitis, fecal impaction, intestinal,
bilary tract obstruction
 b. Surgical Management
i. Exploratory Laparotomy

ii. Salphingectomy

Exploratory Laparotomy

-this was done to the patient because she suffered from ectopic pregnancy

-since the patient had an ectopic pregnancy in her abdomen they used
laparotomy to explore the cause of preoperative symptoms

-using this surgical treatment there are normal results in reasons why
exploratory laparotomy is performed. The procedure may indicate further
treatment if necessary.

-various diagnostic tests maybe perform to determine if exploratory laparotomy

is necessary. Example of this is CT Scan, X-ray, MRI. Also the presence of
intraperitoneal fluid maybe an indication that laparotomy is necessary.

Salphingectomy

- An operation to removed fallopian tube.

-performed Salphingectomy as an emergency procedure because the patients

fallopian tube has ruptured.

- this operation is most frequent indication for ectopic pregnancy.

 c. Nursing Care Plan
NURSING
ASSESSTMENT INFERENCE PLANNING RATIONALE EVALUATION
INTERVENTIONS
Problem: STO: Independent: STO:
Risk for infection Surgical incision After 30 mins - assess patients - to identify and assess Goal met. Patient
↓ health teaching, perception, level of different interventions was able to
Subjective: Broken skin patient will be understanding and to be done identify 3 out of 5
“may tahi ako sa ↓ able to identify 3 needs - fever may indicate ways to reduce
tiyan” as Open wound, out of 5 ways to - assess v/s especially infection risk for infection.
verbalized by the possibility of reduce risk for temperature - serves as first line of
patient microorganisms infection - emphasize defence
to enter. importance of hand - regular wound
↓ washing dressing facilitates
Objective: Risk for - maintain aseptic faster wound healing
-dry and intact infection technique when and drying of wounds LTO:
wound dressing LTO: changing dressing / - wet area can be Goal met. Patient
During the course wound care lodge area of bacteria did not manifest
Nursing of confinement, - to impart to patient any signs of
Diagnosis: patient will not - keep area around when the wound infection during
Risk for infection manifest any wound clean and dry become infected and the course of
related to signs of infection. - discuss to patient the when to sought confinement.
surgical incision signs of infection medical care
- premature
discontinue of
- emphasize necessity treatment when client
of taking antibiotics as feels well may result in
ordered return of infection
- to know if the patient
really understand the
- demonstrate and proper principle of
allow return wound care
demonstration of
wound care - to prevent infection

Dependent:
- administer antibiotic
medication
Problem: STO: Independent: STO:
Post-op pain Surgical incision After 4 hours of - assess patients - to identify and assess Goal partially met.
↓ nursing perception, level of different interventions Patients
Complex intervention, understanding and to be done perception of pain
Subjective: responses of patients needs - to assess the was lessen but
“medyo masakit nerve endings perception of pain - obtain clients effectiveness of the with a pain scale
pa yung sa may due to trauma will be lessen as baseline v/s including intervention and for of 4/10.
tahi ko” ↓ evidence by pain pain scale baseline data for
As verbalized by Hypersensitivity scale of 3/10. future use
the patient. of central - encourage clients - because pain is high
nervous system verbal report during subjective
↓ and after intervention LTO:
Objective: Unpleasant LTO: - positioning the client - to provide comfort Goal met.
- pale and weak physical and After 8 hours of where she is Patient did not
in appearance emotional nursing comfortable - to divert clients complain of pain
- (+) facial responses intervention, - teach client attention from pain higher than pain
grimace ↓ patient will not diversional activities scale of 3/10
- pain scale of 5 pain complain of pain - to prevent bleeding
(10 as the higher than the - instruct client to
highest) pain scale of 3/10. avoid strenuous
exercise
- alleviate pain
Dependent:
- administer
Nursing analgesics as ordered
Diagnosis:
Acute pain
related to
surgical incision
as manifested by
pain scale of
5/10.
Problem: Environmental STO: Independent: STO:
Inadequate sleep factors Within the shift, - assess sleep pattern - sleep disturbances Goal met. Patient
(government patient will have disturbances that are can affect the recovery verbalized
hospital setting: an improvement associated with of patient enhancement of
Subjective: 2patients per in sleep pattern environment sleep pattern and
“hindi ako bed) as evidence by - observe and obtain -to determined usual appeared rested
makatulog ↓ verbalization of feedback regarding sleeping patterns and within the shift.
masyado sa iyak External factors enhancement in sleeping pattern, if there are any
ng mga baby at (crying babies sleep pattern and bedtime routine and changes/improvement
mayat-maya and nurses’ rested hours of sleep s
minomonitor frequent appearance -do as much care as
ako” as monitoring of possible without -to avoid disturbances
verbalized by the vital signs) waking the patient and and to maximize sleep
patient. ↓ do as much care as and rest of the patient
Inability to sleep possible when patient
↓ is awake
Objective: Inadequate -explain the
- weak in sleep importance of -to minimize
appearance monitoring v/s and complaints and for
- yawning care when hospitalized patient to understand
-presence of eye the care being done to
bags her
-restless

Nursing
Diagnosis:
Disturbed
sleeping patterns
related to
therapeutic
purposes and
other generated
awakening as
manifested by
restlessness and
presence of eye
bags
Problem: Ruptured Short term Independent: STO:
ectopic objective:
Anemia pregnancy -Monitor vitalsigns, -to evaluate degree of Goal met.
After 1 hour of heart sounds, and inadequacy of tissue
↓ nursing cardiac rhythm perfusion After 1 hour of
Interventions, the nursing
Objective: Emergency client will -measure capillary -to note degree of interventions, the
- (+) pale & weak laparotomy and verbalize refill then palpate for impairment client verbalized
in appearance salpingectomy understanding of presence or absence understanding of
conditions, and quality of pulses conditions, therapy
- Hgb Count of ↓ regimens, and
therapy regimens, -Perform assistive or
103 Profuse blood and when to active ROM exercises when to contact
loss contact health -to maximize tissue health care
- edema present perfusion provider.
care provider. -encourage early
on the legs and ↓
feet ambulation when -enhances venous
Anemia possible return
Long term -discourage sitting or LTO:
Objective: standing for long Goal not met.
Nursing
Diagnosis: After 8 hours of periods,wearing -to maximize tissue
After 8 hours of
nursing constrictive clothing or perfusion
“ Inadequate crossing legs nursing
intervention, the intervention, the
Tissue Perfusion
client will -elevate the legs when client still exhibits
related to
demonstrate sitting but avoid sharp decreased tissue
decreased
increased angulation of the hips perfusion as
hemoglobin
perfusion as or knees evidenced by
concentration in
evidenced by
the blood as -to maximize tissue presence of
absence of edema edema.
manifested by perfusion
paleness and
weakness
X. Discharge Summary (METHODS)
Medications

· Instruct client to continue take her prescribed medications

· Orient the client about the name of drugs, their actions, the exact
dosage, the frequency and the route of administration.

· Instruct client to follow the instruction when administering medication.

· Advice the significant others not to leave the client during medication

· Explain to the client the side effects and adverse effects of the drugs she
takes by

prescribing its manifestations.

· Advice client not to stop intake of prescribed medications, unless

approved by the

physician.

Exercise

· Instruct client to balance activities with adequate rest periods.

· Educate client on proper body mechanics to prevent muscle strain and

enable client to

relax.

· Encourage client to ambulate and assume normal activities

· Encourage deep breathing exercise

Treatment

· Educate client the importance of drug compliance.

 · Discuss to the client the complication of the condition because
knowledge about the

condition supports learning that will decrease deficit and anxiety.

· To promote healing, eat a balanced diet rich in fresh fruits and

vegetables.

Hygiene

· advise client to keep incision sites clean and dry.

· advise client not to douche or put anything in your vagina, such as a

tampon, until your doctor tells them otherwise.

· Encourage client to do daily hygiene

· Encourage client to ask assistance if needed

Outpatient orders

-advise client to Call the doctor if any of the following occurs:

· Develop a fever.

· Become dizzy and faint.

· Experience nausea and vomiting.

· Become short of breath.

· Have heavy bleeding.

· Have leakage from the incision or the incision opens up.

· Have pain when you urinate.

· Have swelling, redness, or pain in your leg.

· Have questions about the procedure or its result.

Diet

· To promote healing, eat a balanced diet rich in fresh fruits and

vegetables. Depending on

how much blood loss occurred during surgery, you may require a daily
iron supplement.

· Eat high-fiber foods, drink plenty of water, and if necessary, use stool
softeners.

· Instruct client to eat foods that are high in protein and vitamins and
minerals.

Bibliography

Pillitteri, Adele. 2007. Maternal and Child Health Nursing: Care for the
Childbearing
and Childbearing Family, ed. 5. Philippines: Lippincott Williams and Wilkins.

Abarquez, et. al. (2006) A Case Study on Ectopic Pregnancy. Ateneo de Davao
University College of Nursing.

Weber and Kelley (2007) Health assessment

Doenges, Moorhouse, Geissler-Murr (2004) Nurse’s Pocket Guide 9th edition

Palma, Oseda (2009) G&A notes

Lippincott and William’s 2011 Drug Guide

http://www.scribd.com

http://www.smokersworld.info

http://www.nursingcrib.com

http://www.americanpregnancy.org/pregnancycomplications/ectopicpregnancy.html

http://www.wrongdiagnosis.com/e/ectopic_pregnancy/stats-
country.htm#extrapwarning

http://www.medterms.com/script/main/art.asp?articlekey=9809
http://www.medcompare.com/jump/750/ectopic_pregnancy.html

http://en.wikipedia.org/wiki/Ectopic_pregnancy

http://www.ectopicpregnancy.net/resources_physicians.html

http://www.pregnancy.com.ph/ectopic_pregnancy.htm