INSTITUTE OF NURSING

Morayta, Manila

Case Study
(Ectopic Pregnancy)
Presented by :
BSN122
GROUP 87 - A
Avestruz, Jose Vincente T.
Gratuito, Rachel S.
Jacinto, Arvie D.
Jornacion, Catrisha Elaine T.
Macaballug, Katrina B.
Maningding, Marvic S.
•
•
•Biographic Data
Name: Mrs. SR
Address: Baliuag, Bulacan
Age: 34 yrs. old
Gender: Female
Religious Affiliation: Catholic
Marital Status: Married
Occupation: Housewife
Room and Bed #: 301
Chief Complaint: Bleeding
Provisional Diagnosis: Ectopic Pregnancy
Attending Physician: Dr. E. Bugay
 •
•
•
•
•Nursing History
Past Health History
According to the client, she can remember some of her childhood illnesses
but not all. She did recall she had chickenpox, measles and typhoid fever with
unremembered medications taken. She certainly verbalized that he has no
complete immunization, “di pa naman uso noon”. The patient enumerated her
allergies on drugs such as antibiotics particularly Clindamycin; and in some
NSAIDs such as Ibuprofen. She is also allergic to seafoods. She described her
allergies on dermal reactions such as rashes. She manages her allergies with
antihistamines. There’s no previous or any major accident encountered by the
patient except for some common minor injuries such as burns. Her past
hospitalization was 2002 when she was diagnosed with cyst in her left breast.
Procedure done to remove the cyst, but treatments were unrecalled during the
said hospitalization. The patient is not using any medications prior to
confinement. The patient has no foreign travel yet.
 •
•
•
•
•
•History of Present Illness
January 8, 2010, 4am, prior to admission, the patient
experienced bleeding after using the comfort room. The patient
was already predetermined that her current pregnancy is
complicated after her first bleeding during the 2nd week of her
pregnancy. Before confinement, she is already 6 weeks pregnant.
Thus, last January 8, she already consulted her OB-Gyne and
hence confined.
 •
•
•
•Obstetric History
Mrs. SR has an obstetric score of G3P2 (0-2-0-1) before she was
admitted in the hospital. On the date of interview, the client’s OB
score then was G3P2 (0-2-1-1) . According to the client, in 2002, her
first baby was 5 months and 14 days or approximately 21 weeks
was terminated because of complication – the baby died inside
the uterus. But the traumatic death of their first baby was
consigned to oblivion when they welcome their 8 month old baby
boy – second pregnancy – now alive, healthy and well on April
2006. Last December 2009, she discovered that she was
pregnant but later detected to be ectopic, thus, undergone Gyne-
Lap which led to termination of her pregnancy to prevent further
complications.
•Family History
•
•
•Patterns of Functioning
I.Psychological Health
Coping Patterns
According to the client in terms of coping patterns, “Sa akin naghahanap
ako ng something to look forward to yung tipong magpapaka-busy ako para
hindi ko masyado maisip yung nangyari sa dapat kong magiging baby. Sa
March nga may training ako eh.” The client always makes her busy so that she
cannot be depressed whenever she is alone.
Interaction Patterns
According to the client, she interact with her friends and family by always
keeping in touch and she always make sure that she is updated with her family
and friends. And prayer is one of her interaction not only to her family but also
to God.
Cognitive Patterns
According to the client, she is a college graduate and work as a researcher
and instructor before but after she had her 1st alive child she decided to
become a fulltime housewife.
 Self-Concept
When we asked her about self concept, she said that she always think
positive and she wanted to be more productive to have a happy family because
in what she had experienced before in her 1st pregnancy she wanted to be more
productive until now.
Emotional Patterns
According to the client, whenever she encounters a problem, her
husband talks about it. She is very vocal in her feelings so every time they have
problems in their family, she confronts her husband to solve it immediately. And
when she is alone, she always cry because of what happened to her 1st and 3rd
pregnancy and she said that she always remember it, so she wants to make
herself busy and pre-occupied as much as possible.
Sexuality
According to her, they don’t used any family planning methods because
she said that she had waited such a long time to be pregnant and she always
wanted to have a baby again but there’s always complication whenever she got
pregnant. “Hirap nga ako magkaroon ng baby kaya di na kami gumagamitnun.”
When we asked her if how many times they do sexual contact she said 1-2
times a week with a smile in her face.
 Family Coping Patterns
According to her she always have time with her child and husband. She
said that they have an excellent bonding within their family and she always
make sure about that.

Analysis and Interpretation:

In her psychological health, there is no problem in any of the given patterns
and from the information she had given.
Each person has certain psychology needs, such as the need for love,
security, and self-esteem, which must be met to maintain psychological
homeostasis. When one or more of these needs is not met or threatened,
certain coping mechanisms are activated to protect the person and provide
psychologic homeostasis. Psychologic homeostasis is acquired or learned
through the experience of living and interacting with others. In addition societal
norms and culture influence behavior.

Reference: Kozier and Erb’s Fundamental of Nursing, 7th edition, p. 189-

190
 I.
II.
III.Socio-Cultural Patterns
Significant Relationships
According to her, she always has time in her child and
husband. And in terms of her family and friends she always keeps
in touch.
Recreation Patterns
For the client, she always plays with her child. Surfing the
internet or movie marathon is her daily activities to make her busy.
Environment
She said that she is not sociable with other people because
her trust has to be gained first. She just can mingle to those
people who are close to her like her family and friends.
Economic
According to the client, her husband is the only one who works
for them and she said that the salary of her husband is just
enough for their family.
 Analysis and Interpretation:
In her socio-cultural patterns, she can socialize with her significant others
and she makes sure that she has time with her child and husband. But with
other people who is not close to her she cannot mingle with them so easily
because her trust has to be gained first before she immerse herself to others
and it is one of the problems about social wellness.
Social wellness is the ability to interact successfully with people and within
the environment of which is person is a part, to develop and maintain intimacy
with significant others and environmental wellness is the ability to promote
health measures that improve the standard of living and quality of life in the
community.
Reference: Kozier and Erb’s Fundamental of Nursing, 7th edition, p. 172-
173
 I.
II.
III.
IV.Spiritual Patterns
According to her, she is a Roman Catholic but she is not the person who
always goes to church every Sunday. But she said that she prays everyday and
that is her way of communication to God. She prays the rosary because it is
one of showing her faith to God.

Analysis and Interpretation:

In her spiritual pattern, she said that she is not the person who goes to
church every Sunday but she make sure that she always pray everyday.
Spiritual health is manifested by a feeling of being “generally alive,
purposeful, and fulfilled” (Ellison 1983, p. 332). According to Pilch (1988),
spiritual wellness is “a way of living, a lifestyle that views and lives life as
purposeful and pleasurable, that seeks out life-sustaining and life-enriching
options to be chosen freely at every opportunity, and that sinks its roots deeply
into spiritual values and/or specific religious beliefs” (p. 31).

Reference: Kozier and Erb’s Fundamental of Nursing, 7th edition, p. 996

 Activities of Daily Living
Nutrition
Before Hospitalization:
According to the client, she eats a balanced diet although she highly prefer
eating vegetables. She also loves to eat junk foods and drink sodas. She
verbalized, “kumakain naman ako ng gulay parati pero mahilig talaga ako
kumain ng mga junk foods ganyan, mga soda, di ko talaga maiwasan yun,
kadalasan snacks kojunk foods.” When asked how often she drinks sodas,
she verbalized, “mga 4-5 times a week siguro.” She usually eats 3x a day
(breakfast, lunch and dinner) and also eats snacks during afternoon and has a
good appetite. The client also added that she drinks 5-6 glasses of water
everyday.
During Hospitalization:
The client was ordered by her doctor to have a low salt diet during the first day
after her surgery. According to her, her eating habits gradually changed during
her hospitalization because her appetite was partially lost although her water
intake has still the same amount which was 5-6 glasses. Her typical diet was
back to normal at the 2nd day after her surgery.
Interpretation and Analysis
•The client's variety of her food has changed during her hospitalization. This
was due to her condition which requires her to have a low salt diet while she
was admitted in the hospital. Her appetite also changed because of her
condition.
•Alterations in the client’s diet are often needed to treat a disease process, to
prepare for a special examination or surgery, to increase or decrease weight, to
restore nutritional deficits, or to allow an organ to rest and promote healing.

( Fundamentals of Nursing by Kozier and Erb vol. 2 p. 1260)

 Elimination
Before hospitalization
According to the client, she has a normal bowel movement and defecates
everyday without any difficulties. Semi-solid and aromatic in odor, brown in
color and formed. She verbalized, “araw-araw ako dumudumi wala akong
problema pagdating don.” When asked about how often she voids in one day,
she verbalized, “ mga 6 times siguro, mahina kasi urine retention ko eh kaya
kahit uminom lang ako ng konti naiihi na kaagad ako.” Light yellow in color and
faint aromatic in odor.
During hospitalization
The client was not able to defecate since she was not ambulatory at the
first 2 days after her operation; she verbalized “ after ako inoperahan, hindi ako
dumumi noon for two days kasi di ako ambulatory, ngayon pa lang ako ulit
nakadumi”, said on her third day after her surgery. She also voids 5-6 times a
day and experience pain in her abdomen when urinating because of her
surgery.
Interpretation and Analysis
•Although the client’s urinating habits stayed the same, her defecation habits
has changed when she was hospitalized. This may be due to her condition
after her surgery because she experiences pain in her abdomen.
•
•Early bowel training may establish the habit of defecating at a regular time.
Many people defecate after breakfast, when the gastro colic reflex causes
mass peristaltic waves in the large intestine.
(Fundamentals of Nursing by Kozier and Erb vol. 2 p. 1327)
•
•Clients who experience discomfort when defecating often suppress the urge
to defecate to avoid pain. Such clients can experience constipation as a result.
Clients taking narcotic analgesics for pain may also experience constipation as
a side effect of the medication.
(Fundamentals of Nursing by Kozier and Erb vol. 2 p. 1327)
 Exercise
Before hospitalization
The client does not perform any kinds of exercises. She
verbalized, “ nako wala akong exercise, mga gawaing bahay lang
ganun o kaya pag hinahabol ko yung anak ko pag makulit, yun na
siguro ang pinaka-exercise ko. “

During hospitalization
The client does not perform any kind of exercises although she
was able to get up from her bed at the 3rd day after her surgery.
Her movements were just light, gradual and limited.
Interpretation and Analysis
•The client’s movement changed and become limited because of her
insufficient strength brought by her surgery.
•
•Limitations to movement may be medically prescribed for some health
problems. Bed rest may be a therapeutic choice for certain clients, for example,
to relieve edema, to reduce metabolic and oxygen needs, to promote tissue
repair, or to decrease pain.
(Fundamentals of Nursing by Kozier and Erb vol. 2 p. 1117)
 Hygiene
Before hospitalization
According to the client, she describes her hygiene “5 Star”. She usually
takes a bath twice a day (at morning and at night). She uses deodorant for her
underarms. When asked how many times she brushes her teeth, she
verbalized, “usually 3x a day eh pero pag may nakain akong matamis nag-
bubrush ako after, so minsan more than 3”.

During hospitalization
The client was not able to take a bath since she was not ambulatory. But
her mother-in-law sponge gives her a spongebath. She verbalized, “ for the last
2 days hindi pa ko nakakaligo kasi nakahiga lang ako, pero ini-spongebath
naman ako ng mother-in-law ko.” According to her, she brushes her teeth twice
a day during hospitalization.
Interpretation and Analysis
•The client was not able to take a bath because of she was not ambulatory.
She will be needing assistance if she would like to take a bath.
•
•Clients whose cognitive function is impaired or whose illness alters energy
levels and motivation will usually need more assistance.
(Fundamentals of Nursing by Kozier and Erb vol. 1 p. 743)
 Substance Abuse
The client does not have any vices like smoking, drinking alcoholic
beverages and taking drugs before and during hospitalization.
 Sleep and Rest
Before Hospitalization
According to the client, she usually has 8-10 hours of sleep, satisfied and
without interruptions. She verbalized that she usually sleeps at 10-11PM and
wakes up at 8AM. She also took nap in the afternoon with her son.

During hospitalization
The client has the same amount of sleep during hospitalization but she is
not satisfied with the quality because she was usually interrupted due to vital
signs monitoring and giving of medications.
Interpretation and Analysis
•The client was not able to get a normal and satisfied amount of sleep during
her hospitalization.
•
•Environment can promote or hinder sleep. Any change- for example, noise in
the environment can inhibit sleep. Noise is a major disturbance in the hospital
setting, making it difficult for the clients to sleep. Clients are often awakened
early for obtaining lab specimens, weights, assessments, and medication
administration.
( Fundamentals of Nursing by Kozier and Erb vol. 2 p. 1170)
 Sexual Activity
Before hospitalization
According to the client, she and her husband performs sexual intercourse
up to twice a week usually at weekends only. She verbalized “Sa weekends
lang kasi nagkakaron ng time yung husband ko kasi masyado syang busy sa
trabaho nya as a call center manager. Pag umuuwi sya from work parati na
syang pagod.”

During hospitalization
The client does not have any sexual encounter during her hospitalization.
Interpretation and Analysis
•There was an absence of sexual activity between the client and her husband.
This is because of the change in their environment like the hospital setting and
also because of the client’s condition.
•
•Health factors can interfere with the people’s expression of sexuality. Physical
changes brought on by illness, injury, or surgery may inhibit full sexual
expression.
(Fundamentals of Nursing by Kozier and Erb vol. 2 p. 1028)
Physical Assessment
Physical Assessment Findings
Name of Client: Mrs. SR
Age: 34 y/o

Vital signs
Temperature: 36.2 degrees Celsius
Pulse Rate: 65 bpm
Respiratory Rate: 23 cpm
Blood Pressure: 100/70 mmHg
 GENERAL SURVEY
ASSESSMENT NORMAL FINDINGS ACTUAL FINDINGS INTERPRETATION/
ANALYSIS
Body built, height, and
 Proportionate, varies with No data available
weight in relation to lifestyle and age
client’s age, (Fundamentals of nursing
by kozier and erbs 8th
edition p.572)

Posture and gait,

 Relaxed, erect posture,
standing, sitting and coordinated movement
walking (Fundamentals of nursing
by kozier and erbs 8th
edition p.572)
She has a relaxed erect
posture, coordinated
movement

Overall hygiene and

 Clean, neat Her hygiene and grooming
grooming (Fundamentals of nursing is clean and neat
by kozier and erbs 8th
edition p.572)

Body Odor and breath No body odor; no breath She has no body odorand
odor in relation to activity odor no breath odor
level. (Fundamentals of nursing
by kozier and erbs 8th
edition p.572)
Signs of distress in posture No distress noted
 There is a sign of distress and There is distress and
or facial expression (Fundamentals of nursing by she has facial expression facial expression it is
th
kozier and erbs 8 edition due to pain being felt
p.572)
Healthy appearance The client looks healthy
Signs of health or illness
 (Fundamentals of nursing by
kozier and erbs 8th edition
p.572)
Attitude
 Cooperative She is cooperative.
(Fundamentals of nursing by
kozier and erbs 8th edition
p.572)
Mood; appropriateness of
 Appropriate to situation Her mood is appropriate in
responses (Fundamentals of nursing by the situation. Smiley face
kozier and erbs 8th edition
p.572)
Quantity of speech, quality Understandable, moderate
 Her quality and
and organization and pace, exhibits thought quantity of speech is
functions of vagus nerve association in moderate pace and
(Fundamentals of nursing by understandable.
kozier and erbs 8th edition
p.572)

Relevance and organization Logical sequence; makes

 The relevance and
of thoughts sense; has sense of reality organizations of her thought
(Fundamentals of nursing by is in logical sequence and in
kozier and erbs 8th edition the sense of reality
p.572
VI. Course in the Ward
•
•Laboratory and Diagnostic Examination Results
HEMATOLOGY
February 5, 2010
Procedure SI SI Traditional Interpretation and
Analysis

Hematocrit 0.47 M= 0.42-0.54 M= 42-54 vol % There is an increase

F= 0.36-0.46 F= 36-46 vol % level of hematocrit.
*A high hematocrit may
reflect an absolute
increase in the number of
erythrocytes, or a decrease
in plasma volume, in
conditions such as:
Severe dehydration –
e.g. in case of burns,
diarrhea or excessive
use of diuretics
Erythrocytosis –
excessive red blood
cell production
Polycythemia vera –
abnormal increase of
blood cells
Hemachromatosis – an
inherited iron
metabolism disorder

Hemoglobin 152 M= 140-180 g/L M= 14-18 g% Normal

F= 115-160 g/L F= 11.5-16 g%

WBC 7.9 5-10 x 10 g/L Normal

RBC 4-10 x 10 g/L
Platelet count 140-130 x 10 g/L
Reticulocyte 5-15 x 10.3 mm
Different Count
Segmented Granulo 0.46 0.36-0.70 36-70 %
Lymphocytes 0.50 0.22-0.44 22-40 % There is an
increase level of
lymphocytes.
* A high lymphocyte
count is defined as an
absolute lymphocyte or
lymphocytosis. The most
common cause of
lymphocytosis is
infection, usually a
viral infection.

Eosinophils 0.02 0.01-0.04 1-4 % Normal

Monocytes 0.00-0.06 0-6%
Band Granulocytes 0.02 0.02-0.05 2-5 % Normal
0-1 %

Bleeding time 2’ 25” 1-5 minutes 1-5 minutes Normal

Closing time 3’ 30” 2-5 minutes 2-5 minutes
HEMATOLOGY
February 8, 2010

Procedure SI SI Traditional Interpretation

and Analysis
Hematocrit 0.40 M= 0.42-0.54 M= 42-54 vol %
F= 0.36-0.46 F= 36-46 vol %

Hemoglobin 130 M= 140-180 g/L M= 14-18 g%

F= 115-160 g/L F= 11.5-16 g%

WBC 5-10 x 10 g/L

RBC 4-10 x 10 g/L
Platelet count 140-130 x 10
g/L
Reticulocyte 5-15 x 10.3 mm
Different Count
Segmented 0.36-0.70 36-70 %
Granulo
Lymphocytes 0.22-0.44 22-40 %
Eosinophils 0.01-0.04 1-4 %
Monocytes 0.00-0.06 0-6%
Band 0.02-0.05 2-5 %
Granulocytes 0-1 %

Bleeding 1-5 minutes 1-5 minutes

time
Closing time 2-5 minutes 2-5 minutes
Medications
Brand Name : 150 mg twice H2 antagonist used to treat Hypersensitivity - chest pain and Assess patient for
Zantac daily. and prevent , Cross- fever epigastric or
Generic Name: ulcers in the sensitivity may - easy bruising or abdominal pain and
Ranitidine stomach and occur; some oral bleeding, unusual frank or occult
intestines. It liquids contain weakness blood in the stool,
also treats alcohol and - fast or slow emesis, or gastric
conditions in should be heart rate aspirate.
which the avoided in - Confusion, Inform patient that
stomach produces patients with dizziness, it may cause
too much acid, known drowsiness, drowsiness or
such as intolerance. hallucinations, dizziness
Zollinger-Ellison headache Inform patient that
syndrome. - nausea, stomach increased fluid and
Ranitidine also pain, low fever, fiber intake may
treats loss of appetite, minimize
gastroesophageal dark urine, clay- constipation.
reflux disease colored stools, Advise patient to
(GERD) and other jaundice report onset of
conditions in black, tarry stools;
which acid backs fever, sore throat;
up from the diarrhea; dizziness;
stomach into the rash; confusion; or
esophagus, hallucinations to
causing health car
heartburn. professional
promptly.
Inform patient that
medication may
temporarily cause
stools and tongue to
appear gray black.
Brand Name: Adults: Two Anti-emetics Dyspeptic symptomGI hemorrhage, Allergic
domperidone tablets (20 mg) 3 complex mechanical reactions, such as
Generic Name: to 4 times per associated w/ obstruction or rash or urticaria,
motilium day, 15 to 30 delayed gastric perforation; in have been
minutes before emptying, GERD, patients w/ reported.
meals and, if esophagitis eg prolactin- Abdominal cramps
necessary, before epigastric sense releasing have been
retiring. of fullness, pituitary tumor reported.
early satiety, (prolactinoma).
feeling of Known
abdominal intolerance to
distension, upper the drug.
abdominal pain;
bloating,
eructation,
flatulence;
heartburn w/ or
w/o
regurgitations of
gastric contents
in the mouth.
Nausea &
vomiting of
functional,
organic,
infectious or
dietetic origin
or induced by
radio- or drug
therapy.
Brand Name: 30 mg/day Laxatives Use to treat Abdominal abdominal Advise
Bisacodyl single dose constipation pain, nausea discomfort patients,other
Generic Name: and vomiting than those with
Dulcolax and spinal cord
obstruction injuries that
laxatives should
be used only for
short term
therapy
Advise patient
to increase fluid
intake 1500-2000
ml/ day
Advise patient
that bisacodyl
should not be
used when
constipation is
accompanied by
abdominal
pain,fever,nausea
and vomiting.
Asses color,
consistency and
amount of stool
produced
Planax 275 mg twice NSAIDS Relief of mild Hypersensitiv Headache, Advise the
daily to moderately ity, active GI drowsiness,dizz patient to take
severe pain & bleeding, iness, dyspnea, this medicine
fever w/ or w/o Ulcer disease. nausea,dyspepsi with a full glass
accompanying a,vomiting, of water and to
inflammation tachycardia and remain into an
eg constipation upright position
musculoskeleta for 15-30 minutes
l trauma, post- after
op pain & administration.
post-dental Instruct patient
extraction. to take
Relief of pain medication
associated w/ exactly as
postpartum directed.
cramping & Advise patient to
dysmenorrhea. consult physician
Treatment of or other helath
acute migraine care provider if
attack. rash, itching,
visual
disturbances,
tinnitus, weight
gain, edema,black
stools,
persistent
headache occurs
BrandName: Adult 250- Anti- Short term In cases of Gastro- Observe patient
Cyklokapron 500 mg fibronolyti use in the massive intestinal for signs and
Generic IM/slow IV c treatment of upper disorders symptoms of
Name: bid-tid. hyphaema and urinary (nausea, thrombosis such
Tranexamic in patients tract vomiting, as leg pain,
acid with haemorrhage, diarrhoea) respiratory
established antifibrinol may occur. distressor
coagulopathi ytics should chest pain
es who are be avoided report
undergoing to reduce Anticipate
minor the risk of reduced dosage
surgery. ureteric in patients
Menorrhagia obstruction. with impaired
renal function
Stress the
importance of
opthalmological
examinations at
regular
intervals
during therapy.
Tramal Initial dose Analgesics (Moderate
Opioid) to Acute Sweating, Assess type,
of 50 mg, severe intoxication dizziness, location, and
followed by chronic & w/ alcohol, muzziness, intensity of
50 mg or 100 acute pain, hypnotics, vomiting, dry pain before and
mg 4-6 diagnostic analgesics mouth. 2-3 hr (peak)
hourly. procedure & or Headache, after
surgery. psychotropic vomiting and administration.
s. Narcotic constipation Assess BP & RR
w/drawal before and
treatment. periodically
during
administration.
Encourage
patient to
cough and
breathe deeply
every 2 hr to
prevent
atelactasis and
pneumonia.
Brandname:Diph PO 25-50 mg Anti- used to treat cardiac headache, Caution the
enhydramine q4-6 hr, 50mg histamine sneezing; disease or fatigue, client that the
Generic Name: 20-30 mins runny nose; hypertension, anxiety, medication may
before bedtime itching, glaucoma, tremors, cause drowsiness,
Benadryl watery eyes; gastric or vertigo, creating
hives; rashes; duodenal confusion, difficulties or
itching; and ulcers depression, hazards or other
other symptoms seizures, activities that
of allergies hallucinations, require
and the common tachycardia, alertness.
cold. palpitations, Tell the client
orthostaic to take the
hypotension, medication with
heart failure food to decrease
GI upset.

Explain to the
client that
arising quickly
form a lying or
sitting position
may cause
orthostatic
hypotension.
Explain to the
client that use
of these drugs in
warm weather may
increase the
likelihood of
heatstroke.
cefazolin sodium Adults: 1 g IM Cephalosporins - Perioperative - CNS- confusion, - Obtain specimen
/ Ancef or IV to 30 to prevention in Contraindicated seizures for culture and
60 minutes contaminated in patients CV- phlebitis, sensitivity tests
before surgery; surgery. hypersensitive thrombophlebitis before giving first
then 0.5 to 1 g - Infections of to drug or other with IV injection dose. Therapy may
IM or IV q 6 to respiratory, cephalosporins. GI- begin pending
8 hours for 24 biliary, and GU - Use cautiously pseudomembranous results.
hours. In tracts; skin, in patients colitis, nausea, - Expect to adjust
operations soft-tissue, bone, hypersensitive anorexia, vomiting,dosage and dosing
lasting longer and joint to penicillin diarrhea, interval if
than 2 hours, infections; because of the glossitis, creatinine clearance
give another 0.5 septicemia; possibility of dyspepsia, falls below
to 1 g dose IM endocarditis cross- abdominal cramps, 55mL/minute.
or IV caused by E.coli, sensitivity with anal pruritus, After reconstitution,
intraoperatively. Enterobacteriace other beta- oral candidiasis inject drug IM
Continue ae, gonococci, lactam GU- genital without further
treatment for 3 Haemophilus antibiotics. pruritus, dilution. This drug
to 5 days if influenza, Use cautiously candidiasis, isn’t as painful as
life-threatening Klebsiella in breast- vaginitis other cephalosporins.
infection is species, Proteus feeding women Hematologic- Give injection
likely. mirabilis, and in patients neutropenia, deeply into a large
Staphylococcus with a history leucopenia, muscle, such as the
aureus, of colitis and eosinophilia, gluteus maximus or
Streptococcus renal thrombocytopenia lateral aspect of
pneumonia, and insufficiency. Skin- the thigh.
group A beta- maculopapular and - If large doses are
hemolytic erythematous given, therapy is
streptococci. rashes, urticaria, prolonged, or patient
pruritus, pain, is at high risk,
induration, monitor patient for
sterile abscesses, signs and symptoms
tissue sloughing of super-infection.
at injection site, - Don’t confuse drug
Steven-Johnson with other
syndrome cephalosporins that
Other- sound alike.
hypersensitivity - Instruct patient
reactions, serum to report adverse
sickness, reactions promptly.
anaphylaxis, drug - Tell patient to
fever report discomfort at
IV injection site.
ceftazidime / Adults and Cephalosporins - Serious UTIs - CNS- headache, - Obtain specimen
Robicef children age 12 and lower Contraindicated dizziness, for culture and
and older: 1 to respiratory in patients paresthesia, sensitivity tests
2 g IV or IM q 8 tract infections; hypersensitive seizures before giving first
to 12 hours; up skin, to drug or other CV- phlebitis, dose. Therapy may
to 6 g daily in gynecologic, cephalosporins. thrombophlebitis begin pending
life-threatening intra-abdominal, - Use cautiously GI- results.
infections. and CNS in patients pseudomembranous - For IM
infections; hypersensitive colitis, nausea, administration,
bacteremia; and to penicillin vomiting, diarrhea,inject deeply into a
septicemia because of abdominal cramps large muscle, such as
caused by possibility of GU- vaginitis, the gluteus maximus
susceptible cross- candidiasis or the lateral
microorganisms, sensitivity with Hematologic- aspect of the thigh.
such as other beta- eosinophilia; - If large doses are
streptococci lactam thrombocytosis, given, therapy is
(including antibiotics. leucopenia, prolonged, or patient
Streptococcus - Use cautiously hemolytic anemia, is at high risk,
pneumonia and in breast- agranulocytosis, monitor patient for
S.pyogenes), feeding women thrombocytopenia signs and symptoms
penicillinase-and and in patients Skin- of super-infection.
non- with history of maculopapular and - Commercially
penicillinase- colitis and erythematous available
producing renal rashes, urticaria, preparations either
Staphylococcus insufficiency. pain, induration, sodium caronate
aureus, E.coli, sterile abscesses, (Fortaz, Tazicef,
Klebsiella, tissue sloughing Tazidime) or
Proteus, at injection site arginine (Ceptaz) to
Enterobacter, Other- facilitate
Haemophilus hypersensitivity dissolution of drug.
influenza, reactions, serum Safety and efficacy
Pseudomonas, and sickness, of solutions
some strains of anaphylaxis containing arginine
Bacteroides. in children younger
- Uncomplicated than age 12 haven’t
UTIs. been established.
- Complicated - Don’t confuse drug
UTIs. with other
cephalosporins that
sound alike.
Co-amoxiclav / Euroclav ADULTS AND CHILDREN Antibacterial Co-amoxiclav is - Co-amoxiclav should Co-amoxiclav is well
OVER 12 YEARS: indicated for treatment be used with care in tolerated. Side effects,
Mild-moderate of the following patients with hepatic as with amoxicillin, are
infections: One Co- bacterial infections impairment. Changes in uncommon and mainly of
amoxiclav 375 mg due to susceptible liver function tests mild and transitory
tablet every 8 hours. organisms: have been observed in nature. The reported
Severe infections: One -Upper respiratory some patients adverse effects include
Co-amoxiclav 625 mg tract infection receiving amoxicillin- diarrhea, nausea,
tablet every 8 hours. (including ENT), e.g. Clavulanic acid. vomiting, antibiotic-
Severe dental tonsillitis, sinusitis, - Hepatic function associated colitis
infections (but not otitis media. monitoring is (including
generally first-line): -Lower respiratory recommended with the pseudomembranous
One Co-amoxiclav 375 mg tract infections, e.g. use of Co-amoxiclav in colitis), and candidiasis
tablet every 8 hours acute and chronic patients with hepatic have been reported.
for 5 days. bronchitis, lobar and dysfunction. Hepatitis and cholestatic
Co-amoxiclav 375 mg and bronchopneumonia. Cholestatic jaundice, jaundice have been
625 mg tablets are not -Genito-urinary tract which is usually reported rarely.
recommended in infections, e.g. reversible, and may Uriticarial and
children of 12 years cystitis, urethritis, very rarely be severe, erythematous rashes
and under. pyelonephritis, pelvic has rarely been sometimes occur. Rarely
CHILDREN 12 YEARS AND infections, chancroid, reported, either erythema multiforme
BELOW: gonorrhoea. during, or shortly (including Stevens-
Dosage usually depends -Skin and soft tissue after, the use of Johnson syndrome), toxic
on the severity of the infections, e.g. boils, amoxicillin-Clavulanic epidermal necrolysis,
infection. Generally, abscesses, cellulitis, acid. exfoliative dermatitis
total daily dose animal bites, wound - Co-amoxiclav should and vasculitis have been
should be divided into infections. be used with care in reported.
3 equal doses to be -Bone and joint patients with moderate Treatment should be
administered every 8 infections, e.g. or severe renal discontinued if one of
hours. osteomyelitis. impairment. Dosage these types of rash
DOSAGE IN RENAL -Dental infections, e.g. should be adjusted in appears.
IMPAIRMENT: dentoalveolar abscess. response to the degree Prolongation of bleeding
ADULTS: -Other infections, e.g. of renal impairment. time, dizziness, headache
Mild impairment puerperal sepsis, - Co-amoxiclav should convulsions (particularly
(Creatinine septic abortion, intra- be given cautiously to with high doses or in
clearance>30 ml/min): No abdominal sepsis. patients with renal impairment) may
change in dosage. gastrointestinal occur very rarely.
Moderate impairment disease as it may lead
(Creatinine clearance to pseudomembranous
10-30 ml/min); colitis.
One Co-amoxiclav 375 mg - Erythematous rashes
tablet or one Co- have been associated
amoxiclav 625 mg with glandular fever
tablet every 12 hours. in patients receiving
Severe impairment amoxicillin. Avoid Co-
(Creatinine amoxiclav if glandular
clearance<10 ml/min): fever is suspected.
Not more than one Co- - Prolonged used may
amoxiclav 375 mg also occasionally
tablet every 24 hours. result in overgrowth
Co-amoxiclav 625 mg of non-susceptible
tablets are not organisms.
recommended. - The duration of
Or as prescribed by treatment should be
the physician. appropriate to the
indication and should
not usually exceed 14
days.
VII. Pathophysiology
 Pathophysiology of Ectopic Pregnancy
Risk Factors:
•Use of an intrauterine device (IUD), a form of birth control, at the time of conception.
•History of pelvic inflammatory disease (PID).
•Sexually-transmitted diseases such as chlamydia and gonorrhea.
•Congenital abnormality (problem present at birth) of the fallopian tube.
•History of ectopic pregnancy.
•Unsuccessful tubal ligation (surgical sterilization) or tubal ligation reversal.
•Fertility drugs.
•Smoking
•Infertility treatments such as in vitro fertilization (IVF).
•Previous elective abortion

ilia which normally propel the fertilized ovum through the tube into the uterine
 Disruption or scarring of the fallopian tube

k or slows the movement of a fertilized egg through the fallopian tube to the ute

Fertilized egg attaches to an area outside of the uterus

Severe Abdominal Pain Abnormal bleeding or spotting

 VIII. Ecologic Model
A. Hypothesis
An ectopic pregnancy, or eccyesis, is a complication of pregnancy 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 bleeding being a common
complication. Most ectopic pregnancies occur in the Fallopian tube (so-called tubal pregnancies),
but implantation can also occur in the cervix, ovaries, and abdomen. An ectopic pregnancy is a
potential medical emergency, and, if not treated properly, can lead to death.
In the case of our patient she had an elective abortion on her first pregnancy which may
predispose the occurrence of ectopic pregnancy in the present. Other than that, the client was
diagnosed of having a polycystic ovary. The husband also smokes which makes the client a
second-hand smoker. And least but hypothetical prediction is her nutritional status because
according to her she loves to eat junk foods.
B. Predisposing factors

Host
•Female
•Filipino
•34 years old
•Roman Catholic
•She eats junk foods

Agent
•Previous elective abortion

Environment
•Husband smokes
 C. Ecologic
Model

Host: Agent: previous elective abortion

Female
Filipino
34 years old
Roman Catholic
She eats junk foods

Environment
Husband smokes
 D. Analysis
The agent-host-environment model of health and illness also called as the
ecologic model is used primarily in predicting illness rather than in promoting
wellness, although identification of risks factors that result from the interaction
of agent, host and environment are helpful in promoting and maintaining health.
Because each of the agent-host-environment factors constantly interacts with
the others, health is an ever changing state. When the variables are in balance,
health is maintained; when variables are not in balance disease occurs.

Reference: Kozier and Erbs (Fundamentals of Nursing)

Ectopic pregnancy, there are no unusual symptoms at the time of

implantation. The corpus luteum of the ovary continues to function as if the
implantation were in the uterus. No menstrual flow occurs. A woman may
experience the nausea and vomiting of early pregnancy and a pregnancy test
for hCH will be positive. A woman usually experiences a sharp, stabbing pain in
one of her lower abdominal quadrants at the time ruptures, followed by scant
vaginal spotting.

Reference:
(Maternal and Child Health Nursing 5th Ed by Pillitteri)
E. Conclusion and Recommendations

We therefore conclude that our client has suffered from ectopic pregnancy. It is due to
her previous history of abortion and her environment. Other factors may include her age
and way of living.
Recommendations include different nursing management that could help when a client is
suffered from ectopic pregnancy:
•Ensure that appropriate physical needs are addressed and monitor for complications.
Assess vital signs, bleeding, and pain.
•Provide client and family teaching to relieve anxiety.
1.Explain the condition and expected outcome.
oMaterial prognosis is good with early diagnosis and prompt
treatment, such as laparotomy, to ligate bleeding vessels and repair or
remove the damaged fallopian tube.
oPharmacologic agents, such as methotrexate followed by leucovorin,
may be given orally when ectopic pregnancy is diagnosed by routine
sonogram before the tube has ruptured. A hystesolpingogram usually
follows this therapy to confirm tubal patency.
oRh-negative women must receive RhoGAM to provide protection
from immunization for future pregnancies.
2.Describe self-care measures, which depend on the treatment.
•Address emotional and psychosocial needs.
 IX . Nursing Care Plan
Nursing Problem/ Analysis Goal Nursing Rationale Evaluation
Cues Interventions

Acute pain related to Acute pain is caused After 1 hour of nursing -Perform a Pain must be After 1 hour of nursing
surgical incision as by activation of interventions the comprehensive described by the intervention the
evidenced by nociceptorsm is client’s pain will be assessment of pain to client so that they can clients level of pain
usually of short relieved include location receive prompt was lessened
Subjective: duration(less than 6 characteristics, evaluation and
months) and has and onset , duration , treatment
She also voids 5-6 immediate onset such frequency, quality,
times a day and as incisional pain after intensity and other
experience pain in her surgery precipitating factors of
abdomen when pain
urinating because of
her surgery. -Teach the use of To enhance more the
non-pharmacological effects of pain relief
Her movements were technique like deep medications
just light, gradual and breathing
limited.
- Provide pain relief
Objective: drugs as ordered by To administer
Temp: 36.2 degrees the physician analgesics in an
Celsius individualized, timely
PR: 65 bpm and safe manner
RR: 23cpm
BP: 100/70 mmHg -Monitor Vital signs It helps the physician
Guarding behavior on to determine the
the surgical site physiologic status
Grimace facial
expression
•Discharge Plan
Medications to take at home
✔ Take the prescribed regimen for home medications given by the physician
Exercise
✔ Low intensity exercise like gradual walking
Treatments
✔Continuous taking of prescribed medications
Health Teachings
✔ Advised to rest and not to perform extreme activities
✔ Informed patient to avoid lifting heavy objects for 1-2 weeks
✔Discouraged patient to participate in strenuous activities that might precipitate
stress and trauma to the wound
Out-patient follow up
✔ None
Diet
✔Diet as tolerated
✔Encouraged client to increase intake of fiber to avoid constipation
✔Instructed to increase fluid intake
✔Instructed to increase intake of nutritious foods such as fruits and vegetables
Sexual Activity
✔Not advised to perform sexual activities during the first week of her
post-operation