You are on page 1of 39

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.
II.

Introduction
Objectives

III.

Significance of the study

IV.

Patient’s Profile

V.

VI.
VII.
VIII.

IX.

Patient’s History
a. History of Present Illness
b. History of Past Illness
c. Family History
Assessment
Laboratory/ Diagnostic
Disease Identity
a. Anatomy and Physiology
b. Pathophysiology
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

VI.

DISEASE

MOTHER

FATHER

Cardiac Problem

Diabetes Mellitus

Meningitis

Asthma

Tuberculosis

Otitis Media

Hypertension

Cancer

Assessment
Body System

Methods of
assessment

FINDINGS

SIGNIFICANCE/RE

I

Pa

Pe

A

MARKS

General Appearance
Inspect physical
appearance.
Assess behaviour.

Assess overall
development and
speech.

Inspect and palpate
skin.

Conscious and
coherent
Cooperative ;
interacts well
with others
Moderate
speech, clear
voice with
moderate pace

Assess interactions
with parents and
nurse.

Vital Signs
Measure blood
pressure.
Measure pulse rate
Measure respiratory
rate.
Measure
temperature.
Skin , Hair and Nails

Appears weak


Inspect and palpate


hair( distribution and
characteristics)
Inspect and palpate


nails(texture, shape,
color, condition)
Head, neck and Cervical Lymph nodes
Inspect and palpate
the head(symmetry,


condition of
fontanelles)
Inspect and palpate
the face
Inspect head control,
head posture and

Expected weakness
related to the postop status
Normal
Normal

Normal

110/70 mmHg

Normal

66 beats/ min

Normal

22 breaths/min

Normal

36.8⁰C

Normal

No
swelling/lesions
noted; skin warm
to touch with
good turgor
Evenly
distributed; fine
and silky
Smooth, convex
in shape, light
pink in color
Normocephalic,
no lesions are
visible.
Symmetric with
an oval
appearance, no
abnormal
movements
noted.
Full range of
motion- up and

Normal

Normal
Normal

Normal

Normal

Normal

down and
sideways

range of motion.
Inspect and palpate
the neck
( suppleness, lymph
nodes for swelling,


mobility,
temperature and
tenderness)
Mouth, throat, nose and sinuses
Inspect mouth and
throat( tooth
eruption, condition of


gums, lips, teeth,
palpates, tonsils.
Tongue and buccal
mucosa)
Inspect nose and
sinuses (discharge,

tenderness.
Turbinates[color,swel
ling])
Eyes
Inspect external eye.
Observe for redness,
swelling or discharge
or lesions


No nodules or
swelling noted,
(+) pain in the
nape.

Abnormal

(+) Mouth lesion
(gingivitis)

Improper oral
hygiene

Smooth and
symmetrical;
client reports no
tenderness

Normal

Bilaterally equal
in size
Skin on both
eyelids is without
redness, swelling
or lesion.

Normal
Normal

Ears

Inspect external ears

Thorax and lungs
Inspect shape of
thorax and
respiratory effort

Equal in size
bilaterally; skin is
smooth with no
lesions, lumps or
nodules. Color is
consistent with
facial color
Scapulae are
symmetric and
non-protruding.
Shoulders and
scapulae are at
equal horizontal
position.
Respirations are
within normal
range, relaxed,
effortless, and

Normal

Normal

Percuss the lungs

Auscultate for breath
sounds and
adventitious sounds.
Breasts
Inspect and palpate
breasts(shape,
discharge, lesions)
Heart
Auscultate heart
sounds
Abdomen
Inspect shape
Observe the
coloration of the skin

quiet
Resonance,
elicits flat tone
over the scapula
Breath sounds
clear; No
adventitious
sounds
auscultated.

Normal

Symmetrical, no
discharge or
lesions are noted

Normal

S1 and S2. No S3
and S4 noted.

Normal

Symmetry
Abdominal skin is
paler than the
general skin
tone.

Normal

Normal
Normal

Muskuloskeletal
Assess feet and legs

Assess spine and
posture

Assess gait

Assess joints

Assess muscles

VII.

(+) edema
Clients appear to
be relaxed with
shoulders
Gait is steady:
opposite arm
swings
Client reports no
pain in her joints
No muscle
weakness noted

The edematous area
when held for a few
seconds, the
depression rapidly
refills.
Normal
Normal
Normal
Normal

Laboratory/ Diagnostic
Hematology Report – (March 14, 2011)
Lab Test
Performed

N.V.

A.V.

Significance

1.

Hgb

F: 120 – 160

60

2.

WBC

5 – 10 x 10⁹/1

15.5

3.

Hematocrit

F: 37 – 47

18

Low. Chronic Blood loss
* This is used to evaluate
the hemoglobin content
of erythrocytes.
High. Acute Infection
*The WBC is an indicator
of Immune function of the
body. Elevation is seen
during
the
ongoing
infection of inflammation.
Low. Hemorhage;
*This test is useful in the
diagnosis of anemia.
High. Infection

4.

Segmenters

.50 – .70

.78

5.

Lymphocytes

.20 – .40

.15

* A segmenters count is
usually a part of a
peripheral complete
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
peripheral complete
blood cell count and is
expressed as percentage
of lymphocytes to total
white
blood
cells
counted.
Normal

6.

Monocytes

7.
Platelet
Count

.02 – .08

.07

150 – 300 x
10³/1

289 x 10³/1

* A monocyte count is
usually a part of a
peripheral complete
blood cell count and is
expressed as percentage
of monocytes to total
white
blood
cells
counted.
Normal
*It is used to diagnose
bleeding disorders

Hematology Report – (March 15, 2011)
Lab Test
Performed

1. Hgb

2. Hematocrit

N.V.

A.V.

F: 120 – 160

94

F: 37 – 47

28

Significance

Low. Chronic Blood loss
* This is used to evaluate
the hemoglobin content
of erythrocytes.
Low. Hemorhage;
*This test is useful in the
diagnosis of anemia.

Hematology Report – (March 15, 2011)
Lab Test
Performed

N.V.

A.V.

Significance

1.
2.

Hgb
Hematocrit

F: 120 – 160

83

F: 37 – 47

26

Low. Chronic Blood loss
* This is used to evaluate
the hemoglobin content
of erythrocytes.
Low. Hemorhage;
*This test is useful in the
diagnosis of anemia.

Hematology Report – (March 16, 2011)
Lab Test
Performed

1.

Hgb

2.

Hematocrit

N.V.

A.V.

F: 120 – 160

103

F: 37 – 47

31

Significance

Low. Chronic Blood loss
* This is used to evaluate
the hemoglobin content
of erythrocytes.
Low. Hemorhage;
*This test is useful in the
diagnosis of anemia.

Vitros Clinical Patient Report – (March 15, 2011)
Lab Test
Performed

N.V.

A.V.

Urea

2.5 – 6.1

3.7 mmol/L

Creatinine

62. – 106.

61. umol/L

Significance
Normal
*often requested to monitor
kidney function before
starting to take certain
drugs and while taking
them.
Slightly Low
*Creatinine levels are
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 childbirth.

during

pregnancy

but

can

expand

dramatically

 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
Factors:

Predisposing
Factors:
24yrs
old

Femal
e

Previous
abortion

Tubal
scarring or
scars in the
uterus from
previous
operations

Abdominal
utlrasound findings:
No gestational sac
identified
Abnormal
bleeding in the
vagina

Smoki
ng
Presence of
a protein –
PROKR1

travelling
long
distances
without
resting

prevents the muscles
in the walls of the
fallopian tubes from
contracting

Blocks or slows the movement of a fertilized
egg through the fallopian tube to the uterus

Fertilized egg attaches to an
area outside the uterus
(ampullar region of the
fallopian tube) where it
implants and grows

Sharp stabbing
pain radiating to
neck and
shoulders

No
Prenatal
Checkups

Inability
to know
condition
of
pregnanc
y

Inability
to
prevent
complica
-tions

Tubal
rupture
Ectopic Pregnancy

hemorrhag
e

IX.

Medical Management, Surgical Management and Nursing Management

a. Drug Study

Name of Drug
Generic Name:
Clindamycin
Brand Names:
Dalacin C
Dosage:
300mg TID
Route:
Per orem (P.O.)

Generic Name:
Mefenamic Acid

Brand Names:
Ponstel
Dosage and Route:

Mechanism of Action
Category:
Anti-bacterial

Side Effects, Adverse Reactions
and Contraindications
Side Effects:
GI: nausea, vomiting

Mechanism of action:
Adverse Reactions:
It inhibits protein synthesis in CNS: convulsions (over dosage)
susceptible bacteria, causing GI:
Severe
colitis,
including
cell death
pseudomembranous
colitis,
diarrhea,
abdominal
pain,
esophagitis,
anorexia,
jaundice,
hepatic function changes
Hema:
Neutropenia,
Leukopenia,
agranulocytosis, eosinophilia
Hypersensitivity: Rashes, utricarial to
anaphylactoid reaction

Category:
Non-Steroidal
inflammatory
(NSAID), antipyretic

Nursing Interventions

Take each dose with a full
glass of water (decreases
esophageal
irritation)

May be taken without
for
Report S&S of
diarrhea
and

regard
meals
severe
colitis

Monitor BP and pulse after
administration.
 Be
alert
for
signs
of
superinfection
and
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
antidiarrheal preparations.
Side Effects:
Assessment:
Anti- Upset stomach, nausea, heartburn,  Renal, hepatic, blood studies:
Drug dizziness, drowsiness, diarrhea, and BUN,
creatinine,
Hgb,
before
treatment, periodically thereafter
headache may occur.
• Pain: note type, duration, location,
and intensity with ROM 1 hr after
administration

5oomg 1cap TID

Mechanism of action:
Adverse Reactions:
• Audiometric, ophthalmic exam
It
inhibits
prostaglandin GU: nephrotoxicity, renal failure
before, during, after treatment; for
synthesis
by
decreasing Hema: Leukopenia, thrombocytopenia,
eye, ear problems: blurred vision,
enzyme
needed
for
agranulocytosis,
anemia,
tinnitus; may indicate toxicity
biosynthesis; analgesic, antineutropenia,
inflammatory, antipyretic
lymphocytosis, eosinophilia,
• Fever: temp before and 1 hr after
pancytopenia, hemolytic
administration
anemia
Misc: Anaphylaxis, serum sickness

Cardiac
status:
edema
(peripheral),
tachycardia,
Contraindications:
palpitations; monitor B/P, pulse for
Hypersensitivity to cephalosporins
character,
quality,
rhythm
especially in patients with cardiac
disease/ elderly

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
Side Effects/ Adverse Effect:
 Substitution of one iron salt for
another
without
Constipation,
gastric
irritation,
proper
adjustment
may
result
in
nausea,
serious
over
or
abdominal
cramps,
anorexia,
under dosing.
diarrhea,
 Eggs, milk, coffee, or tea

Generic Name:

Classifications:

Brand Names:

Action of Drug:
Iron is absorbed from the
duodenum and upper jejunum

Ferrous Sulfate
(FeSO4)

Anti-anemic, Iron

For history of peptic ulcer
disorder;
asthma,
aspirin,
hypersensitivity, check closely for
hypersensitivity reactions

Dosage and Route:

200mg 1cap OD

by an active
through
mucosal
cells
combines
with
transferrin.

mechanism
the
where
it
theprotein

dark colored stools
Contraindications:
Hemosiderosis, hemochromatosis,
peptic
ulcer,
regional
enteritis,
and 
ulcerative
colitis.
Hemolytic
anemia,
pyridoxineresponsive anemia, and cirrhosis of
the liver. Use in those with normal
iron balance.

Generic Name:
KETOROLAC
Brand Names:
TORADOL
Dosage and Route:
30mg/1amp IV q 8 x
4dose

Classifications:

Side Effects/ Adverse Effect:

Non-steroidal
anti- - CNS: drowsiness, abnormal thinking,
inflammatory
agents, dizziness, euphoria, headache.
nonopioid analgesics
- RESP: asthma, dyspnea
- CV: edema, pallor, vasodilation
Action of Drug:
- DERM: pruritis, purpura, sweating,
Inhibits
prostaglandin urticaria
synthesis,
producing - HEMAT: prolonged bleeding time
peripherally
mediated - LOCAL: injection site pain
- NEURO: paresthesia
analgesia.
- Also have anti-pyretic and - MISC: allergic reaction, anaphylaxis
anti-inflammatory properties. Contraindications:
- Therapeutic effect:Decreased
pain.
- Hypersensitivity
- Cross-sensitivity with other NSAIDs
may exist¨Pre- or perioperative use
- Known alcohol intolerance
Use cautiously in:
1) History of GI bleeding
2) Cardio vascular disease

consumed with a meal or 1hr
after may significantly inhibit
absorption
of
dietary iron.
Ingestion of calcium and iron
supplements
with
food
can
decrease
iron
absorption
by
one-third;
iron absorption is not decreased
if
calcium
carbonate is used and taken
between meals.
Do not crush or chew sustainedrelease product.

Patients who have asthma,
aspirin-induced allergy, and
nasal polyps are at increased
risk for developing
hypersensitivity reactions.
Assess for rhinitis, asthma,
and urticaria.
Assess pain (note type,
location, and intensity) prior
to and 1-2 hr following
administration.
Ketorolac therapy should
always be given initially by
the IM or IV route. Oral
therapy should be used only
as a continuation of
parenteral therapy.
Caution patient to avoid
concurrent use of alcohol,
aspirin, NSAIDs,
acetaminophen, or other OTC
medications without
consulting health care
professional.

Generic name:
cefuroxime
Brand name:
Ceftin
Dosage:
750mg.
IVq8h
Route:
Oral (P.O)

Classification:
Antibiotic
Action of the Drug:
Bactericidal; inhibits synthesis
of bacterial cell wall, causing
cell death.

Side Effects:
CNS: headache, dizziness,lethargy,
paresthesias,
GI: n/v, diarrhea, anorexia, abd.pain,
flatulence, hepatotoxicity
GU: nephrotoxicity
Hypersensitivity: serum sickness
reaction
Local: pain, abscess at injection site,
phlebitis
Other: disulfiram-like reaction with
alcohol





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.

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.
Report loose stools or diarrhea
promptly.
Report any signs or symptoms of
hypersensitivity.
Do not breast feed while taking
this drug.
Determine
history
of
hypersensitivity
reactions
to
cephalosporin, penicillin, and
history of allergies, particularly
to drugs, before therapy is
initiated.
Monitor I&O rates and pattern.

Brand name:
Zantac
Generic name:
ranitidine
Dosage:
50mg q8h
Route:
Intravenous (IV)

Action of the Drug:
Inhibits the action of histamine
at the H2 receptor site located
primarily in gastric parietal
cells, resulting in inhibition of
gastric acid secretion.
Classification:
Anti-ulcer agents
H2 antagonist

Side Effects:
CNS: h/a,
CV: tachycardia, bradycardia, PVCs
(rapid IV administration)
Dermatologic: alopecia
GI: Constipation, diarrhea, Nausea &
vomiting, abdominal pain
GU: gynecomastia, impotence or
decreased libido
Local: pain at IM site, local burning or
itching at IV site
Adverse reaction
CNS: malaise, dizziness, drowsiness,
somnolence, insomnia, vertigo
Dermatologic: Rash
GI: hepatitis, increased ALT levels.
Hematologic: leukopenia,
granulocytopenia,
thrombocytopenia,pancytopenia
Other: arthralgias

• Assess patient for epigastric or
abdominal pain and frank or occult
blood in the stool, emesis, or gastric
aspirate.
• Nurse should know that it may
cause false-positive results for urine
protein; test with sulfosalicylic acid.
• Inform patient that it may cause
drowsiness
or
dizziness.
• Inform patient that increased fluid
and fiber intake may minimize
constipation.
• Advise patient to report onset of
black, tarry stools; fever, sore
throat; diarrhea; dizziness; rash;
confusion; or hallucinations to
health care professional promptly.
• Inform patient that medication
may temporarily cause stools and
tongue to appear gray black.

Contraindications:
 Contraindicated with allergy to
Ranitidine, lactation
 Use cautiously with impaired
renal or hepatic function,
pregnancy
GENERIC NAME:
metronidazole
BRAND NAMES:
Flagyl
DOSAGES & ROUTE:
500mg
I.V. q 8◦

CLASSIFICATIONS:
Amoebicides &
Antiprotozoals
ACTION OF DRUG:
Bactericidal; Inhibits DNA
synthesis

SIDE EFFECTS/ADVERSE EFFECT:
CNS: fever, vertigo, headache, ataxia,
dizziness, syncope, incoordination,
confusion, irritability, depression,
weakness, insomnia, seizures,
peripheral neuropathy
CV: flattened T wave, edema, flushing,
thrombophlebitis after I.V. infusion
GI: unpleasant metallic taste, anorexia,
nausea & vomiting, diarrhea, GI upset
cramps

•Do not drink alcohol (beverages or
preparations containing
alcohol,cough syrups) for 24-72◦ of
drug use;severe reactions may
occur.
•Your urine may be a darker color
than usual; this is expected.
•Refrain from sexual intercourse
during treatment for trichomoniasis,

GU: dysuria, incontinence, darkening of
urine
LOCAL: thrombophlebitis (I.V.),
redness, burning, dryness, and skin
irritation
HEMATOLOGIC: transient leukopenia,
neutropenia
MUSKULOSKELETAL: fleeting joint pains
RESPIRATORY: upper respiratory tract
infection
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

unless partner wears condom.
•You may experience these side
effects:dry mouth w/ strange
metallic taste (frequent mouth care,
sucking sugarless candies may
help); nausea, vomiting,
diarrhea(eat frequent small meals)
•Report severe GI upset, dizziness,
unusual fatigue, or weakness, fever,
chills.

Generic Name:
BISACODYL
Brand Name:
BUSCOPAN
Dosage:
10mg ( 1 suppository
daily rectally)
Route:
Rectal (suppository)

Classification:
Laxatives
Action of the Drug:
It works by stimulating enteric
nerves to cause colonic mass
movements. It is also a
contact laxative; it increases
fluid and NaCl secretion.
Action of Bisacodyl on small
intestine
is
negligible;
stimulant
laxatives
mainly
promote evacuation of the
colon.

Side effects:
Upset stomach, diarrhea, intestinal
irritation

Adverse effects:
Abdominal pain, cramping, perineal
irritation, excessive bowel activity


Use other methods to relieve
constipation where possible.


Don’t give if client has
abdominal pain.


Contraindications:
Hypersensitivity rectal fissures,
abdominal pain, nausea, vomiting,
appendicitis, acute surgical abdomen,
ulcerated haemorrhoids, acute
hepatitis, fecal impaction, intestinal,
bilary tract obstruction

Assess usual bowel patterns.

Provide comfort measures.


Carefully monitor the I&O
when patient is receiving tube
feedings.

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
ASSESSTMENT
Problem:
Risk for infection
Subjective:
“may tahi ako sa
tiyan” as
verbalized by the
patient
Objective:
-dry and intact
wound dressing
Nursing
Diagnosis:
Risk for infection
related to
surgical incision

INFERENCE
Surgical incision

Broken skin

Open wound,
possibility of
microorganisms
to enter.

Risk for
infection

PLANNING
STO:
After
30
mins
health teaching,
patient will be
able to identify 3
out of 5 ways to
reduce risk for
infection

NURSING
INTERVENTIONS
Independent:
assess
patients
perception, level of
understanding
and
needs
- assess v/s especially
temperature
emphasize
importance of hand
washing
maintain
aseptic
technique
when
changing dressing /
wound care

RATIONALE

- to identify and assess
different interventions
to be done
- fever may indicate
infection
- serves as first line of
defence
regular
wound
dressing
facilitates
faster wound healing
and drying of wounds
LTO:
- wet area can be
During the course
lodge area of bacteria
of
confinement,
- to impart to patient
patient will not - keep area around when
the
wound
manifest
any wound clean and dry
become infected and
signs of infection. - discuss to patient the when
to
sought
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

EVALUATION
STO:
Goal met. Patient
was
able
to
identify 3 out of 5
ways to reduce
risk for infection.

LTO:
Goal met. Patient
did not manifest
any
signs
of
infection
during
the
course
of
confinement.

Problem:
Post-op pain
Subjective:
“medyo masakit
pa yung sa may
tahi ko”
As verbalized by
the patient.
Objective:
- pale and weak
in appearance
(+)
facial
grimace
- pain scale of 5
(10
as
the
highest)

Nursing
Diagnosis:
Acute
pain
related
to
surgical incision
as manifested by
pain
scale
of
5/10.

Surgical incision

Complex
responses of
nerve endings
due to trauma

Hypersensitivity
of central
nervous system

Unpleasant
physical and
emotional
responses

pain

STO:
After 4 hours of
nursing
intervention,
patients
perception of pain
will be lessen as
evidence by pain
scale of 3/10.

Independent:
assess
patients
perception, level of
understanding
and
needs
obtain
clients
baseline v/s including
pain scale

- to identify and assess
different interventions
to be done
to
assess
the
effectiveness of the
intervention and for
baseline
data
for
future use
- encourage clients - because pain is high
verbal report during subjective
and after intervention
LTO:
- positioning the client - to provide comfort
After 8 hours of where
she
is
nursing
comfortable
to divert clients
intervention,
teach
client attention from pain
patient will not diversional activities
complain of pain
- to prevent bleeding
higher than the - instruct client to
pain scale of 3/10. avoid
strenuous
exercise
- alleviate pain
Dependent:
- administer
analgesics as ordered

STO:
Goal partially met.
Patients perception
of pain was lessen
but with a pain
scale of 4/10.

LTO:
Goal met.
Patient
did
not
complain of pain
higher than pain
scale of 3/10

Problem:
Inadequate sleep
Subjective:
“hindi
ako
makatulog
masyado sa iyak
ng mga baby at
mayat-maya
minomonitor ako”
as verbalized by
the patient.
Objective:
weak
in
appearance
- yawning
-presence of eye
bags
-restless

Nursing
Diagnosis:
Disturbed
sleeping patterns
related
to
therapeutic
purposes
and
other generated
awakening
as
manifested
by
restlessness and
presence of eye
bags

Environmental
factors
(government
hospital setting:
2patients per
bed)

External factors
(crying babies
and nurses’
frequent
monitoring of
vital signs)

Inability to sleep

Inadequate
sleep

STO:
Within the shift,
patient will have
an improvement
in sleep pattern
as evidence by
verbalization
of
enhancement in
sleep pattern and
rested
appearance

Independent:
- assess sleep pattern
disturbances that are
associated
with
environment
- observe and obtain
feedback
regarding
sleeping
pattern,
bedtime routine and
hours of sleep
-do as much care as
possible
without
waking the patient and
do as much care as
possible when patient
is awake
-explain
the
importance
of
monitoring v/s and
care when hospitalized

STO:
Goal met. Patient
verbalized
enhancement
of
sleep pattern and
-to determined usual appeared
rested
sleeping patterns and within the shift.
if
there
are
any
changes/improvement
s
- sleep disturbances
can affect the recovery
of patient

-to avoid disturbances
and to maximize sleep
and rest of the patient

-to
minimize
complaints and for
patient to understand
the care being done to
her

Problem:
Anemia

Ruptured
ectopic
pregnancy

Objective:
- (+) pale & weak
in appearance
- Hgb Count of
103
- edema present
on the legs and
feet

Emergency
laparotomy and
salpingectomy

Profuse blood
loss

Anemia

Nursing
Diagnosis:

Inadequate
Tissue Perfusion
related
to
decreased
hemoglobin
concentration in
the
blood
as
manifested
by
paleness
and
weakness

Short
term Independent:
objective:
-Monitor
vitalsigns,
After 1 hour of heart
sounds,
and
nursing
cardiac rhythm
Interventions, the
capillary
client
will -measure
refill then palpate for
verbalize
understanding of presence or absence
and quality of pulses
conditions,
therapy regimens, -Perform assistive or
and
when
to active ROM exercises
contact
health
care provider.
-encourage
early
ambulation
when
possible

STO:
-to evaluate degree of Goal met.
inadequacy of tissue
After 1 hour of
perfusion
nursing
-to note degree of interventions, the
impairment
client
verbalized
understanding of
conditions, therapy
regimens,
and
when to contact
care
-to maximize tissue health
provider.
perfusion
-enhances
return

Long
term -discourage sitting or
Objective:
standing
for
long
-to maximize
After 8 hours of periods,wearing
constrictive
clothing
or
perfusion
nursing
crossing
legs
intervention, the
client
will
demonstrate
increased
perfusion
as
evidenced
by
absence of edema

-elevate the legs when
sitting but avoid sharp
angulation of the hips
or knees
-to maximize
perfusion

venous
LTO:
Goal not met.
tissue

After 8 hours of
nursing
intervention,
the
client still exhibits
decreased
tissue
perfusion
as
evidenced
by
of
tissue presence
edema.

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 9 th 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/statscountry.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

Research Paper help
https://www.homeworkping.com/