UNIVERSITY OF THE CORDILLERAS

College of Nursing
Governor Pack Road, Baguio City, Philippines 2600
(+6374) 442-3316, 442-2564, 442-8219, 442-8256
E-mail: webmaster@bcf.edu.ph
Website: www.bcf.edu.ph

Commented [GLMS1]: (8 single spaces)

Pls check format again

ECTOPIC PREGNANCY, PIH

PREGNANCY INDUCED HYPERTENSION Commented [GLMS2]: (6 single spaces)

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A Case Presented to the

College of Nursing Commented [GLMS3]: (4 single spaces)

Pls check format again

In Partial Fulfillment of the requirements in the Course

NCM 112 CARE OF THE CLIENTS WITH PROBLEMS IN OXYGENATION, F&E, INFECTIOUS, I&I
RESPONSE, CELLULAR ABERRATION, ACUTE & CHRONIC

Submitted by:

BELLY, Audrey Rose T.

CARAGAN, Mac Cristian A.
IBAÑEZ, Alice Joy S.
MEDENILLA, Gemalyn B.
OGUNDEJI, Ayomide Florence
PRENDOL, Ryna Kryzzea B.
RAFAEL, Hajime Melchor W.
REBOLLEDO, Osdrei Marion S.
TABIOS, Shaira Annie A.
TIYAD, Emily B.
TOLERO, Kenji F.
VALLEDO, Denielle T.
VELORIA, Mikko DC.

(Date: 16-NOVEMBER-2020)

Noted and Approved for Presentation:

Name of Case Presentation Adviser or Panel/s

________________________
 Signature of Adviser / Date Commented [GLMS4]: First page

ABSTRACT

TITLE: Ectopic pregnancy (EP) and Pregnancy Induced Hypertension (PIH) is a condition Commented [GLMS5]: are conditions
presenting as a major health problems for women of childbearing age. This study aimed to Commented [GLMS6]: case report aims to
identify potential risks, to evaluate the contribution of the risk factors associated to and the
treatment and management used for these diseases.

BACKGROUND: Ectopic pregnancy 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 the death of the fetus. Without timely diagnosis and treatment, ectopic
pregnancy can become a life-threatening situation. While pregnancy induced
hypertension (PIH) is one of the most common causes of both maternal and neonatal
morbidity, affecting about 5 – 8 % of pregnant women. It is associated with adverse
pregnancy outcomes as well as maternal morbidity and mortality.

CASE DESCRIPTION: Patient A is 31 years old, married, a resident of Puguis, La Trinidad,

Benguet. She is on her 8 weeks of AOG, and went to Benguet General Hospital Emergency Commented [GLMS7]: complete the demo details
department with chief complaints of irregular vaginal bleeding, abdominal discomfort,
31 years, old, married, on her 8 weeks AOG, Roman Catholic, and a
weakness, headache, and dizziness. Upon assessment, her initial blood pressure is 140 / 100 resident of Puguis, La Trinidad, Benguet
mmHg and heart rate is 97 bpm. The abdomen is soft and non-distended. There is
tenderness on deep palpation in the suprapubic and right iliac fossa regions, but no GTPAL
rebound tenderness or guarding. Bimanual examination is performed. The patient was
conscious and responsive. Her skin feels cool to touch with mild edema noted on her upper
and lower extremities. Skin turgor revealed 3 seconds with mild edema noted on her lower
extremities. Her eyes were slightly sunken with pinkish conjunctiva. PERRLA was noted. She
was seen wearing corrective glasses and she reported that she has been utilizing it for four
years now due to her nearsightedness. She also relayed to have (+) family history of the
following: Type 1 Diabetes from his father’s side; Chronic Hypertension from both her
parents’ side; and CVA from her grandfather. After several minutes of assessment, the
patient reported to feel dizzy or weak; having headache; flulike symptoms, and nausea.
The patient was given PLRS 1L X 20 gtts / min, Aspirin, Ca, Methotrexate, Hydralazine,
Nifedepine, low Na diet and strict BR.

CONCLUSION: Poor knowledge of management of PIH and EP, and inadequate resources Commented [GLMS8]: remove
are a threats to the proper management of these diseases. This study helps us to acquire Commented [GLMS9]: threats
knowledge, and integrate our ideas and competency and also application of nursing
Commented [GLMS10]: case report
process to help the patient have a better health. Health education is an important way to
Commented [GLMS11]: knowledge, integrate…
help the patient reduced the risk of having EP and PIH.
Commented [GLMS12]: competencies,
Commented [GLMS13]: processes / procedures /
interventions
Commented [GLMS14]: Ectopic Pregnancy and Pregnancy
Induced Hypertension

１
 TABLE OF CONTENTS

I. Introduction .................................................................................................................................... ３

II. Statement of Objectives ......................................................................................................................... ３

A. General Objectives .......................................................................................................................... ３

B. Specific Objectives .......................................................................................................................... ３

III. Patient’s Profile ............................................................................................................................... ４

IV. Chief Complaint............................................................................................................................... ４

V. Present History of Illness ............................................................................................................... ４

VI. Past History of Illness ................................................................................................................. ４

VII. Family Health History................................................................................................................. ４

VIII. Developmental History ............................................................................................................. ４

IX. Social and Environmental History......................................................................................... ４

X. Lifestyle and Health Practices .................................................................................................... ５

XI. Health Assessment .................................................................................................................... ５

A. General Survey ....................................................................................................................... ５

B. Head to Toe Assessment .......................................................................................................... ５

C. 13 Areas of Assessment ....................................................................................................... ６

XIII. Comprehensive Pathophysiology ....................................................................................... 17

XIV. Treatment/Management ..................................................................................................... 18
A. Drugs.......................................................................................................................................... 18
B. IV Fluids ..................................................................................................................................... 26
XV. Nursing Care Plans .................................................................................................................... 27
A. Prioritization of Problems ...................................................................................................... 27
a.1. List of Problems ................................................................................................................... 27
a.2. Basis for Prioritization ..................................................................................................... 27
B. Nursing Care Plans ................................................................................................................... 29
NCP 1: Acute Pain related to Abdominal Discomfort ......................................................... 29
NCP 2: Ineffective tissue perfusion related to vasoconstriction of blood vessels ...... 31
NCP 3: Hyperthermia related to infectious process ............................................................ 33
NCP 4: Disturbed sleeping pattern related to abdominal pain ....................................... 35
NCP 5: Risk for deficient fluid volume ..................................................................................... 37
C. Discharged Plan ..................................................................................................................... 39
XVI. Learning Insights..................................................................................................................... 40
XVII. List of References . ................................................................................................................. 43
Commented [GLMS15]: 3

２
I. Introduction Commented [GLMS16]: worldwide incidence → national →
client
[space]
Commented [GLMS17]: and then relate it to your client
As the word ‘ectopic’ means ‘the wrong place’, the ectopic pregnancy depicts the
abnormal pregnancy, where the embryo develops outside of the uterus (Thomas, 2016).
95% of ectopic pregnancies typically occur in the fallopian tube. Other sites are ovary,
cervix, and abdomen. Between 6 to 16% of pregnant women who go to an emergency
department in the first trimester for bleeding, pain or both have an ectopic pregnancy. The
incidence of ectopic pregnancy is about 1%-2% of all pregnancies reported in the
developed world (Ali, et al, 2019). According to the March of Dimes, about 1 in every 50
pregnancies in the U.S. is an ectopic pregnancy “tubal pregnancy” (Danielsson, 2020).
There was approximately six-fold multiplication in the incidence of ectopic pregnancy
which is mainly due to three prominent factors: increased use of Assisted Reproductive
Technology (ART), Pelvic Inflammatory Diseases (PID) and increased smoking consumption
in the women of reproductive age (Ali et al, 2019). ART procedures involve surgically
removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and
returning them to the woman’s body or donating them to another woman (CDC, 2019).
Pelvic inflammatory disease is an infection of a woman’s reproductive organs. It is a
complication often caused by some STDs, like chlamydia and gonorrhea. Other infections
that are not sexually transmitted can also cause PID (CDC, 2015).

Pre-eclampsia is a serious condition that can occur during pregnancy where there is
high blood pressure and abnormal kidney function. During pregnancy your blood pressure
will be checked at every antenatal appointment because a rise in blood pressure can be
the first sign of pre-eclampsia, also called pregnancy-induced hypertension (PIH), pre-
eclamptic toxemia and hypertensive disease of pregnancy. Although most cases of pre-
eclampsia are mild and cause no trouble, the condition can get worse and be serious for
both mother and baby. It can cause fits (seizures) in the mother, which is called 'eclampsia',
and can affect the baby’s growth (N.A. 2018). Disorders of pregnancy induced
hypertensive are a major health problem in the obstetric population as they are one of the
leading causes of maternal and perinatal morbidity and mortality. The World Health
Organization estimates that at least one woman dies every seven minutes from
complications of hypertensive disorders of pregnancy (Gudeta et al, 2019).
Commented [GLMS18]: Gestational Hypertension also
referred to as Pregnancy-Induced Hypertension (PIH) is a condition
characterized by high blood pressure during
pregnancy. Gestational Hypertension can lead to a serious
condition called Preeclampsia, also referred to as Toxemia.
Hypertension during pregnancy affects about 6-8% of pregnant
women.
https://americanpregnancy.org/pregnancy-
complications/gestational-hypertension-
859/#:~:text=Gestational%20Hypertension%20also%20referred%20t
o,also%20referred%20to%20as%20Toxemia.

The Philippine’s maternal mortality continues at an unacceptably high level. While

maternal mortality figures vary widely by source and are highly controversial, the best
estimates for the Philippines suggest that approximately 4,100 to 4, 900 women and girls die
each year due to pregnancy-related complications. Additionally, another 82, 00o to 147,
000 Filipino women and girl will suffer from disabilities caused by complications during
pregnancy and childbirth each year (MNPI, N.A.).

II. Statement of Objectives

A. General Objectives
This case analysis aims to increase the understanding and knowledge
of student nurses on Ectopic pregnancy and PIH and how to care for patients Commented [GLMS19]: This case analysis aims to increase the
with Ectopic pregnancy effectively and efficiently. understanding and knowledge of student nurses on how to care for
patients with Ectopic Pregnancy and Pregnancy Induced
Hypertension effectively and efficiently.
B. Specific Objectives
Specifically, this case analysis aims to:
1. define Ectopic pregnancy and its effects to the body as a whole; Commented [GLMS20]: and Pregnancy Induced Hypertension
2. illustrate the pathophysiology of Ectopic pregnancy and in relation to Commented [GLMS21]: and Pregnancy Induced Hypertension
the signs and symptoms specifically observed in the patient;
3. describe and identify the common signs and symptoms, clinical
manifestations, and risk factors of Ectopic pregnancy; Commented [GLMS22]: and Pregnancy Induced Hypertension
4. discuss the medical interventions for the management of Ectopic Commented [GLMS23]: and surgical
pregnancy; Commented [GLMS24]: and Pregnancy Induced Hypertension
5. formulate appropriate nursing care plans suited for the patient based
on the assessment findings;

３
 6. identify care measures to be given to the patient and family to
promote continuity of care and independence after discharge; and
7. identify measures to prevent Ectopic pregnancy . Commented [GLMS25]: and Pregnancy Induced Hypertension

III. Patient’s Profile

Name : Patient X
Ethnic Background : Igorot Commented [GLMS26]: Pregnancy Induced Hypertension

Civil Status : Married Commented [GLMS27]: remove

Religion : Roman Catholic Commented [GLMS28]: characterized to be
Occupation : none Commented [GLMS29]: remove
Admitting Diagnosis : Abdominal Pain & Vaginal Bleeding t/c Commented [GLMS30]: OB Hx
Ectopic Pregnancy
Final/Principal Diagnosis : Ectopic Pregnancy, PIH Commented [GLMS31]: If possible find out how long current
Date and Time Admitted : November 5, 2020 at 11:00 pm illnesses have been going on, and obtain dates for any events It
may not be necessary to ask every question, if not pertinent
Date Handled : •Childhood illnesses
•Adult illnesses o Include any recent illnesses (i.e. infection)
IV. Chief Complaints •Surgeries
•Injuries
Irregular vaginal bleeding, abdominal discomfort, weakness, headache, and •Trauma
dizziness. •Screening tests or exams

Commented [GLMS32]: OB HISTORY?

V. Present History of Illness GTPAL?

The patient’s condition started 2 days PTA, when the patient, noticed the bleeding She delivered at 39 weeks for her first pregnancy and at 36 weeks
previously and it is dark red, sufficient for her need to wear a sanitary towel, but not heavy. on her second pregnancy. On her second pregnancy, she was also
admitted prior to conception due to hypertension.
The abdominal discomfort is suprapubic and crampy, slightly more on the right-hand side.
Commented [GLMS33]: “She remembered that she had
She had experienced fever, change in appetite, nausea, or vomiting for four days already.
two episodes of seizures when she was in her teens but
She says that her bowel and urinary habits are usually normal, defecating once to twice a has never reoccurred lately”
day, except for the previous two days wherein she did not yet have any bowel movement.
Commented [GLMS34]: were
Commented [GLMS35]: and
VI. Past History of Illness
The patient had no history of accidents and or trauma, only minor illnesses, such as Commented [GLMS36]: She

cough, colds and fever and was remedied with over the counter medications such as Commented [GLMS37]: •Age/current health status of
parents, siblings and grandparents (if applicable)
Bioflu, and water therapy, with rest. The patient however, was admitted last May 2019 at •Based on judgment could ask about similar symptoms or
Benguet General Hospital Emergency department prior to conception due to hypertension. conditions in family

She received medical interventions such as medications for hypertension and was CAD
discharged home after 5 days of hospitalization. The patient has unrecalled immunization Asthma
Obesity
status and with no history of prolonged case of use of medications such as aspirin or NSAIDs. Kidney Diseases
He also verbalized that she did not have known allergies for foods or medications. Cancer
Commented [GLMS38]: OB Hx:

VII. Family Health History
The patient claims to have familial history of Type 1 Diabetes from his father’s side;
Chronic Hypertension from both her parents’ side; and CVA from her grandfather. No
present illness is currently experienced by any member of the family.
VIII. Developmental History
The patient is a female, 31 years old, married, and already in her 3rd pregnancy ,
She delivered at 39 weeks for her first pregnancy and at 36
weeks on her second pregnancy. On her second
pregnancy, she was also admitted prior to conception due
to hypertension.
Commented [GLMS39]: Mental illness of other conditions?
Commented [GLMS40]: This portion describes significant
patterns of the patient’s behavior in line with his current
stage of development. (Can use other developmental
theories like Erikson, Piaget, Sullivan and others)

and according to Erik Erikson's psychological stage, she is under intimacy vs. isolation which Commented [GLMS41]: Is she the only child ? etc

is appropriate to her age because patient is able to share herself more intimately with Commented [GLMS42]: •Exposure (if applicable, such as
with infections)
others and has a sense of commitments, safety, and care within relationship.
COVID?
Commented [GLMS43]: Add data

IX. Social and Environmental History Commented [GLMS44]: Can you add description of her house
for potential risks?
Patient has smoked for 10 years but already refrained to do so for 2 years. She is a
Commented [GLMS45]: How about the current COVID
Roman Catholic and married to her husband for 8 years. She is currently pregnant and they situation in her area?
are currently residing at Puguis, La Trinidad Benguet,
Commented [GLMS46]: How many stick/s per day? How many
pack years?
Commented [GLMS47]: presently

４
The patient belongs to a family with history of type 1 diabetes from her father’s side, chronic
hypertension from both her parents sides, and Cerebrovascular accident or stroke from her
grandfather, thus making her mindful of any changes with her physical health during her
pregnancy, Commented [GLMS48]: How about water source?

Transportation? Accessibility? Garbage disposal?

X. Lifestyle and Health Practices
Commented [GLMS49]: •Recreation
She is hypertensive and she is mindful of her current health condition because she is • Safety situations
able to go to the hospital and consult with medical professionals with regards to her Commented [GLMS50]: [.]
complaints of having irregular vaginal bleeding, abdominal discomfort, weakness, Commented [GLMS51]: Regular prenatal check ups?
headache and dizziness. Her current sleep is not enough due to discomfort and even Commented [GLMS52]: Underwent COVID swab test?
though she tried to do so she can’t. According to her, she often drinks coffee, coke and
rarely drinks water. She also admitted that she smoked 7-10 sticks of cigarettes for 10 years Commented [GLMS53]: How many pack years?
but she has already quit on doing it 2 years ago. She reported that during intercourse with
her husband, they generally use condoms but there were times that they don’t. She is also
mindful with her health because she submitted herself to have sexual health screen 6
months ago at a genitourinary clinic in which fortunately all her swabs were negative.

XI. Health Assessment

A. General Survey Commented [GLMS54]: Include ht., wt., BMI, body built,
posture and gait, hygiene and grooming, body and
breath odor, signs of distress, obvious signs, attitude,
The patient was received awake, lying on bed, with an ongoing IVF of PLRS I L x 20 affect and mood, speech and thought process.
gtts per minute infusing well on the left arm. Patient appears weak, with limited movements Commented [GLMS55]: her
and slow ambulation. She wears a neat gown, hygiene is fair. Patient is conversant,
conscious and responsive. Speech is well formulated, oriented to the self and others around
her, able to determine the time and date. Patient is easily irritable with poor pain threshold.
No signs of distress noted and thought process is stable.

Commented [GLMS56]: Add data

B. Head to Toe Assessment
Commented [GLMS57]: Parasites?

1. Head The head is normocephalic, no palpable Commented [GLMS58]: Range of motion?

masses and nodules. Hair is well distributed, Commented [GLMS59]: Lesions?

oiliness and flaking noted. Commented [GLMS60]: Add data

Commented [GLMS61]: Periorbital edema?

2. Eyes Eyes were slightly sunken with pinkish
Commented [GLMS62]: PERRLA
conjunctiva. The pupils are equally round
Commented [GLMS63R62]:
and reactive to light and accommodation
Commented [GLMS64]: Constriction or dilation re light
(PERLA was noted). Corrective glasses
accommodation?
were noted for near sightedness. Able to Color?
Lacrimal gland condition?
follow the penlight when assessing the six
fields of gazes. Fine distribution of hair on
Commented [GLMS65]: Alignment?
eyebrows and eyelashes. Presence of dark
Commented [GLMS66]: ask about hearing, hearing aid, recent
circles under the eyes were noted. changes in hearing, ringing in ears (tinnitus),
dizziness (vertigo), ear pain, drainage, etc

3. Ears Able to understand and hear spoken Commented [GLMS67]: Add data

language correctly, with minimal yellowish

cerumen build – up in the ear canal, sliver
and intact tympanic membrane. Both ears
are symmetrical, no lesions and masses
noted.
Commented [GLMS68]: Size? Location ? what assessment was
done?
Commented [GLMS69]: stuffiness, runny nose (rhinorrhea),
postnasal drip, itching, dryness, bleeding (epistaxis), sinus
pain, reduced or enhanced sense of smell, etc
Commented [GLMS70]: Add data

4. Nose and sinuses Nose is patent, septum is located at the
midline, no flaring noted, no tenderness
noted upon palpation. No presence of
discharges.
5. Mouth Teeth are slightly yellow in color, and no
mal-aligned tooth, no dental caries noted.
Commented [GLMS71R70]:
Commented [GLMS72]: about issues with teeth/gums,
bleeding gums, frequency of visiting dentist, sores on tongue,
mouth or lips, fever blisters/cold sores, canker sores, thrush,
tonsillitis, frequent sore throats, hoarseness/voice changes,
etc
Commented [GLMS73]: Add data
Commented [GLMS74]: Tongue description?

５
 Oral mucosa is moist and pinkish, no lesions
noted, tonsils are not inflamed, uvula is
located at the midline.
6. Neck ROM intact, able to change direction of
head slowly without complaints of pain,
carotid pulse are bilaterally symmetrical,
full and strong pulses, 2+, jugular vein is not
distended, superficial cervical lymph nodes
are palpable but non tender. Thyroid and
trachea noted to be located midline, no
enlargement noted.
7. Chest Appearance is symmetrical, along with the
rise and fall of the chest during respiration.
Normal lung sounds on all lobes of the
lungs. No crackles, wheezes, or stridor
noted. Normal chest configuration, no use
of accessory muscles while breathing.
8. Cardiac Normal heart rate noted, no murmurs, no
visible pulsations noted.
9. Breast/Chest Breasts appear symmetrical. Skin color is
similar with the rest of the body, nipple is
dark colored, no discharges.
10. Abdomen Abdomen was soft and non-distended.
Tenderness was noted on deep palpation
in the suprapubic and right iliac fossa
regions. No rebound tenderness and
guarding noted.
11. Genitals Minimal to moderate amount of dark red
bleeding noted. No rashes, lesions and foul
discharges noted.
12. Musculoskeletal Limited movements and slow ambulation
noted. No visible tremors noted.
13. Integumentary The skin is cool to touch with mild edema
noted on upper and lower extremities. Skin
turgor is 3 seconds long with mild edema
noted on the lower extremities.
C. 13 Areas of Assessment
1. Psychosocial and Psychological Status
Patient X is a 31-year-old Filipina, . She is a Roman Catholic, and is a resident of
Puguis, La Trinidad, Benguet. According to Erik Erikson’s stages of psychosocial
development, Patient X falls under the category of Intimacy vs. Isolation, wherein the
patient is more focused on forming intimate, loving relationships with other people. The
patient will start exploring relationships with someone other than a family member that will
lead to a long-term commitment. When intimacy is avoided, or because of the fear of
commitment and relationships, this will then lead to the feelings of isolation, loneliness, and
６
Commented [GLMS75]: Add data
Commented [GLMS76]: Assessment of the thyroid gland?
Commented [GLMS77]: coughing, sputum (including color,
quantity), dyspnea, chest pain, coughing up blood (hemoptysis),
wheezing, dyspnea on exertion, orthopnea, last CXR etc
Commented [GLMS78]: Add data
Commented [GLMS79]: Tenderness or mass noted?
Commented [GLMS80]: cyanosis, syncope, chest pain /
discomfort, palpitations, edema, last EKG, etc
Commented [GLMS81]: Add data
Commented [GLMS82]: ask about lumps,
pain/discomfort/tenderness, self‐examination, last clinical
exam/mammogram, etc
Commented [GLMS83R82]:
Commented [GLMS84]: Add data
Commented [GLMS85]: abdominal pain, not wanting to eat
(anorexia), N/V, diarrhea, constipation, change in bowel
habits/appearance, dysphagia, odynophagia, heart burn,
regurgitation, vomiting blood (hematemesis),
indigestion/bloating, gas, melena, etc
Commented [GLMS86R85]:
Commented [GLMS87]: Add data
Commented [GLMS88]: ask about change in frequency/volume
of urine, polyuria, nocturia, pain/burning on urination, flank pain,
hematuria, urgency, straining, incontinence, change in color/odor,
genital discharge, sores, any other related issues with genitalia, etc
Commented [GLMS89]: Add data
Commented [GLMS90]: muscle pain/tenderness, backache,
joint pain/swelling, tenderness/heat, etc
Commented [GLMS91]: Add data
Commented [GLMS92]: Muscle wasting?
Bruises?
Lesions?
Commented [GLMS93]: ask about rashes, hives, lumps, sores,
itching, dryness, recent changes in skin/hair/nails, etc
Commented [GLMS94]: Add data
Commented [GLMS95]: Pitting?
Commented [GLMS96]: psychiatric/emotional distress,
nervousness/anxiety, mood, personality changes, insomnia,
hallucinations/delusions, etc
Commented [GLMS97]: GTPAL
Commented [GLMS98]: Copy and paste?
sometimes depression. Commented [GLMS99]: Can also add Freud’s theory

The patient is under the genital stage.

2. Mental and Emotional Status Commented [GLMS100]: Add data
Patient X was conscious and responsive, although according to the patient,
Structured assessment of the patient's behavioral and cognitive
because of her poor pain threshold, she tends to be irritated easily at times. functioning. It includes descriptions of the patient's appearance
and general behavior, level of consciousness and attentiveness,
motor and speech activity, mood and affect, thought and
3. Environmental Status perception, attitude and insight
Patient X stayed in the OB ward in Benguet General Hospital, along with her
Commented [GLMS101]: Is she also coherent?
husband. The surroundings are clean and properly ventilated. Her bed was 2nd from the last Oriented to time and place?
Does she act according to her age?
cubicle at the end of the ward. There also seemed to be adequate lighting shining through
the entire ward and also adequate distances between each cubicle – providing a Commented [GLMS102]: COVID situation?

comfortable space and allowing for privacy of the patient. Commented [GLMS103]: environmental factors that affects
client’s road to recovery. Recognized environmental factors that
contribute to positive patient outcomes and improve patients'
4. Sensor Status experiences in hospital environments.

a. Visual Status – Corrective glasses were noted for near sightedness. Sunken eyes
noted with pinkish conjunctiva. Able to follow the six fields of gazes with ease. Dark
circles were noted under the eyes.

b. Auditory – Color of the pinna is the same as the rest of the face, top of the ear is
aligned with the outer cantus of the eye. Able to understand words properly without
the need to repeat.

c. Olfactory Status – the nose is positioned on the midline of the face, size is
proportional to the face and has the same color with the rest of the face. Septum is
located at the midline with no visible lesions noted. Patient was able to differentiate
the different scents.

d. Gustatory Status – Teeth are yellowish in color, lips are slightly brown in color and no Commented [GLMS104]: 5 taste buds?
lesions were noted. Able to distinguish various tastes.

e. Tactile Status – No masses, no wounds. Cool to the touch with mild edema noted
on her upper and lower extremities. Slow skin turgor of 3 seconds long.
5. Motor Status
The patient has limited movements and slow ambulation.
6. Thermoregulatory Status – Normal temperature for 31-year-olds is 36.5 – 37.5 degrees
Celsius. The patient’s temperature ranges from 36.5 – 37.5 degree Celsius which is within the
normal range.
Commented [GLMS105]: Is she able to differentiate light and
firm touch?
Able to perceive heat, cold and pain in proportion to stimulus?
Sensitive to pressure?
Commented [GLMS106]: Performed a -based scale that was
developed as a means of assessing everyday Motor function of the
patients.
Commented [GLMS107]: Thus, does she need assistance in
doing her ADLS?

Date Time Temperature

8am 37 °C
November 5, 2020 10am 37.5 °C
2pm 37 °C
4pm 37.3 °C
8am 36.5 °C
November 6, 2020 10am 37.4 °C
2pm 37.3 °C
8am 36.7 °C
November 7, 2020 10am 37 °C
2pm 37 °C

7. Respiratory Status - Normal respiratory rate for 31-year-olds is 16 – 20 cpm while the
normal oxygen saturation ranges from 95 – 100%. The patient’s respiratory rate ranges from
16 – 20 cpm which is within the normal range.

Date Time RR SPO2

７
 8am 20 cpm 98%
November 5, 2020 10am 18 cpm 95%
2pm 20 cpm 97%
4pm 19 cpm 97%
8am 20 cpm 97%
November 6, 2020 10am 16 cpm 96%
2pm 16 cpm 97%
8am 18 cpm 98%
November 7, 2020 10am 19 cpm 96%
2pm 20 cpm 97%

8. Circulatory Status - Normal cardiac rate for 31-year-olds is 60 – 100 bpm, while the normal Commented [GLMS108]: BP?
range for capillary refill is 1-2 seconds. The patient’s cardiac rate ranges from 78 – 99 bpm
which is within the normal range for adults. The patient’s capillary refill also, is 1-2 seconds
long which is within the normal capillary refill range.

Commented [GLMS109]: Add data

Date Time CR Capillary
8am 97 bpm Elaborated dietary, biochemical, and anthropometric
measurements as nutritional assessment methods that can be
November 5, 2020 10am 85 bpm 1-2 seconds applied in all forms of nutritional assessment system.
2pm 99 bpm Commented [GLMS110]: Patient has hypertension
4pm 78 bpm
Treatment depends on how close you are to your due
8am 82 bpm date. If you are close to your due date and the baby is
developed enough, your health care provider may want to
November 6, 2020 10am 80 bpm 1-2 seconds deliver your baby as soon as possible.
2pm 82 bpm If you have mild hypertension and your baby is not fully
developed, your doctor will probably recommend the following:
8am 82 bpm •Rest, lying on your left side to take the weight of the
baby off your major blood vessels.
November 7, 2020 10am 78 bpm 1-2 seconds •Increase prenatal checkups.
2pm 82 bpm •Consume less salt.
•Drink 8 glasses of water a day.
If you have severe Hypertension, your doctor may try to
treat you with blood pressure medication until you are far
9. Nutritional Status enough along to deliver safely.
The patient noted that she has had a change in appetite.
Commented [GLMS111]: Add more assessment… what else?
Her intake? Her diet? etc
10. Elimination Status
Commented [GLMS112]: Intervention?
The patient reported to have a decreased urine output wherein she only urinated
Commented [GLMS113]: Add data
thrice a day. She also verbalized that she defecates once or twice a day, except for the
previous day wherein she did not yet have any bowel movement. Asses client need for sleep/rest and intervene as needed
Applied knowledge of client pathophysiology to rest and sleep
interventions. Scheduled client care activities to promote adequate
11. Sleep, Rest and Comfort Status rest
The patient reported that she was able to sleep less than 5 hours due to the Commented [GLMS114]: Assess client need for sleep/rest and
discomfort she felt. She tried taking naps but was unable to do so. intervene as needed
Applied knowledge of client pathophysiology to rest and sleep
interventions. Scheduled client care activities to promote adequate
12. Fluids and Electrolytes Status res

The patient reported that she often drinks 5 cups of coffee a day, 1-2 cans of coke
every after two days and minimal daily water intake. She also added that he only drinks 3
glasses maximum of water a day. The patient also had 1L of PLRS, set to a rate of 20
gtts/min.
Commented [GLMS115]: Symptoms of ectopic
pregnancy
The symptoms of ectopic pregnancy can mimic miscarriage or
the symptoms of other reproductive disorders, such as pelvic
inflammatory disease (PID) or endometriosis. An ectopic
pregnancy can first appear as a normal pregnancy.

The symptoms of ectopic pregnancy can include:

13. Integumentary Status •the usual signs of pregnancy, such as amenorrhoea
(missed period), morning sickness and breast tenderness
The patient’s skin feels cool to touch with mild edema noted on her upper and lower •pain in the lower abdomen
•pain in the lower back
extremities. Skin turgor is 3 seconds long.
•cramps on one side of the pelvis
•vaginal bleeding or spotting
•sudden and severe pain in the lower abdomen (if the
fallopian tube ruptures).

Commented [GLMS116]: Assess the integument ary system

and involved inspection and palpation of the skin, hair, scalp, and
nails. Findings included.
Commented [GLMS117]: Add data

Assessed the integument ary system and involved inspection and

palpation of the skin, hair, scalp, and nails. Findings included.

８
XII. Diagnostics
Diagnostic Description of Procedure
Procedure
Complete A complete blood count is a
Blood Count blood test used to evaluate
the client’s overall health and
detect a wide range of
disorders, including anemia,
infection and leukemia. And
to determines if there are any
increases or decreases in your
blood cell counts. Normal
values vary depending on
your age and your gender.
Your lab report will tell you the
normal value range for your
age and gender.
Significance/Purpose of Date of Procedure Findings Implications Commented [GLMS118]: Relate it to your patient’s case
the Procedure
Is a very common test to November 05, 2020 Red Cell Count – 4.18 x
help determine general 1012/L
status and can help
Mean Platelet Volume 8.0
diagnose a broad range of Fl
conditions, from anemia
and infection to cancer. Platelet 302 x 109 /L RBC, MPV, Platelet,
Haemoglobin, Eosinophils,
Haemoglobin 12.3 g/dL
Lymphocytes, and Nucleated
Eosinophils 0.4 x 109 /L RBC are within normal range
Lymphocytes 2.6 x 109 /L
Nucleated RBC 0 x 109 /L
White Cell Count + 14.2 x WBC, MCH,MCHC, RDW,
109/L neutrophils, monocytes are
MCH 88.7 Fl above normal range signs that
MCHC 29.3 Pg there is a presence of infection.
RDW 33.0 g/dL And the body is not able to get
Neutrophils ++ 10.3 x 109 /L as much as oxygen to go
Monocytes 0.9 x 109 /L throughout the body.
9
Basophils – 0.0 x 109 /L Basophils and MCV are within
below normal indicates that
MCV 37.1%
there is low oxygen in the blood
due to imbalance between
demand and supply of the
blood and presence of infection.

10
Urinary A human chorionic
pregnancy gonadotropin (hCG) urine test
test is a pregnancy test. A
pregnant woman's placenta
produces hCG, also called the
pregnancy hormone. If you're
pregnant, the test can usually
detect this hormone in your
urine about a day after your
first missed period.
The hCG urine test is a
qualitative test, which
means that it will tell you
whether or not it detects
the hCG hormone in your
urine. It's not intended to
reveal specific levels of the
hormone. The presence of
hCG in your urine is
considered a positive sign
of pregnancy
November 05, 2020 6,500 mIU per Ml ; positive Having a positive test means that
you are pregnant. False-positive
urine pregnancy tests may put
patients at risk for unnecessary
treatment. It is important to
confirm a suspected false-
positive urine hCG test using a
quantitative serum hCG test.
11
Urinalysis A urinalysis is simply an analysis
of the urine. It is a very
common test that can be
performed in many health
care settings including
doctor’s offices, urgent care,
facilities, laboratories,
hospitals, and even at home.
Sodium This test is performed on a
blood sample, obtained by
venipuncture. A technician
will insert a small needle into a
vein on your arm or hand. This
will be used to fill a test tube
with blood.
Urinalysis can disclose November 05, 2020 Protein trace, blood Urine is normally clear. Bacteria,
evidence of disease even negative, nutrites negative blood, sperm, crystals, or mucus Commented [GLMS119]: Relevance to client
some that have not and leukocytes negative. can make urine look cloudy.
caused significant signs or
symptoms. Therefore, a
urinalysis is commonly a
part of routine health
screening.
A sodium test checks how November 05, 2020 139 mmol/L Normal sodium levels are usually
much sodium is in the between 136 and 145 millimoles
blood. Sodium is both an per liter (moll/L). Blood sodium
electrolyte and mineral. It levels below 136 mmol/L may
helps keep the water (the mean you have low blood
amount of fluid inside and sodium “hyponatremia”
outside the body's cells)
and electrolyte balance of
the body. Sodium is also
important in how nerves
and muscles work.
12
Potassium Potassium is an electrolyte.
Electrolytes become ions
when they’re in a solution,
and they conduct electricity.
Our cells and organs require
electrolytes to function
normally. A potassium test is
performed as a simple blood
test and carries few risks or
side effects. The blood sample
drawn will be sent to a
laboratory for analysis. Your
doctor will review the results
with you.
Urea A blood urea nitrogen (BUN)
test measures the amount of
nitrogen in your blood that
comes from the waste
product urea. Urea is made
when protein is broken down
in your body. Urea is made in
the liver and passed out of
your body in the urine.
A potassium test is used to
measure the amount of
potassium in your blood.
Potassium is an electrolyte
that's essential for proper
muscle and nerve
function. Even minor
increases or decreases in
the amount of potassium
in your blood can result in
serious health problems.
The urine urea nitrogen
test determines how much
urea is in the urine to
assess the amount of
protein breakdown. The
test can help determine
how well the kidneys are
functioning and whether
your intake of protein is too
high or low. Additionally, it
can help diagnose
whether you have a
problem with protein
digestion or absorption
from the gut.
November 05, 2020 4.0 mmol/L Normally, your blood potassium
level is 3.6 to 5.2 millimoles per
liter (mmol/L).
November 05, 2020 2.3 mmol/L In general, around 7 to 20 mg/dL
(2.5 to 7.1 mmol/L) is considered
normal. Low urea levels are not
common and are not usually a
cause for concern. They can be
seen in severe liver disease or
malnutrition but are not used to
diagnose or monitor these
conditions. Low urea levels are
also seen in normal pregnancy.
13
Commented [GLMS120]: A urea test is done to see
how well your kidneys are working. If your
kidneys are not able to remove urea from the
blood normally, your urea level rises. Heart
failure, dehydration, or a diet high in protein can
also make your urea level higher. Liver disease
or damage can lower your urea level. A low urea
level can occur normally in the second or
third trimester of pregnancy.
Commented [GLMS121]: 2.5 – 4.3 in first trimester
http://perinatology.com/Reference/Reference%20Ranges/Urea.ht
m
Creatinine A creatinine blood test A creatinine test is used to November 05, 2020 54 umol/L The normal range for creatinine Commented [GLMS122]: Normal
measures the level of see if your kidneys are in the blood may be 0.84 to 1.21 35 - 62
creatinine in the blood. working normally. It's often milligrams per deciliter (74.3 to
Creatinine is a waste product ordered along with 107 micromoles per liter),
that forms when creatine, another kidney test called although this can vary from lab
which is found in your muscle, blood urea nitrogen (BUN) to lab, between men and
breaks down. Creatinine levels or as part of a women, and by age.
in the blood can provide your comprehensive metabolic
doctor with information about panel (CMP). A CMP is a
how well your kidneys are group of tests that provide
working. information about different
organs and systems in the
body.

Liver function A liver function test measures Liver function tests are November 05, 2020 Albumin – 33 g/L Total Albumin, Total protein, Bilirubin,
test enzymes, proteins, and other blood tests used to help Protein 68g/L Bilirubin ALT, ALP are in a normal range.
substances that are produced diagnose and monitor liver total 6 umol/L ALT 19
or excreted by the liver, such disease or damage. The u/L ALP + 141 u/L
as alanine aminotransferase tests measure the levels of
(ALT), alkaline phosphatase certain enzymes and
(ALP), aspartate proteins in your blood.
aminotransferase (AST),
gamma-glutamyl
transpeptidase (GGT),
bilirubin, and albumin.

14
Serum uric A uric acid blood test, also
acid known as a serum uric acid
measurement. The test can
help determine how well your
body produces and removes
uric acid. Uric acid is a
chemical produced when
your body breaks down foods
that contain organic
compounds called purines.
Laparoscopic A laparoscopy is a type of
test surgery that checks for
problems in the abdomen or a
woman's reproductive system.
Laparoscopic surgery uses a
thin tube called a noninvasive methods are
laparoscope. It is inserted into
the abdomen through a small
incision. An incision is a small a
cut made through the skin
during surgery.
Uric acid blood test can
help determine how well
your body produces and
removes uric acid.
Laparoscopy is often used
to identify and diagnose
the source of pelvic or
abdominal pain. It’s
usually performed when
unable to help with
diagnosis.
November 05, 2020 Uric Acid 371 umol/L Uric acid level is normal Commented [GLMS123]: Please review the normal
Commented [GLMS124]: Hyperuricemia is a common finding
in preeclamptic pregnancies evident from early pregnancy. Despite
the fact that elevated uric acid often pre-dates the onset of clinical
manifestations of preeclampsia, hyperuricemia is usually
considered secondary to altered kidney function. Increased serum
uric acid is associated with hypertension, renal disease and adverse
cardiovascular events in the non-pregnant population and with
adverse fetal outcomes in hypertensive pregnancies.
November 05, 2020 Distended right uterine An ectopic pregnancy is when a Commented [GLMS125]: Laparoscopic surgery is done to
tube, showing the typical fertilised egg implants itself remove the embryo and attempts are made to repair the fallopian
tube.
bluish bulge. There is no outside of the womb, usually in
evidence of blood in the one of the fallopian tubes. The
pouch of Douglas to fallopian tubes are the tubes
suggest rupture of the connecting the ovaries to the
ectopic pregnancy. womb. If an egg gets stuck in
them, it won't develop into a
baby and your health may be at
risk if the pregnancy continues.
15
Transvaginal A transvaginal ultrasound, also Transvaginal ultrasound is November 05, 2020 A pregnancy in the Adnexa refer to the anatomical
ultrasound called an endovaginal an examination of the adnexa. area adjacent to the uterus, and
scan ultrasound, is a type of pelvic female pelvis. It helps to contains the fallopian tube,
ultrasound used by doctors to see if there is any ovary, and associated vessels,
examine female reproductive abnormality in the uterus ligaments, and connective
organs. This includes the (womb), cervix (the neck tissue.
uterus, fallopian tubes, ovaries, of the womb),
Majority of the adnexal masses
cervix, and vagina. endometrium (lining of the
diagnosed in pregnancy are
“Transvaginal” means womb), fallopian tubes,
benign and will resolve
“through the vagina.” This is ovaries, bladder or the
spontaneously. Consequently, in
an internal examination. pelvic cavity.
the absence of symptoms or
sonographic findings concerning
malignancy, patients should be
managed expectantly.

16
XIII. Comprehensive Pathophysiology Commented [GLMS126]: MODIFY

INCOMPLETE

NCP FOLLOWS

Risk factor SMOKING

↓

IMPLANTATION OF DEVELOPING BLASTOCYSTS

OUTSIDE THE UTERINE CAVITY

↓ → EMBRYO AND TROPHOBLAST Death

ECTOPIC
PREGNANCY
↓

PENETRATION OF OVUM INTO MUSCULAR

WALL OF FALLOPIAN TUBE

MATERNAL BLOOD SEEPS INTO TUBAL TISSUE AND LEAKS INTO PERITONEALCAVITY

↓ ↓

Tubal distention
Abdominal Vaginal bleeding
↓ cramp/pain
Tubal rupture

Intra – abdominal hemorrhage

Dizziness / ↓ level of consciousness

syncope/ weakness / headache/ shock

17
XIV. Treatment/Management

A. Drugs

DRUG NAME MECHANISM OF ACTION INDICATION / ADVERSE EFFECT NURSING RESPONSIBILITIES Commented [GLMS127]: categorize your NURSING
CONTRAINDICATION IMPLICATION as to Before, During and After giving the
medication and each has Dx, Tx and EDx for DRUG
Generic Name: -Thought to produce CONTRAINDICATION: CNS: Agitation, cerebral Before: STUDY.
ASPIRIN analgesia and exert it’s -Contraindicated in those edema, coma, -Monitor salicylate level.
-Assess hematocrit, Hb level, PT, INR,
anti- inflammatory effect with NSAID- induced confusion, dizziness, and renal function.
Brand Name: by Inhibiting sensitivity reactions, G6PD headache, lethargy,
Asaphen, Asatab prostaglandin and other deficiency or bleeding seizures, subdural or During:
substances that sensitize disorders such as intracranial hemorrhage. -Monitor patient for sensitivity such
Pharmacologic Class: pain receptors. Drug may hemophilia, Von CV: Arrythmias, as anaphylaxis and asthma.
-Administer the drugs with food, milk,
Salicylates relieve fever through Willebrand disease, hypotension, antacid, or large glass of water to
Therapeutic Class: central action in the bleeding ulcers and tachycardia, reduce GI reactions.
NSAIDs hypothalamic heat- hemorrhagic states. EENT: Tinnitus, hearing
regulating center. In low -Severe hepatic loss. After:
Dosage: doses, drug also appears impairment and active GI: Nausea, GI bleeding, -Introduce low salt diet (1 tab of
Aspirin contains 553 mg of sodium).
81 mg OD to interfere with clotting peptic ulcer disease. dyspepsia, GI distress, -Remind patient not to stop
by keeping a platelet- -Chicken pox and Flulike occult bleeding, medication without first discussing to
Route: aggregating substance symptoms. pancreatitis, vomiting. the prescriber.
Oral from forming. GU: Antepartum and -Advise patient to take the drug
INDICATIONS: post-partum bleeding, same time each day.
-Encourage the use of soft-bristle
-Mild pain or fever interstitial nephritis, brush.
prolonged pregnancy
and labor, proteinuria,
renal failure.
HEMATOLOGIC:
Prolonged bleeding time,
leukopenia,
18
thrombocytopenia.
HEPATIC: Hepatitis
METABOLIC: Dehydration.
Hyperkalemia, metabolic
acidosis, hyperglycemia,
hypoglycemia(children),
respiratory alkalosis.
SKIN: Rash, bruising,
urticaria, hives.
OTHER: Angioedema,
Reye syndrome, low birth
weight (infants), stillbirth.

19
20
 DRUG NAME MECHANISM OF ACTION INDICATION / ADVERSE EFFECT NURSING RESPONSIBILITIES Commented [GLMS128]: your NURSING IMPLICATION
CONTRAINDICATION as to Before, During and After giving the medication
and each has Dx, Tx and EDx for DRUG STUDY.
Generic Name: -Replaces calcium and CONTRAINDICATIONS: CNS: Tingling sensation Before:
Calcium maintains calcium level. -Bone metastases, and in CV: Bradycardia, -Monitor calcium level frequently.
-Monitor symptoms of
those with ventricular arrythmias, cardiac hypocalcemia.
Brand Name: fibrillation, arrest, vasodilation -Monitor pulse, blood pressure, and
Cal-Citrate hypophosphatemia, renal GI: Constipation, Irritation, ECG frequently.
calculi chalky taste, nausea,
Therapeutic Class: vomiting thirst, abdominal During:
-Make sure to administer drugs after
Calcium Supplements INDICATIONS: pain meals and at bedtime.
-Hypocalcemia GU: Polyuria, renal calculi -Check the medication to be
Pharmacologic Class: -Dietary supplement METABOLIC: administered.
Calcium Salts -Hyperphosphatemia Hypercalcemia
SKIN: Local reactions, After:
-Tell patient to take oral calcium 1 to
Dosage: necrosis, tissue sloughing, 1 and half hours after meals if GI
1.5g OD cellulitis upset occurs.
-Advise patient to notify the
Route: prescriber if taking OTC products
Oral such as iron.
-Tell patient to report anorexia,
nausea, vomiting, constipation,
abdominal pain, dry mouth, thirst
and polyuria.

21
 DRUG NAME MECHANISM OF ACTION INDICATION / ADVERSE EFFECT NURSING RESPONSIBILITIES
CONTRAINDICATION
Generic Name: -Interferes with folic acid CONTRAINDICATION: CNS: Arachnoiditis, Before:
Methotrexate metabolism. Result is -Hypersensitivity malaise, fatigue, dizziness, -Monitor pulmonary function test
and fluid intake and output.
inhibition of DNA synthesis -Pregnancy and Lactation fever, aphasia. -Monitor uric acid level.
Brand Name: and cell reproduction. -Active infections CV: Chest pain, -Monitor for symptoms of pulmonary
Trexall Also has -Chronic debilitating Hypotension, pericarditis. toxicity.
immunosuppressive illnesses EENT: Pharyngitis, blurred
Therapeutic Class: activity. -Renal and Hepatic vision During:
-Clarify all ambiguous order, check
Antineoplastics impairment GI: Gingivitis, stomatitis, single, daily, and course of therapy
GI bleeding dose limits.
Pharmacologic Class: GU: Renal failure, tubular -Observe the patient for any
Folate Antagonist INDICATIONS: necrosis. Nausea, symptoms during administration.
Dosage: -Trophoblastic neoplasms vomiting -Inform the patient that this may
cause dizziness and blurred vision.
15mg HEMATOLOGIC:
Leukopenia, After:
Route: thrombocytopenia -Advise patient to avoid caffeine-
Oral HEPATIC: Acute toxicity, containing beverages.
chronic toxicity, hepatic -Emphasize the importance of
follow-up exams to monitor progress.
fibrosis
METABOLIC: Diabetes
MUSCULOSKELETAL:
Arthralgia, myalgia,
RESP: Pulmonary interstitial
infiltrates, pneumonitis
SKIN: Urticaria, pruritis,
hyperpigmentation,
alopecia, acne,
22
photosensitivity reactions
and ecchymoses.
OTHERS: Septicemia,
sudden death.

23
 DRUG NAME MECHANISM OF ACTION INDICATION / ADVERSE EFFECT NURSING RESPONSIBILITIES
CONTRAINDICATION
Generic Name: -A direct- acting CONTRAINDICATION: CNS: Headache, Before;
Hydralazine peripheral vasodilator -Hypersensitivity dizziness, peripheral -Monitor patients BP, pulse rate, and
weight frequently.
Hydrochloride that relaxes arteriolar -Mitral valvular rheumatic neuritis - Obtain CBC, lupus erythematous
smooth muscle. heart disease CV: Angina pectoris, cell preparation and ANA titer
Brand Name: -Cardiac disease, stroke palpitations, tachycardia, determination before therapy
Apresoline -Severe renal impairment orthostatic hypotension, -Advise patient to report all adverse
edema reactions and to avoid sudden
posture changes and to rise slowly
Therapeutic Class: INDICATION: EENT: Conjunctivitis. Nasal to avoid dizziness upon standing.
Antihypertensives -Hypertension congestion -Advise patient to take drug in the
GI: Nausea, vomiting, morning to avoid need to urinate at
Pharmacologic Class: diarrhea, constipation, night.
Peripheral dilators paralytic ileus
During;
GU: Difficult urination -Monitor frequency of prescription
Dosage: HEMATOLOGIC: refills to determine adherence.
10mg q 6˚ x 3 days Neutropenia, leukopenia, - Administer the medication with
10mg IV PRN agranulocytosis, meals to the patient.
thrombocytopenia -Advise patient to consult health
provider before taking Rx, OTC and
Route: MUSCULOSKELETAL: herbal medicines
Oral Muscle cramps, arthralgia
IV RESP: Dyspnea After;
SKIN: Rash - Monitor intake and output ratios
OTHERS: Hypersensitivity, daily and weight.
- Don’t confuse hydralazine with
chills hydroxyzine
-Advise patient to consult health
provider before taking Rx, OTC and
herbal medicines.
24
 DRUG NAME MECHANISM OF ACTION INDICATION / ADVERSE EFFECT NURSING RESPONSIBILITIES
CONTRAINDICATION
Generic Name: -Thought to inhibit CONTRAINDICATIONS: CNS: Dizziness,
Nifedipine calcium ion influx across -Hypersensitivity headache, light- Before;
cardiac and smooth -Angina, MI headedness, -Monitor BP and HR regularly.
-Administer drug with meals if GI
Brand Name: muscle cells, decreasing -Hepatic Failure nervousness, sleep irritation becomes a problem.
Adalat CC, Procardia contractility and oxygen -Major surgery disturbance -Advise patient to take medication
demand. Drug may also -Severe aortic stenosis CV: Flushing, heat exactly as directed, even if feeling
Therapeutic Class: dilate coronary arteries -chronic renal failure sensation, peripheral well.
Antihypertensives and arterioles. edema, palpitations
During;
INDICATIONS: EENT: Nasal congestion, - Monitor intake and output ratios
Pharmacologic Class: -Hypertension sore throat, blurred vision. daily and weight.
Calcium channel -Vasospastic angina GI: Nausea, heartburn, - Watch for symptoms of HF.
blockers -Ureteral Calculi diarrhea, constipation, - Advise patient to avoid driving or
flatulence doing other activities.
Dosage: MUSCULOSKELETAL: After;
30 mg Muscle cramps, tremor, -Assess signs of CHF such as
joint stiffness peripheral edema, dyspnea and
Route: RESP: Dyspnea, cough, rales/crackles.
Oral wheezing, shortness of - Raise side rails, because this may
cause drowsiness.
breath - Advise patient to notify physician if
SKIN: Dermatitis, pruritus, irregular heartbeat, dyspnea,
sweating swelling of hands and feet, dizziness,
OTHERS: difficulties in constipation or hypotension occurs
balance, chills, sexual
difficulties

25
B. IV Fluids

Name Classification Component/s Use & Effects Nursing Responsibilities Commented [GLMS129]: Before
During
1. PLRS Isotonic - calcium chloride: 0.02 - to treat dehydration. - Observe for signs of fluid overload. after
grams. - Monitor manifestation of continued
- to facilitate the flow of IV
-potassium chloride: medication during surgery. hypovolemia.
0.03 grams. - Check and regulate the drop rate.
- to restore fluid balance after - Elevate the head of the bed at 35
-sodium chloride: 0.6 significant blood loss or burns. to 45 degrees.
grams.
- to keep a vein with an IV - Change the IV Fluid Solution
-sodium lactate: 0.31 catheter open. - Check the level of IV Fluid.
grams. - Elevate the patient’s leg.
- Check integrity of IV Solutions.
-water
Effects: - Educate Patient and Watcher to
- swelling recognize signs and symptoms of
- edema fluid overload.
- chronic kidney disease
- congestive heart failure
- hypo-albuminemia
- cirrhosis

26
C. Surgery
LAPAROSCOPY

XV. Nursing Care Plans

A. Prioritization of Problems

a.1. List of Problems

1. Acute pain related to abdominal discomfort
2. Ineffective tissue perfusion related to vasoconstriction of blood vessels
3. Infection related to compromised secondary defenses
4. Disturbed sleeping pattern related to abdominal pain
5. Risk for fluid volume deficit

a.2. Basis for Prioritization

NURSING DIAGNOSES JUSTIFICATION

Acute pain related to abdominal In order to achieve the Maslow’s hierarchy of needs,
discomfort an individual must be capable of doing things
without alteration or pain. This is an actual problem
because pain causes changes to the client’s
homeostasis and can affect the treatment and
cooperation of the patient. This must be address first
before proceeding to other problems. Pain is
considered as 5th vital sign and needs an
immediate intervention. The patient also verbalized
that she has low pain threshold. Pain can also affect
the ABC by increasing the blood pressure and
respiratory rate.

Ineffective tissue perfusion Ineffective tissue perfusion r/t vasoconstriction

related to vasoconstriction of would be the second priority because basing on
blood vessel ABC it affects the blood circulation and distribution
of oxygen and nutrients to the body tissues. The lack
of an adequate energy supply leads to the buildup
of waste products and failure of energy-dependent
functions, release of cellular enzymes, and
accumulation of calcium and reactive oxygen
species (ROS) resulting in cellular injury and
ultimately cellular death.

Infection related to Infection can affect the ABC by worsening the

compromised secondary blood flow to vital organs, such as your brain, heart
defenses and kidneys, becomes impaired. Sepsis can also
cause blood clots to form in your organs and in your
arms, legs, fingers and toes — leading to varying
degrees of organ failure and tissue death.
Compromised body defense can affect the ABC
specially the circulation, altering the normal values.

Disturbed sleeping pattern Sleep and rest belongs to the Biological and
related to abdominal pain Physiological needs In Maslow’s Hierarchy of needs .
Sleep is required to regain energy for physical and
mental activities.

Sleep deprivation negatively affects ventilatory,

circulatory, immunologic, hormonal and metabolic
stability. Sleep deprivation also impacts a person’s
ability to perform physical activities and affects

27
 cognitive function as evidenced by delirium,
depression and other psychiatric impairments.

Risk for deficient fluid volume This would be the last priority because their is no
presence of the actual problem and it doesn’t have
enough data to support the need of urgency.

28
 B. Nursing Care Plans

NCP 1: Acute Pain related to Abdominal Discomfort

Assessment Explanation of the Objective Nursing Intervention Rationale Evaluation
Problem Commented [GLMS130]: Customize it too that it is related to
your client
SUBJECTIVE: Ectopic pregnancy is STO: DX: DX: STO:
Commented [GLMS131]: PQRST of Pain?
gestation located
- “Masakit ang After 8 hours of nursing Assess the client’s perception, -To identify and assess the nursing Goal is met - After 5
outside the uterine
tiyan ko” as intervention, the patient level of understanding and interventions to be done hours of nursing
cavity. The fertilized
verbalized by will be able to: needs intervention, the pain is Commented [GLMS142]: One evaluation for every objective
the patient ovum implants outside
relieved and controlled
- The patient of the uterus, usually in • demonstrate the use
and the patient was
reported to the fallopian tube. of diversional activities
-Pain is a subjective data that able to demonstrate
have a poor Predisposing factors and relaxation skills to Assess the severity, frequency, Commented [GLMS135]: Assess duration and type of pain,

manage pain. and characteristic of pain should be reported and to the use of watching characteristics (intensity, quality, onset, alleviating or aggravating
pain threshold includes adhesions of the factors), severity by a standard pain scale, and location
tube, saltingitis, • be relieved from the determine patient’s level of pain movies and listening to
Commented [GLMS138]: Characteristics and location of pain
pain or will be able to music to distract herself
congenital and indicate cause. Uterine contractions and cramping pain occur with
control the pain felt. from the pain. spontaneous abortion (SAB) or GTD. Ectopic pregnancy may yield
developmental dull aching or severe pain (with ruptured fallopian tube). Abruptio
OBJECTIVE: anomalies of the -Increased pain and abdominal placenta (concealed) may cause severe abdominal pain.
Monitor for increase and pain
fallopian tube, review distention indicates rupture and Commented [GLMS134]: how will you measure?
- Facial mask of ectopic pregnancy. Use and abdominal distention and
possible intra-abdominal
pain rigidity
of an intrauterine device haemorrhage
(grimacing) Commented [GLMS132]: restless?
for more than 2 years, LTO:
- Tenderness on Crying?
multiple induced LTO: Moaning?
deep Monitor complete blood count -To determine the amount of
abortions, menstrual After 72 hours of nursing
palpation in (CBC) blood loss Goal partially met -
the reflux, and deceased intervention, the patient
After 72 hours of
suprapubic tubal motility. will be able to maintain
nursing intervention,
and right iliac the absence of signs and
the patient still showed
fossa regions symptoms of pain and will
occasional signs of
- Easily irritated display an improvement TX:
TX: pain but was able to
- Limited in mood.
movements display an
Provide comfort measure like

29
 - Slow Reference: back rubs, deep breathing. -Promotes relaxation and ease improvement in mood. Commented [GLMS139]: Positioning in labor affects anatomic
ambulation the pain felt. and physiologic responses (i.e., alters cardiac output, enhances or

- BP- 140/60 https://www.webmd. reduces effectiveness of uterine contractions, synchronizes

abdominal muscle work, and reduces pressure on the preterm fetal
mmHg head). Frequent position changes increase comfort and circulation
com/baby/ and relieve fatigue
Instruct in relaxation or
pregnancy-ectopic- -Promotes relaxation and may Commented [GLMS133]: Alteration in BP
visualization exercise.
pregnancy enhance patient’s coping abilities Commented [GLMS136]: Teach and assist with appropriate
nonpharmacologic methods of pain relief (e.g., breathing and
by refocusing attention relaxation techniques, application of heat or cold, hydrotherapy,
acupressure, effleurage to the abdomen or continuous and firm
NURSING DIAGNOSIS: sacral pressure during each contraction, relaxation conditioned in
Provide directional activities response to the partner’s touch, massage, and music).
Acute pain related to
-Diversional activities aids in Commented [GLMS140]: Nonpharmacologic methods reduce
abdominal stress, relieve body tension by promoting relaxation, often
refocusing attention and
discomfort increase endorphin levels, and have fewer side effects than
enhancing coping with limitations medications. Sacral pressure relieves strain put on the sacroiliac
joint from the fetal head in the occiput posterior position.
Administer analgesics as Commented [GLMS137]: Position for comfort and physiologic
indicated response; promote position changes q30min while the patient is
-To maintain acceptable level of awake.
pain Commented [GLMS141]: The goal of medication
administration is to adequately relieve pain without causing
maternal or fetal risk. Seven rights of administration means right
drug, right dose, right preparation, right route, right time, right
EDX: patient, and right documentation.
EDX:
Encourage early ambulation
-To promote blood circulation

Instruct the client to avoid

strenuous activities and exercise -To prevent for further bleeding

30
NCP 2: Ineffective tissue perfusion related to vasoconstriction of blood vessels
Assessment Explanation of the Objective Nursing Intervention Rationale Evaluation
Problem
Subjective: Increased in cardiac STO: DX: DX: Short term:
output that injures the
“Sumasakit ulo ko at Within 5 hours of nursing Monitor blood pressure regularly -To have a baseline data of blood Goal met - After 8 hours
endothelial cells of the
nahihilo naman ako” interventions, the patient pressure of nursing interventions,
arteries and the action of
as verbalized by the will be able to reduce the the patient’s blood
prostaglandins.
patient blood pressure within the pressure was reduced
Vasoconstriction occurs
normal range. -To prevent fluid and sodium from 140/100 mmHg to
and due to stressful Monitor intake and output of
experiences or negative the patient retention in the body and reduce 120/80 mmHg.
Objective: mood states the blood BP

- Mild edema pressure increases.

on upper and LTO:
lower TX: TX:
Long term:
extremities Within 48-72 hours of
Assist with position changes. -Gently repositioning patient from
- Skin is cool to giving effective nursing Goal met - After 48-72
Reference: a supine to sitting/standing
touch interventions, the patient hours of giving
position can reduce the risk of
- Basophils – 0.0 will be able to maintain effective nursing
Traum, A., & Somers, M., orthostatic BP changes.
x 109 /L adequate tissue interventions, the
(2007). Blood Pressure.
- MCV 37.1% perfusion. patient was able to
- BP: 140/100 Blood pressure-an
maintain adequate
mmHg overview l Science Direct -It conserves energy lowers tissue tissue perfusion as
Topics. Retrieved from Provide a quiet and restful
oxygen demand evidenced by absence
https://www.science environment
of edema on the upper
direct.com/topics/ and lower extremities,
-Antihypertensive drugs help warm skin and normal
immunology-and- Administer antihypertensive
decrease and control blood MCV levels.
NURSING DIAGNOSIS microbiology/blood- drugs as ordered
pressure
Ineffective tissue pressure
perfusion related to

31
vasoconstriction of EDX: EDX:
blood vessels
Advice low-fat and low self-diet -To maintain a normal BP and
reduce weight

-Increasing intake of fruits and

Emphasize increase intake of
vegetables can lower blood
fruits and vegetables
pressure, reduce the risk of heart
disease and have a positive
effect upon blood sugar.

32
NCP 3: Hyperthermia related to infectious process
Assessment Explanation of the Objective Nursing Intervention Rationale Evaluation
Problem
Subjective: Infections occur when STO: DX: DX: STO:
the natural defense
“apat na araw After 4 hours of nursing Assess fluid loss and facilitate -Increase metabolic rate and Goal met - After 4
mechanism of an
akong nagsusuka intervention the patient oral intake diaphoresis hours of nursing
individual are
tapos namamaga pa will maintain the intervention, the
inadequate to protect
yung paa at kamay resistance from infection patient’s temperature
them. Organisms such as
ko” and vomiting will be Monitor vital signs -Notes progress and changes in was reduced from 38
bacteria, viruses, fungus,
reduced condition degrees Celsius to 37.5
and other parasites
degrees Celsius.
invade susceptible hosts
Objective: through inevitable injuries
and exposures. Infections -Prevents dehydration
- Weak in Maintained IV fluid as ordered
appearance prolong healing and can
by physician
- Warm to touch result in death if treated LTO:
- Mild edema inappropriately. LTO:
noted on her Goal Met - After 72
After 78 hours of nursing Monitor hematologic test and -Indicates presence of infection
lower and upper hours of nursing
intervention, the patient other pertinent lab results and dehydration
extremities intervention, the
- Nausea and will be able to remain free
patient was free from
vomiting for four Reference: from any signs and
any signs and
days symptoms of infection as TX: TX: symptoms of infection
- White Cell Count Vera, M. (2020). Risk for evidenced by normal vital
as manifested by
+ 14.2 x 109/L Infection Nursing Care signs and normal Acknowledge patients question -Enhances heat loss by
absence of fever,
- MCH 88.7 Fl Plan. Retrieved on 15 laboratory results. regarding infection cause and evaporation and conduction
normal temperature
- MCHC 29.3 Pg November from control
and normal laboratory
- RDW 33.0 g/dL https://nurseslabs.
- Neutrophils ++ findings.
com/risk-for-infection/
10.3 x 109 /L Administer antibiotic as ordered -Dissipates heat by convection
- Monocytes 0.9 x
109 /L
33
- Presence of Promote bed rest Reduces fever
protein in the
urine (proteinuria)
-Treats underlying cause

-Reduces body heat production

NURSING DIAGNOSIS: EDX:

Infection related to Encourage ample fluid intake EDX:
compromised by mouth
secondary defenses -If the patient is dehydrated or
diaphoretic, fluid loss contributes
to fever
Encourage adequate nutrition
and hydration

-Providing health teachings to the

patient and family aids in coping
Instruct patient and significant
with disease condition and could
others on proper prevention of
help prevent further
infection
complications of hyperthermia

34
NCP 4: Disturbed sleeping pattern related to abdominal pain
Assessment Explanation of the
Problem
SUBJECTIVE: Pain feels less control
over sleep affecting the
“Nakatulog lang ako
health and exhibit
ng mga less than 5
greater sleep sensitivity.
hours kase panay
Time-limited disruption of
sakit ng tyan ko” as
sleep (natural, periodic
verbalized by the
suspension of
client
consciousness) amount
and quality. This may
result for the body where
OBJECTIVE: it is unable to function at
an optimal level.
- Restlessness
- Presence of eye
bags
- Yawning Reference:
- Easily irritated https://nandadiagnosis
.blogspot.
NURSING DIAGNOSIS:
Disturbed sleeping
Objective
STO:
After 8 hours of nursing
intervention, the client will
report decreased feeling
of discomfort as
manifested by an
improved sleeping
pattern.
LTO:
After 72 hours of nursing
intervention the client will:
• Be able to be free
from any signs and
symptoms of disturbed
sleep patterns
• Achieve 7-8 hours of
continuous sleep per
day
Nursing Intervention Rationale Evaluation
DX: DX: STO:
Observe and obtain feedback -To determine usual sleep pattern Goal Met
from client regarding usual and provide comparative
After 8 hours of nursing
bedtime, rituals and number of baseline
intervention, the
hours of sleep
patient reported
feeling relieved from
discomfort and was
Assess patient’s perception of -Knowing the specific etiologic
able to sleep for at
cause of sleep difficulty and factor will guide appropriate least 6 hours.
possible relief measures to therapy
facilitate treatment
LTO:
TX:
TX: Goal Met
-To alleviate discomfort
Position client in a comfortable After 72 hours of
position nursing interventions,
the client was able to
establish normal
-To distract attention on pain,
Provides comfort measures sleeping patterns of
(touch, quite environment, dim reduce tension and to promote continuous 8 hours of
light, light music) non-pharmacological pain sleep daily and was
management seen to have an
absence of eye bags
and yawning with
-To help in providing better improved mood
Provide a quiet and peaceful sleep/rest throughout the day.
35
pattern related to environment during sleep
abdominal pain periods
EDX:

-This contains ingredients that

EDX:
decreases the ability to fall asleep
Instruct patient in limiting of
caffeine and soft drinks use
-Verbalizing concerns may
promote relaxation
Encourage the client to
verbalize concerns when
unable to sleep
-Relaxation techniques can help
to fall asleep more quickly
Teach relaxation techniques,
pain relief measures, or the use
of imagery before sleep

36
NCP 5: Risk for deficient fluid volume
Assessment Explanation of the Objective Nursing Intervention Rationale Evaluation
Problem
Subjective: Risk for deficient fluid STO: DX: DX: STO:
volume or fluid volume
“Konti lang iniinom ko After 4 hours of nursing Monitor intake and output, -Provides information about Goal met
deficit is a state or
sa isang araw, mga 3 interventions, the patient character, and amount of overall fluid balance, renal
condition where the fluid After 4 hours of nursing
baso ng tubig” as will be able: stools. function, and bowel disease
output exceeds the fluid intervention, the
verbalized by the control.
intake. It occurs when • To verbalize patient:
patient
the body loses both understanding on
water and the importance of • Verbalized that
electrolytes from the ECF adequate water -Indicator of overall fluid and adequate
Monitor weight daily. water intake
Objective: in similar proportions. intake nutritional status
• To demonstrate helps the body
- Skin turgor of 3 Common sources of fluid
lifestyle changes to function
seconds loss are the properly and
gastrointestinal tract, avoid progression -Indicates excessive fluid loss or
- Sunken eyeballs Observe for excessively dry skin maintain the
of dehydration resultant of dehydration.
- Decreased urine polyuria, and increased and mucous membranes, body’s fluid
output (3x a day) perspiration. It also decreased skin turgor and balance.
- Minimal daily pertains to decreased LTO: slowed capillary refill. • Was able to
water intake intravascular, interstitial, demonstrate
- Vomiting for four and intracellular fluid. After 72 hours of nursing the lifestyle
days interventions, the patient TX: changes to
- Nausea will maintain adequate TX:
avoid
-Colon is placed at rest for
- Presence of fluid volume and be free Provide oral restrictions, bed rest dehydration
bleeding healing and to decrease intestinal
from signs of dehydration. and avoidance of exertion such as drinking
fluid losses. at least 2 liters of
Reference:
water daily.
Marily E., et al. Nurses
NURSING DIAGNOSIS: pocket Guide p.90 Administer parenteral fluids as -Fluids are necessary to maintain
hydration status LTO:
ordered
Risk for deficient fluid
Goal Met

37
volume
Provide comfortable
environment by covering
patient with light sheets
EDX:
Encourage to drink bountiful
amounts of fluid as tolerated or
based on individual needs
After 72 hours of
nursing intervention,
-Drop situations where patient
the patient was able to
can experience overheating to
maintain adequate
prevent further fluid loss
fluid volume as
evidenced by
balanced intake and
EDX: output and was free
-Patient may have restricted oral from any signs of
intake in an attempt to control dehydration.
urinary symptoms, reducing
homeostatic reserves and
increasing risk of dehydration.

Enumerate interventions to -Patient needs to understand the

prevent or minimize future value of drinking extra fluid during
episodes of dehydration bouts of fever, vomiting and other
conditions causing fluid deficits.

-Increasing the patient’s

Enumerate the relevance of
knowledge level will assist in
maintaining proper nutrition and
preventing and managing the
hydration
problem

38
C. Discharged Plan
Health Teaching
Diet/Nutrition 1.Eat a heart-healthy diet Fruits and
vegetables are packed with vitamins and
minerals. They also have fibre, which helps you Commented [GLMS143]: the patient
feel full and is great for you. Try to fill half your
plate with a variety of different fruits and
veggies.

2.Fat-free and low-fat milk products are great.

They are especially good for us to build strong
bones. Look for fat-free or low-fat cheese,
other dairy products. If you can't drink milk, try
soy drinks fortified with calcium and vitamin D.

3.Protein helps your body heal, gives you Commented [GLMS144]: the
energy, and more. Choose a mix of different
protein foods. Good options include fish and
other seafood, poultry (without the skin), lean
meats, beans and peas, eggs, soy products,
and unsalted nuts and seeds. Commented [GLMS145]: Copy and paste?
Activity 1. Avoid exercise and other strenuous activities until
please modify
the doctor says it’s okay.

2.Walk as often as you feel able.

3.Ask your doctor when it’s okay to resume sex.

Medication 1.Always completing all antibiotic doses Commented [GLMS146]: complete
prescribed even if symptoms have gone
away. If there are some tablets left over, they
should not be kept for later use or given to
other people.

2.Antibiotics should be taken for as long as the

doctor has prescribed them it may have an
allergic reaction.

3.Avoiding fruit and fruit juices, dairy, and Commented [GLMS147]: modify
alcohol for 3 hours after taking an antibiotic
rephrase
dose.

4.Be sure to follow the dosage

recommendations printed on the label to
avoid an overdose.
Other 1.Continue with the coughing and deep
breathing exercises that you learned in the
hospital.

2.Make a follow-up appointment as directed

by the staff. Commented [GLMS148]: instructed

3.Your doctor may order follow-up blood tests

to make sure that the ectopic pregnancy has
been completely removed.

39
XVI. Learning Insights
A. Belly, Audrey Rose T.
After reading the data for the case presentation, I have
gained information about the causes, signs and symptoms, and the
effects of ectopic pregnancy and PIH to the client where these
conditions are risky. I realized that educating our patient from this kind
of condition is really important especially to the pregnant mother Commented [GLMS149]: these
because this are complicated and can have a big impact to them. Commented [GLMS150]: on
While doing the case, for me, it is difficult because we didn’t handle
the patient in person wherein we didn’t see the situation for us to
assess, monitor and interview the patient, instead we just used our
imagination with the data that were given but there are some
information that is lacking so we didn’t know if we are going to add
some but instead we did just stick to the data for the case.

B. Caragan, Mac Cristian A.

While doing this case presentation and caring for the patient
for straight three days shift, I’ve learned the many causative agents of
ectopic pregnancy and PIH, the different ways to manage it,
medications to treat the patient and the diagnostics done to confirm if
the patient is really having a ectopic pregnancy and PIH. and more Commented [GLMS151]: M
importantly, I’ve learned the signs and symptoms of it which is very
important for us because when we know it we will be able to guard
ourselves from those patients who have it while we are caring for
them.

C. Ibanez, Alice Joy S.

I was able to learn the risk factors, management, treatment
and nursing process for ectopic pregnancy, and PIH. Throughout the
study teamwork is done and analysis is used for the case. Caring for Commented [GLMS152]: case analysis,
the patient and treating them unique will help the patient recover, Commented [GLMS153]: uniquely
physically, emotionally, and spiritually. Factual data is also used for this
data and input to nurse’s notes. However, ADPIE was used during the
duty and in the study, as well as SMART.

D. Medenilla, Gemalyn B.
My Learning insight about this case, As student it is difficult for Commented [GLMS154]: l
us to do this and finished it early because we just only get some
information thru internet and social media it is difficult to handle this
situation because some of us our internet connections are not stable,
at the same time we have a lots of requirements that we need to finish
on time. But on the final case presentation We do our best just to
make sure we can present well as a Team. Handling ectopic
pregnancy in Ob ward areas is not easy, but one of the best
experience also because We learned a lot not only skills but also the Commented [GLMS155]: w
values, and as a Nurse We have to extend our patience even if its Commented [GLMS156]: it is
difficult to take good care of them.

E. Ogundeji, Ayomide F. Commented [GLMS157]: try to expand further

I learned from this case that ectopic pregnancy is a life
threatening condition, and one of the cause is smoking, and its
management is usually surgical.

F. Prendol, Ryna Kryzzea B.

From the case that was given to us, honestly, it was challenging
to fill in the information needed because of the lack of data from the

40
 given scenario along with the fact that we weren’t there first-hand to
actually assess and monitor the patient. However, it is eye-opening
that all pregnant women are actually at risk of having an ectopic
pregnancy especially if they are not careful with their lifestyle choices
– much more so since they are susceptible to pregnancy induced
hypertension, which is the first sign of an upcoming eclampsia.
Therefore, as student nurses, it is important to properly educate our
patients on the preventive measures to reduce the chances of an
ectopic pregnancy to occur.

G. Rafael, Hajime Melchor W.

In this case presentation our capability as student nurses was tested. we Commented [GLMS158]: were
are bombarded with activities and we are given short span of time to Commented [GLMS159]: W
accomplish. Despite of those things, we accomplished our task using our
Commented [GLMS160]: were
nursing skills which we acquired in the hospital setting. I ponder if we
didn’t have any experience in OB ward, can we really understand the Commented [GLMS161]: were
scenario and decipher the underlying problems if we just learn it behind
the screen? We are lucky enough to experience and learn things in Commented [GLMS162]: in the
actual setting.

H. Rebolledo, Osdrei Marion S.

While doing the case presentation, I have learned many Commented [GLMS163]: much
information specifically about Ectopic pregnancy and PIH from its signs
and symptoms to its nursing care and management. As a student
nurse, I have realized that Ectopic Pregnancy (EP) has been a major
problem for women in childbearing age and correct nursing diagnosis
and management can contribute in reducing the incidence of a life-
threatening conditions in the hospitals. Pregnancy Induced
Hypertension (PIH) on the other hand, although common can be also
life-threatening which if treated right can reduce the overall maternal
and morbidity rate in the Philippines.

I. Tabios, Shaira Annie A.

I learned in this case that ectopic pregnancy is a serious
condition which requires immediate attention because this can be a
life-threatening condition. I learned also about signs/symptoms, and
the proper management of this condition and as a student nurse
these are important for us to deliver the quality care that the patient
needs and also for us to know what we are doing when we will now
be dealing with this such condition.

J. Tiyad, Emily B.
My insight to this case analysis that is given to us is that ectopic
pregnancy is a case that can be life threatening due to bleeding and Commented [GLMS164]: situation
that it needs immediate medical attention. Pregnancy induced
hypertension occurs commonly to pregnant mother due to elevated
hypertension and is manageable. As a student I have realized that
when in the medical field, it is our responsibility to educate our clients
and offer care to them.

K. Tolero, Kenji F.
The knowledge I obtained about the ectopic pregnancy made
me understand the causes, proper treatment and different conditions
of such disease which is essential; and, enabling student nurses like me
to provide proper care to the patients who has same condition. Commented [GLMS165]: have the
Researching and class discussions provided us a deeper
understanding about ectopic pregnancy which established a good
foundation to our knowledge as to how we can properly handle
41
 patients with similar case and how we can properly execute the
treatments that must be given to the patients in order for them to have
a fast recovery.

L. Valledo, Denielle T.
Our schedule was too hectic to finish our case study on
time, so further improvement we should learn how to manage our
time. And also we had a hard time doing our case due to lack of Commented [GLMS166]: is needed on time management
information that was given to us and we could not personally assess skills

the patient because of the situation that we are facing right now. Commented [GLMS167]: Also,

Ectopic pregnancy is too dangerous for both the mother and the
baby that’s why it is important to have a health education regarding
this an how it will be prevented. Overall, as a student nurse, I learned a
lot from this case study. The knowledge and experience I gained was
worth it.

M. Veloria, Mikko DC.

While doing this case presentation, it opened up my mind and
gave me more knowledge I need to know. for example, It’s causes, Commented [GLMS168]: F
pathophysiology, is possible treatments and interventions which I can Commented [GLMS169]: its
use when I will have a patient who has a same case. like this, it can Commented [GLMS170]: the
help me help the patient to alleviate what she is feeling and not Commented [GLMS171]: I
adding another discomfort,. this case presentation also open up my Commented [GLMS172]: T
mind to view ectopic pregnancy not just a problem but it thought me Commented [GLMS173]: enlightened
to view it as a life threatening situation in which I need to take or
handle seriously because the life and the mother itself is in danger just , Commented [GLMS174]: herself
we need to keep in mind that just because it’s ectopic pregnancy Commented [GLMS175]: I
that doesn’t mean that the baby can no longer survive,. according to Commented [GLMS176]: it
researches, a mother can still deliver a healthy, full-term baby after an Commented [GLMS177]: A
ectopic pregnancy, so let’s treat them the way we treat mother who
has normal pregnancy.

42
XVII. List of References . Commented [GLMS178]: a lot of available resources for your
case
Gudeta et al, (2019). Pregnancy Induced Hypertension and Associated
Factors among Women Attending Delivery Service at Mizan-Tepi University research more
Teaching Hospital, Tepi General Hospital and Gebretsadik Shawo Hospital,
Southwest, Ethiopia. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341446/

MNPI, (N.A.). Philippines. Retrieved from

http://www.policyproject.com/pubs/MNPI/Philippines_MNPI.pdf

CDC, (2015). Pelvic Inflammatory Disease (PID) - CDC Fact Sheet. Retrieved
from https://www.cdc.gov/std/pid/stdfact-pid.htm

CDC, (2019). What is Assisted Reproductive Technology?. Retrieved from

https://www.cdc.gov/art/whatis.html

Ali, S. et al (2019). Diagnosis and Management of Ectopic Pregnancy-A Basic

View Through Literature. Retrieved from
https://obstetrics.imedpub.com/diagnosis-and-management-of-ectopic-
pregnancya-basic-view-through-literature.php?aid=24242

N.A. (2018). Pre-eclampsia or pregnancy induced hypertension (PIH).

Retrieved from https://www.healthdirect.gov.au/pre-eclampsia-pregnancy-
induced-hypertension

Thomas, A. (2016). A Brief Introduction Of Ectopic Pregnancy. Retrieved from

https://medium.com/@alithomas072/a-brief-introduction-of-ectopic-
pregnancy-4781bc913ad1

43
XVIII. APPENDICES

44
 Appendix A

Approval/Letter Request

To:

Thru: Juliet Avena

Clinical Coordinator

Dear Ma’am,

Greetings!

We, the Level III Section F Group B, would like to reserve the case with a
diagnosis of Ectopic Pregnancy, PIH for our case presentation this first
semester of school year 2020-2021. This case was presented to us for our
virtual case presentation on November 18, 2020. Our clinical instructors for
the virtual case presentation are Ma’am Jessica Bentayen and Ma’am
Gaeserica Leah Mae Salic-o. Commented [GLMS179]: Gaiserica Lea

We have selected this case to further enhance our knowledge and

management regarding this problem that we have chosen.

Thank you very much for your kind consideration and God Bless!

Respectfully yours,

_______________________________ _____________

Belly, Audrey Rose T. Ogundeji, Ayomide F.

_______________________________ _____________

Caragan, Mac Cristian A. Prendol, Ryna Kryzzea B.

_______________________________ _____________

Ibanez, Alice Joy S. Rafael, Hajime Melchor W.

45
_______________________________ _____________

Medenilla, Gemalyn B. Rebolledo, Osdrei Marion S.

_______________________________ _____________

Tabios, Shaira Annie A. Valledo, Denielle T.

_______________________________ _______________________________

Tiyad, Emily B. Veloria, Mikko DC.

_______________________________

Tolero, Kenji F.

46