I.

Introduction

Ectopic pregnancy is a condition where the fertilized egg implants itself outside the main cavity of the uterus, either in
the fallopian tube, ovaries, abdomen, or cervix. Tubal pregnancy is a type of ectopic pregnancy whereby the fertilized
egg implants on the fallopian tube which supposedly carries to eggs from the ovaries to the uterus. Tubal pregnancy is
the most common type of ectopic pregnancy. Tubal pregnancy occurs to the decreased number of cilia along the
fallopian tube, therefore, slows down or prevents the fertilized egg from moving. There is also non-tubal ectopic
pregnancy, this is where the fertilized egg implants itself in other areas of the female reproductive organs, such as, the
ovary, cervix, or intra-abdomen region. Lastly, the heterotopic pregnancy, where the fertilized egg has implanted itself
inside the uterus and another fertilized egg has implanted elsewhere. Ectopic pregnancies are caused by inflammation
and scarring of the fallopian tubes from a previous medical condition, infection, or surgery, as well as hormonal factors,
genetic abnormalities, birth defects, and medical conditions that affect the shape and condition of the fallopian tubes
and reproductive organs.

II. Objectives

To expand knowledge and understanding of:

1. The causes and risk factors of ectopic pregnancies and why they are likely to occur
2. Prevention of the occurrence of ectopic pregnancies
3. Nursing management for patients who under-go surgeries to terminate the pregnancy

III. Nursing Health History

 Biographic data
 Name: A.G
 Age: 21 years’ old
 Sex: Female
 Civil Status: Married
 Sources of information: The patient
 Admitting impression / final diagnosis (if admitted in the hospital): Ampullary Pregnancy
 Chief complaint
 Vaginal spotting for three days prior to consultation
 Left lower abdominal pain and feeling nauseated
 Pain felt on shoulder
 History of present illness
 Experiences vaginal spotting three days before visiting the Emergency Room
 Obstetric history
 Gravida: 1
 Para: 0
 Past medical history
 Pelvic Inflammatory disease
 Lifestyle
 Sexually active
 Does not use any form of contraceptive
 Regular monthly menstruation
 Non-smoker, healthy BMI, moderately exercises, healthy diet, and less stressors because it reveals that
the patient is non-hypertensive and non-diabetic

IV. Physical Examination

 Vital signs:
o BP: 110/70 mmHg
o PR: 89 bpm
o RR: 21 cpm
o Temperature: 36.7 degrees Celsius
 General appearance:
o Patient was found with good skin turgor, meaning elasticity of the skin is normal and A.G. is
well-hydrated
 Chest area:
o Auscultation was done to observe for abnormal lung sounds, but none were found
 Reproductive area:
 o Palpation of the pelvic area and found that there is tenderness on the left adnexal, this consists
of the uterus, ovaries, and fallopian tubes
o Inspection of the cervix and found that it is still closed
o Observations of the vaginal and found with scanty blood
 Extremities:
o No edema was present, therefore, the patient has sufficient venous blood flow

V. Symptoms Manifested
 Vaginal spotting/bleeding
 Left lower abdominal pain
 Nausea
 Late menstruation
 Pain on shoulder
 Pelvic pain

(Other possible signs/symtopms)

 Upset stomach and vomiting

 Pain on one side of the body
 Dizziness or weakness
 Pain in neck, or rectum

VI. Pathophysiology

Ectopic Pregnancy Schematic Diagram

Predisposed factors: Precipitated factors:

o Anatomic obstruction to the passage of zygote o Drinking alcohol

o Abnormal conceptus o Drugs
o Abnormal mechanisms responsible for tubal motility
o History of inflammation

Fertilized egg cannot travel successfully

from the ovaries to the uterine cavity

The ovum then gets stuck within the Signs and symptoms of vomiting and
left fallopian tube and begins nausea begins, however, may be found
implantation normal if pregnancy is expected.

As a result of several types of pain Sharp abdominal cramps are then felt
experienced, the mother will now feel by the mother, followed by pain on
weak, and dizzy one side of the body/shoulder.

Vaginal bleeding may start to occur as Ectopic pregnancy is

it is a sign that the fallopian tube has suspected evidenced by
ruptured, which can be life-threatening medical diagnosis
VII. Diagnostic and Laboratory
 Serum and pregnancy test was done to the patient that revealed she is positive for pregnancy with her hCG
levels of 6350 mIU/mL
o With a positive result, the levels of hCG is normally more than 20 mIU/mL; while results that show 5
mIU/mL means that the patient is negative for pregnancy
 CBC results of patient show:
o Hemoglobin of 126 g/L
 The normal levels of haemoglobin for a pregnant woman is 12.06-16 g/dL, and patient A.G. is
within that value of 12.6 g/dL, this may indicate that the body is producing more haemoglobin
because of a high demand of blood to supply both the mother and growing fetus
o RBC of 4.64
 2-4 value of red blood cells are considered normal for a pregnant woman. However, A.G.’s
results are over, this could mean that there is a higher demand for blood to supply the mother
and the fetus their oxygen and nutrients
o WBC of 6.0x10^9/L
 The normal value of white blood cells of a pregnant woman is 5,600-16,000 uL, patient A.G.
shows that she is within that normal range
 Transvaginal ultrasound:
o Cervix: 2.8 x 2.6 x 2.9 cm
 The average cervical length at 8 weeks gestation is 4.1 cm with variation. The patient is not
within the normal value, which means that the fertilized egg has not implanted itself on the
uterine cavity because there should be a slight increase in size of the cervix
o Uterine corpus: 5.3 x 4.6 x 5.6 cm (anterverted uterus)
 Normal value size of the uterine corpus is 8 x 4 x 5 cm, this means that the patient is within the
normal reference value
o Endometrium: 1.7 cm (thick and decidualized, no GS seen)
 Normal value is 0.2 cm or more, patient A.G. shows that her endometrium is thick and ready-
made for a growing fetus
o Adnexae:
 Right: 2.0 x 1.2 x 1.2 cm
 Left:3.0 x 1.7 x 2.4 cm (a complex mass of 2.3 x 2.0 x 2.1 cm with GS on tubal ring, inside GS a
yolk of 0.4 cm, no fetal pole is seen)
 Normal size for both ovaries ranges from 2.5-5 cm long, 1.5-3 cm wide, 0.6-1.5 cm thick,
though the sizes are within the normal range, there is a gestational sac observed in the
ultrasound that could lead to diagnosing the patient with ectopic pregnancy
o Others: no free fluid in cul de sac
 Means that the findings are normal

VIII. Medical/Surgical Management

1) Methotrexate: is a type of drug that helps stop the pregnancy from growing. It is given through IM in the
gluteal muscles. No hospital admission is necessary, just regular blood tests to see if the treatment is
working. Then, a second dose is administered and contraception must be used for 3 months after
treatment. The products of consumption are then absorbed by the body for 4-6 weeks. Although, this
treatment is not advisable is the fallopian tube has ruptured and needs removal.
2) Salpingectomy: is a laparoscopic surgery that removes of one (unilateral) or both (bilateral) fallopian
tubes. Partial salpingectomy is the removal of only a part of the fallopian tube.
3) Salpingostomy: is another type of laparoscopic surgery that creates an opening into the fallopian tube to
remove the pregnancy, however, the tube itself is not removed because it is not damage or ruptured
from the pregnancy.
IX. Drug Study

Drug Name Classification Indication and Side Effects and Special Nursing responsibilities
and Mechanism contraindications Adverse Effects Precautio
of Action ns
Generic Name: Classifications: a Indications:  Diarrhea Must not  Observe
Doxycyline class of  Rocky  Esophageal be taken patient’s
medications Mountain ulcer with dairy reaction when
Dosage: called spotted fever  Facial products drug has been
100mg/cap 1 tetracycline  Typhus fever redness (milk, administered,
antibiotics  Typhus group  Headache cheese, report if there
Route: Orally  Q fever  Hives yoghurt) is sudden
Actions: it acts  Rickettsialpox  Inflammatio because it onset of
Frequency and by treating  Tick fevers n of small can stop painful
time: twice a day infections,  Respiratory intestine and the body swallowing for
for 8 or more days stopping the tract infections colon from incidence of
growth and  Urinary tract  Lesions of absorbing esophagitis
spread of infections genitals or the  Report if
bacteria anus medicatio superinfection
Contraindications:  Loss of n. Also, s begin to
 Liver disease appetite avoid manifest
due to rare  Low blood drinking  Educate
fatal sugar alcohol patient to take
hepatotoxicity  Tongue with the
 History of swelling doxycyclin medication
yeast  Upper e. with a full
infections abdominal glass of water
 Recent colitis pain for passage of
caused by  Hemolytic drug to reach
antibiotic use anemia the stomach
 Kidney disease  Exacerbation and prevent
diarrhea from of systemic esophageal
C. Dificile lupus ulceration
 History of erythmatosu  Educate the
lupus s client to avoid
 Porphyria  Pericarditis exposure to
 Low WCW sunlight and
 Myasthenia
and platelet UV light for 4-
gravis
count 5 days after
therapy to
avoid
phototoxic
reaction
Generic name: Classifications: Indications:  Constipation If side  Educate
Multivitamins with Is a supplement  Vitamin  Diarrhea effects patient to take
Iron with different deficiencties  Nausea and become the
vitamins,  Pregnancy vomiting persistent multivitamins
Dosage: 1 tablet minerals and  Poor nutrition  Heartburn , call the with iron after
other  Digestive  Stomach doctor meals to
Route: Orally nutritional disorders pain because reduce GI side
substances, like  Black or iron may effects
Frequency and iron. Contraindications: dark-colored cause the  Warn the
timing: once a day  Iron stools or stools to patient that
for 1 month Actions: metabolism urine turn they may
Are used to disorder  Temporary black, but experience
treat iron or  Overload of staining of it is not discoloured
vitamin iron in the teeth harmful stools, which
deficiencies blood  Headache are not
caused by  Hemolytic  Unpleasant harmful
illness, anemia taste in
pregnancy, poor  Stomach ulcer mouth
nutrition,  Gastritis
digestive  Ulcerative
disorders, and colitis
other.  Diverticular
disease
Generic name: Classifications: Indications:  Diarrhea Check if  Observe for
Mefenamic acid A member of To be used to relieve  Constipation patient is development
 anthranilic acid mild to moderate pain,  Gas or allergic to of severe
Dosage: 500 derivatives class including menstrual bloating any diarrhea and
mg/tablet 1 of NSAIDs pain  Headache compone vomiting
 Dizziness nts of the which could
Route: Orally Actions: Contraindications:  Nervousness drug. cause
Inhibits  Increased of  Ringing in dehydration
Frequency and cyclooxygenase bleeding due the ears Check if and electrolyte
timing: 1 tablet (COX-A and to clotting the imbalance
every 8 hours COX-2), it is a disorder patient  Perform
potent inhibitor  High BP has any of laboratory
of prostaglandin  Chronic heart the tests to
synthesis in failure conditions monitor CBC,
vitro  Abnormal (asthma, Hct and Hgb,
bleeding in the heart and kindery
brain that failure, function tests
could lead to swelling  Educate the
hemorrhagic of hands, patient to d/c
stoke feet and if experiencing
 Ulcer from too ankles or diarrhea, dark
much stomach lower stools,
acid legs, hematemesis,
 Liver problems liver/kidn ecchymoses,
 Kidney ey disease epistaxis or
transplant rash
 Chronic kidney  Educate to
disease contact doctor
 History of is there is GI
kidney discomfort,
donation sore throat,
 History of fever, or
gastric bypass malaise
surgery  Do not drive
or perform
hazardous
activities as it
causes
dizziness and
drowsiness
 Monitor blood
glucose for
loss of
glycemic
control if
diabetic

X. Nursing Care Plan

Assessment Diagnosis Objective/Planning Intervention Rationale Evaluation

Subjective: Acute pain located Short-term goal: Educate the client This will provide an After 6 hours of
Patient is on the pelvic After 1 hour of of her condition understanding to nursing
experiencing region and nursing and why this the pain she is intervention, the
vaginal spotting for shoulder related to interventions, the happens. experiencing. client will be
the past three the effects of client will experiencing less
days, pain felt on ectopic pregnancy. understand why Prepare the client Some clients may pain. She will
left lower she is experiencing for her upcoming in denial that this become more
abdomen, with pain, and to treat surgery to remove rare condition has comfortable and
increasing severity, that is by removing the pregnancy and happened to them. relaxed. When
and pain on the pregnancy implicate that this They may begin to assessing the
shoulder could be life- want the pelvic area, there
Long-term goal: threatening if left pregnancy and not will be less pain
Objective: After 5 hours, the untreated. go through with that is cause by her
BP: 110/70 patient will notice the surgery. ectopic pregnancy.
PR: 89 a decrease of pain Therefore, it is
RR: 21 felt, she will be crucial to educate
Temp: 36.7 able to understand them that it may
techniques on how cause the fallopian
Patient appears to manage post- tube to rupture
uncomfortable, operative pain. and lead to
probably with internal bleeding
facial grimace and which is more
body reflexes difficult to treat
when pelvic area is and could kill the
palpated in client.
response to pain.
Provide emotional Having to hear that
support to the the only way to
client. treat her condition
is by removing the
fetus, it may be
difficult and
upsetting for the
mother. Therefore,
emotional support
can comfort her
and make her at
ease.

Assessment Diagnosis Objective/Planning Intervention Rationale Evaluation

Subjective: Risk for Short-term goal: Ensure that the This will provide After 8 hours, the
Patient is married, psychological After 3 hours of client has a strong the patient client will be aware
sexually active, and health conditions nursing emotional support someone to talk to of conditions she is
has not been using as evidenced by interventions, the people. and decrease her at-risk for and have
any form of the patient’s client will have an thoughts of the techniques to
contraceptive. readiness for a understanding of loneliness, and prevent them from
baby. her condition, and isolation. manifesting. The
Objective: her risks for patient will have a
Positive for serum developing Decrease her risk This will help the good support
pregnancy test. psychological for PTSD client ease back group that can
Reproductive effects symptoms by into her ordinary help her heal from
system is a healthy surrounding her life and any emotional
environment to Long-term goal: with the people temporarily forgets pain.
host a fetus After 8 hours, the she loves, things her recent
client will be aware that provide her situation.
of the signs and happiness.
symptoms of
different Talk to the client This will distract
psychological about her life, her the patient to keep
conditions she is daily activities, her talking and sharing
at-risk for. likes and dislikes. about her life. A
good strong
relationship
between the
patient and client
may also arise with
full of trust and
good
communication.

XI. Discharge Plan / Health Teaching

 Medications:
o Doxycycline: can stop the growth of bacteria that causes inflammation of the reproductive system of the
client
o Multivitamins with iron: can provide proper nutrition and efficient blood clotting time
o Mefenamic acid: can help relieve post-operative pain
 Health teachings:
o Educate the client of the nature of her condition and why this happens
o Mention the factors that increases the chances of ectopic pregnancies
o Provide a healthier, and safer way for pregnancy, such as, in-vitro fertilization, surrogacy, or adoption
 Out-patient follow-up (call the doctor if any of the following occurs):
o After a week, client must visit her doctor again for some laboratory findings, such as, blood serum test.
This will help check if the hCG levels are back to normal and that the pregnancy has been successfully
removed.
 Lifestyle: educate the client on a better, and healthier lifestyle. No drinking or smoking, regular exercises, well-
balanced meals, form of contraception, and family planning.