Case Study On Ectopic

REPUBLIC OF THE PHILIPPINES
SULTAN KUDARAT STATE UNIVERSITY

ACCESS Campus, EJC Montilla, Tacurong City
COLLEGE OF HEALTH SCIENCES
CASE STUDY ON ECTOPIC PREGNANCY
ALHAMBRA, JULIANNE MIRAL

ANKING, LAMIES IBRAHIM
ATOK, METHUSELA ONDIN
BASTARECHE, DIANA MARTIN
BELMONTE, ERIKA JEAN PANDOY
CADUNGOG, CATHERINE MAE VILLAR
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TABLE OF CONTENTS
TITLE PAGE 1
OBJECTIVES 3
General Objective 3
Specific objectives 3
INTRODUCTION 3
DEFINITION OF TERMS 3
REVIEW OF SYSTEM/PHYSICAL ASSESSMENT 5
ANATOMY AND PHYSIOLOGY 6
LABORATORY RESULT 8
PATHOPHYSIOLOGY 9
DRUG STUDY 9
NURSING CARE PLANS 13
PROGNOSIS 17
DISCHARGE PLANNING 19
REFERENCES 21
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OBJECTIVES
General Objective
 Manage ectopic pregnancy cases in any clinical setting with the use acceptable notions,
skills, and outlooks
Specific objectives
 To identify the different anatomical structures of female reproductive organs and
understand its functions.
 To understand the pathophysiology of ectopic pregnancy and to differentiate deviations
from normal.
 To identify and describe the different signs and symptoms of ectopic pregnancy.
 To apply nursing care plan effectively for the management of ectopic pregnancy.
INTRODUCTION
Ectopic pregnancy, in essence, is the implantation of an embryo outside of the uterine

cavity most commonly in the fallopian tube. Smooth muscle contraction and ciliary beat within
the fallopian tubes to assist the transport of an oocyte and embryo. Damage to the fallopian
tubes, usually secondary inflammation, induces tubal dysfunction which can result in retention of
an oocyte or embryo. There are several local factors, such as toxic, infectious, immunologic,
and hormonal, that can induce inflammation. There is up-regulation of pro-inflammatory
cytokines following tubal damage; this subsequently promotes embryo implantation, invasion,
and angiogenesis within the fallopian tube. Chlamydia trachomatis infection results in the
production of interleukin 1 by tubal epithelial cells; this happens to be a vital indicator for embryo
implantation within the endometrium; Interleukin 1 also has a role in downstream neutrophil
recruitment which would further contribute to fallopian tubal damage. Cilia beat frequency is
negatively affected by smoking and infection. Hormonal variations throughout the menstrual
cycle additionally have demonstrated effects in cilia beat frequency.
Ectopic implantation can occur in the cervix, uterine cornea, myometrium, ovaries,
abdominal cavity, etc,. Women with tubal ligation or other post-surgical alterations to their
fallopian tubes are at risk for ectopic pregnancies as the native function of the fallopian tube
would be altered. The patient additionally can have an ectopic pregnancy with a concurrent
intrauterine pregnancy as known as heterotopic pregnancy.
DEFINITION OF TERMS
Amenorrhea ─ is the absence of menstruation, often defined as missing one or more menstrual
periods.
Ampulla ─ widest section of the uterine tubes where fertilization usually occurs.
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Antineoplastic ─ blocking the formation of neoplasms (growth that become cancer).

Antineoplastic drugs are medications used to treat cancer. It is also called anticancer,
chemotherapy, chemo, cytotoxic, or hazardous drugs. These drugs come in many forms, some
are liquids that are injected into the patient and some are pills that patients take.
Beta human chorionic gonadotropin (HCG) – is a hormone produced by the placenta during
pregnancy, and is typically detected in the blood. A Beta HCG test is a blood test used to
diagnose pregnancy, and usually becomes positive around the time of the first missed period
Dysmenorrheal (dysmenorrhea) ─ medical term for painful menstrual periods which are caused
by uterine contractions. Primary dysmenorrhea refers to recurrent pain, while secondary
dysmenorrhea results from reproductive system disorders.
Ectopic Pregnancy - implantation of embryo outside of the uterine cavity.
Ectopic Implantation (other term for ectopic pregnancy) - refers to abnormal implantation of the
blastocyst.
Full blood count (FBC) – a test looks for abnormalities in your blood, such as unusually high or
low numbers of blood cells. This common blood test can help to diagnose a wide range of
illnesses, infections and diseases.
Hemogram - a systematic report of the findings from a blood examination.
Human chronic gonadotropin (hCg) – this hormone is produced by the placenta. Its detection is
the basis of most pregnancy test.
Isthmica nodosa (SIN) - sometimes also referred to as diverticulosis of the fallopian tube, refers
to nodular scarring of the fallopian tubes.
Methotrexate – a medication that destroys pregnancy-related tissue and hastens reabsorption of

this tissue in a woman with an ectopic pregnancy.
Miscarriage – the naturally occurring expulsion of a nonviable fetus and placenta from the
uterus, also known as spontaneous abortion or pregnancy loss.
Salpingectomy – an operation which one or both of the fallopian tubes are removed.
Salpingitis - inflammation of the fallopian tubes.
Salpingostomy - is the creation of an opening into the fallopian tube, but the tube itself is not
removed in this procedure.
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Ultrasound – a picture of internal organs produces by high frequency sound waves viewed as
an image on a video screen; used to monitor growth of ovarian follicles, retrieve eggs, or
monitor growth and development of a fetus. Ultrasound can be performed either abdominally or
vaginally.
REVIEW OF SYSTEM/PHYSICAL ASSESSMENT
System Assessment
Skin Skin is pale colored. Presence of mole on the
left cheek and visible wrinkles in the
forehead. Hair is thick, short and straight
without parasites or flakes. Scalp is mobile
and non-tender.
Head No tenderness or masses.
Eyes Visual fields normal. No visual impairment.
Ears No masses, redness, swelling, lesions,
present in the external ear. The skin is
smooth with no lesions, lumps, or nodules.
The canal walls is pink and smooth and
without nodules. Tympanic membrane intact.
Nose and sinuses Nasal structure is smooth, no tenderness.
The patient is able to sniff. No nasal flaring.
Outward expansion of the abdomen and
lower ribs on inspiration and return to resting
position in expansion. Dark pink, moist, no
exudate, nasal septum is intact.
Mouth/ Throat Lips is smooth and moist without lesions and
swelling. 32 ivory colored teeth. Dental carry
noted at the upper left canine. Buccal
mucosa is pink, tissue is smooth and moist
without lesions. Tongue is pink, moist,
moderate size with papillae, without lesion.
Posterior pharyngeal wall is pink without
exudate or lesions.
Neck Stiffness and limitation in motion is not
evident.
Respiratory Rapid respirations upon arrival on the health
care facility.
Cardiovascular Presence of chest pains. Rapid pulse.
Gastrointestinal Patient is experiencing nausea and vomiting.
Genitourinary Presence of reddish vaginal spotting.
Reproductive Patient is dysmenorrheal.
Nervous system The patient is conscious. Experiencing
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headache and weakness.

Extremities Patient is experiencing body weakness.
Patient is pale and experiencing cold and
clammy extremities.
Endocrine System Slow rising hCG. Patient is experiencing
pregnancy-like symptoms.
ANATOMY AND PHYSIOLOGY

(Female Reproductive System)
The female reproductive organs consist of the ovaries, uterine tubes (fallopian tubes), uterus,
vagina, external genitalia, and mammary glands. The internal reproductive organs of the female
are located within the pelvis, between the urinary bladder and the rectum. The uterus and the
vagina are in the midline, with an ovary to each side of the uterus. The internal reproductive
organs are held in place within the pelvis by a group of ligaments. The most conspicuous is the
broad ligament, which spreads out on both side of the uterus and to which the ovaries and
uterine tubes attach.
The female reproductive system performs the following functions:

o Production of female sex cells.
o Reception of sperm cells from the males.
o Nurturing the development of and providing nourishment for the new individual.
o Production of female sex hormones.
Structure and function of the Female Reproductive System

STRUCTURE DESCRIPTION/PRIMARY FUNCTION
o Ovaries
- Produce oocytes for fertilization.
- Produce the reproductive hormones,
estrogen and progesterone.
o Uterine tubes
- The ovarian end of the uterine tube is
surrounded by fimbriae.
- Cilia in the fimbriae move the oocyte
into the uterine tube.
- Fertilization usually occurs in the
ampulla of the uterine tube, which is
near the ovary.
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o Uterus
- The uterus is a pear-shaped organ. The
uterine cavity and the cervical canal are the space
formed by the uterus.
- The wall of the uterus consist of the
perimetrium or serous layer, the
myometrium (smooth muscle), and the
endometrium.
o Vagina
- The vagina connects the uterus (cervix)
to the vestibule.
- The vagina consist of a layer of smooth
muscle and an inner lining of moist
stratified squamous epithelium.
- Lubricating fluid is produced by the wall
of the vagina.
- The hymen covers the vestibular
opening of the vagina.
o Vestibule
- The vestibule is a space into which the
vagina and the urethra open.
o Clitoris
- The clitoris is composed of erectile
tissue and contains many sensory receptors
important in detecting sexual stimuli.
o Labia minora
- The labia minora are folds that cover the
vestibule and form the prepuce.
o Greater vestibular glands

- The greater vestibular glands produce a
mucous fluid.
o Labia majora
- The labia majora covers the labia
minora, and the pudendal cleft is a
space between the labia majora.
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o Mons pubis
- The mons pubis is an elevated are
superior to the labia majora.
LABORATORY RESULT
Investigation: Hemogram
Result: first reading shows slight reduction but eventually decreases.
Normal values:
Haemoglobin─ 12.0-15.5 grams per decilitre
Haematocrit─ 36%-48%
Clinical Significance: after an acute haemorrhage, a decrease in haemoglobin or haematocrit
level over several hours is a more valuable index of blood loss than the initial reading.
Invetigation: Serum B- hCG

Result: slow rising hCG
Normal Value: double every 48-72 hours until it reaches 10,000-20,000 mIU/mL
Clinical significance: Slow rising hCG level may indicate ectopic pregnancy. Slow rising hCG
might also indicate that a pregnancy is not viable.
Investigation: FBC (full blood count) test

Result: monocyte counts are higher
Normal Values:
Red blood cell count: 3.92-5.13 trillion cells/L
Hemoglobin: 11.6-15 grams/dL
Hematocrit: 35.5-44.9 percent
White blood cell count: 3.4-9.6 billion cells/L
Platelet count: 157-371 billion/L
Clinical significance: monocyte activation in the pathophysiology of EP could be effective in
the formation of tubal motility and microenvironment regulation.
Investigation: Pelvic exam

Result: uterine size not enlarged
Normal values:
In normal pregnancy, uterus enlarged as the baby grow
Clinical Significance: pelvic exam detects tenderness in the uterus or fallopian tube, less
enlargement of the uterus than expected for a pregnancy, or a mass in the pelvic area.
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PATHOPHYSIOLOGY
The mechanism responsible for ectopic implantation are unknown. The four main possibilities
are an anatomic obstruction to the passage of the zygote, an abnormal conceptus,
abnormalities in the mechanism responsible for tubal motility, and transperitoneal migration of
the zygote.
Anatomic distortion and obstruction of the fallopian tube are widely believed to be responsible
for most ectopic implantations. Obstruction could result from PID, salpingitis isthmica nodosa,
tubal endemetriosis, or postsurgical fibrosis. Scarring of the endosalpinx could lead to diverticuli
formation, in which the zygote could be trapped, or to simple obstruction of the tubal passage.
ANATOMIC OBSTRUCTION TO THE PASSAGE OF ZYGOTE
ABDOMINAL CONCEPTUS
ABNORMALITIES IN THE MECHANISM FOR TUBAL MOTILITY
ECTOPIC PREGNANCY ABOVE 35 YEARS OLD
TRANSPERITONEAL MIGRATION OF THE ZYGOTE
CIGARRETTE SMOKING
PREVIOUS ECTOPIC PREGNANCY
DRUG STUDY
DRUG (GENERIC INDICATION ACTION CONTRAINDICATION

NAME AND BRAND
NAME)
Methotrexate Ectopic pregnancy  Reversibly  Contraindicated

(Trexall)  50 mg/m² binds to in patients
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IM; dihydrofolate hypersensitive

Therapeutic class: measure reductase, to drug and in
Antineoplastics serum hCG blocking those with
levels on reduction of psoriasis or RA
Pharmacologic days 4 and folic acid to who also have
class: Folate 7; may tetrahydrofolat alcoholism,
antagonist e, a cofactor
repeat dose alcoholic liver,
necessary for
on day 7 if chronic liver
purine,
necessary. protein, and disease,
 If hCG DNA immunodeficien
levels synthesis. cy syndrome, or
decrease blood
<15% dyscariasis.
between  Use cautiously
days 4 and in very young,
7,
elderly, or
administer
debilitated
methotrexat
e 50 mg/m² patients and in
IM; if hCG those with
≥15% infection, peptic
between ulcerations, or
days 4 and ulcerative colitis.
7,  Contraindicated
discontinue during
treatment pregnancy.
and Don’t use in
measure women of
hCG childbearing
weekly until
potential unless
reaching
nonpregna benefits
nt levels. outweigh risk.
 Contraindicated
in breastfeeding
women.
 If either partner
is receiving
methotrexate,
they should
avoid
conception
during and for a
minimum of 3
months after
10
therapy for
males, and
during and for at
least one
ovulatory cycle
after therapy for
females.
 Drug has been
reported to
cause impaired
fertility,
oligospermia,
and menstrual
dysfunction
during and for a
short period
after therapy
ends.
SIDE EFFECTS ADVERSE NURSING RESPONSIBILITIES
REACTION
 Dizziness, CNS:  Methotrexate should be used only by

drowsiness, arachnoiditis health care providers whose knowledge
headache, within hours of and experience include the use of
swollen, intrathecal use, antimetabolite therapy.
tender gums, subacute  Drug can cause severe and fatal
decreased neurotoxicity toxicities. Modify dosage or discontinue
possibly beginning drug for bone marrow suppression,
appetite,
a few weeks later, infection, and renal, GI pulmonary, and
reddened
demyelination, dermatologic toxicities or
eyes, hair malaise, fatigue, hypersensitivity.
loss dizziness, aphasia,  Methotrexate-induced lung disease,
Serious side effects hemiparesis, fever. including acute or chronic interstitial
pneumonitis, is a potentially dangerous
and needs to refer
CV: lesion that may occur at any time during
to a physician thromboembolic therapy. It isn’t always fully reversible.
immediately: events, chest pain, Pulmonary symptoms (especially a dry,
 Blurred vision hypotension, non-productive cough) may require
or sudden pericardial interruption of treatment and careful
loss of vision, effusion, investigation.
seizures, pericarditis.  Diarrhea and ulcerative stomatitis
confusion, EENT: pharyngitis, require interruption of therapy;
weakness or blurred vision. hemorrhagic enteritis and death from
difficulty GI: gingivitis, intestinal perforation may occur.
moving one stomatitis,  Malignant lymphomas may occur in
diarrhea, GI patients receiving low-dose methotrexate
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or both sides ulceration, GI and may regress upon discontinuing

of the body, bleeding, enteritis, drug.
or loss of nausea, vomiting.  Methotrexate may induce TLS in patients
consciousnes with rapidly growing tumors.
s. GU: nephropathy,  Severe, occasionally fatal skin reactions
tubular necrosis, have been reported following single or
renal failure, multiple doses of methotrexate.
menstrual Reactions have occurred within days of
dysfunction, methotrexate administration. Recovery
abortion, cystitis. has been reported with discontinuation
of therapy.
Hematologic:  Potentially fatal opportunistic infections
leukopenia, especially pneumocystis jiroveci
thrombocytopeni pneumonia, may occur with
a. methotrexate therapy.
Hepatic: acute
toxicity, chronic
toxicity, including
cirrhosis, hepatic
fibrosis.
Metabolic:
diabetes,
hyperuricemia.
Musculoskeletal:
arthralgia,
myagalia,
osteopporosis in
children on long-
term therapy.
Respiratory:
pulmonary
interstitial
infiltrates,
pneumonitis.
Skin: urticaria,
pruritus,
hyperpigmentation,
erythematous
rashes,
ecchymoses, rash,
photosensitivity
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reactions,
alopecia, acne,
psoriatic lesions,
aggravated by
exposure to sun.
Others: chills,
reduced resistance
to infection,
septicaemia,
sudden death.
NURSING CARE PLANS
NURSING CARE PLAN 1

Assessment:
Subjective data: Patient verbalizes experiencing vaginal bleeding which is usually scanty
and dark.
Objective data: lowered blood pressure; body weakness, and pale skin.
Nursing Diagnosis: Deficient fluid volume related to active blood loss secondary to
ectopic pregnancy.
Planning: The patient will re-establish a functional body fluid volume and a balanced input
and output status.
Interventions Rationale
Assess vital signs, conduct physical Edema, headaches, low blood pressure, and
examination, and commence daily weight pain are associated with the patient's blood
monitoring. loss. Fluid retention may be evident if the
patient has an unexplained weight gain.
Start input and output monitoring To monitor circulatory blood volume. To
ensure that the patient has adequate oral
hydration or if there is a need to commence
IV hydration therapy.
Speak to the patient and family about the To treat vaginal bleeding and deficient fluid
need for hospitalization for the treatment of volume related to ectopic pregnancy in
serious hemorrhage and the need for appropriate setting.
surgery.
Prepare the patient for the surgical Salphigostomy is the surgical removal of the
Intervention for ectopic pregnancy. Place the unruptured ectopic pregnancy from the
patient on a nothing by mouth (NBM or NPO) fallopian tube utilizing laparoscopic
status. technique. Salphingectomy is the surgical
resection of the unruptured ectopic and the
involved fallopian tube through laparoscopy.
Placing the patient on "Nothing by mouth"
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(NBM or NPO) is necessary to prepare the

patient for emergent delivery
Prepare for blood transfusion as required. To increase blood volume
Encourage the patient to have a low salt Consuming salt between 2 to 4 g per day is
intake. ideal as a very low salt intake may increase
dehydration.
Evaluation: After 8 hours of nursing intervention, the patient’s fluid volume will be re-
established.
NURSING CARE PLAN 2

Assessment:
Subjective data: Patient is restless and disoriented.
Objective data: rapid respirations and lowered blood pressure.
Nursing Diagnosis: Risk for Maternal Injury
Planning: The patient will maintain safety and participate in the measures that will protect self
during the treatment.
Assess the patient's mental status. Ectopic pregnancy may cause the patient to
have low mood, depression, or negative
emotional status, which puts her at risk for
maternal injury.
Monitor the patient's level of consciousness Heavy vaginal bleeding may result to
using AVPU. hypotension and lower level of
consciousness. Using AVPU scale (i.e. Alert,
Voice, Pain stimuli or
Unresponsive/unconsciousness) can help
determine the urgency of surgical treatment
and increased risk for maternal injury.
Prepare the patient immediate surgical Ectopic pregnancy is the leading cause of
Intervention for the removal of the ectopic maternal death during the first trimester due
pregnancy. to internal bleeding, therefore an urgent
surgery to remove it is needed.
Place the patient in complete bed rest of To reduce pain and keep the patient safe.
there is evidence of severe bleeding.
Evaluation: After 8 hours of nursing intervention, the patient will maintain safety and has
participated with the given measures.
NURSING CARE PLAN 3

Assessment:
Subjective data: Abdominal or pelvic pain.
Objective data: Facial mask of pain. Guarding behaviour. Abnormal tenderness on palpation.
Nursing Diagnosis: Acute pain related to ectopic pregnancy.
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Planning: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of
10, stable vital signs and absence of restlessness.
Administer prescribed pain medications. To alleviate the symptoms of acute
abdominal pain.
Assess the patient's characteristics of pain at To monitor effectiveness of medical treatment
least 30 mins after administration of for the relief of abdominal pain. The tine of
medication. monitoring of vital signs may depend on the
peak time of the drug administered.
Elevate the head of the bed and position the To increase the oxygen level by allowing
patient in semi Fowler's. optimal lung expansion.
Place the patient in complete bed rest during To provide optimal comfort to the patient.
severe episodes of pain. Perform non-
pharmacological pain relief methods such as
relaxation techniques: deep breathing, guided
imagery and provision of distraction such as
TV or radio.
Prepare the patient for surgery. Salpingestomy is the surgical removal of the
unruptured ectopic pregnancy from the
fallopian tube utilizing laparoscopic
technique. Salpingectomy is the surgical
resection of the unruptured ectopic
pregnancy and the involved fallopian tube
through laparoscopy.
Post-surgery, advise the patient to: Have no To reduce post-surgical pain and allow full
strenuous activity for a few weeks. Apply recovery and healing.
support on the abdomen when coughing,
laughing, or moving by placing a pillow over
the abdominal area, inform the healthcare
team if the pain medications are not working.
Evaluation: After 8 hours of nursing interventions, the patient was relieved or controlled.
NURSING CARE PLAN 4

Assessment:
Subjective data: Patient verbalizes concern and grief over loss and verbalizes that she
cannot believe this happened to her.
Objective data: Mood is dysphoric and tearful at times, but client is responsive and
cooperative.
Nursing Diagnosis: Anticipatory grieving related to loss of pregnancy
Desired Outcomes: Progress through the phase of grief as evidenced by verbalization of
grief, use resources support appropriately and discuss concerns and feelings openly with
each other.
Intervention Rationale
Promote feelings of self-worth through one on Promote trust relationship.
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one session.
Encourage verbalization of fears, concerns An increase knowledge base decreases
and questions regarding the condition, anxiety and dispels misconceptions.
treatment and future implications.
Promote family cohesiveness. Frequent contacts reduce feelings of fear and
isolation.
Encourage ventilation of negative feelings This allows for emotional expression without
including projected anger and hostility within loss of self-esteem.
acceptance limits.
Allow for periods of crying and expressions of These are necessary for separation and
sadness. detachment to occur.
Give spiritual support. This facilitates the grief process and spiritual
care.
Evaluation: After 8 hours of nursing interventions, the patient was able to verbalize grief, use
resources support appropriately and discuss concerns and feelings openly with each other.
NURSING CARE PLAN 5

Assessment:
Subjective data: Patient verbalizes feeling sad due to of pregnancy loss.
Objective data: received patient with grimace face.
Nursing Diagnosis: Powerlessness related to loss of pregnancy secondary to ectopic
pregnancy.
Desired Outcomes: Client should be able to create support system and sense of control.
Encourage verbalization of feelings, thoughts, This approach creates a supportive
and concerns about making decisions. environment and sends a message of caring.
Encourage patient to identify strengths. This will aid patient to recognize inner
strengths.
Discuss with the patient concerning her Allowing the patient to participate in
(treatment options, convenience of visits). discussions will increase her sense of
independence or autonomy.
Encourage an increased responsibility for The perception of Powerlessness may
self. negate the patients attention to areas in
which self-care is attainable; however the
patient may require significant support
systems and resources to accomplish goals.
Help patient in reexamining negative The patient may have her own perceptions
perceptions of the situation. that are unrealistic for the situation.
Eliminate the unpredictability of events by Information in advance of a procedure can
allowing adequate preparation for test or provide the patient with a sense of control.
procedures.
Give the patient control over her This approach enhances patient's
environment. independence.
Aid the patient in recognizing the importance Patient may develop powerlessness
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of culture, religion, race, gender and age on especially in a hospital environment when
her sense of powerlessness. they don't speak the dominant language, food
is unusual and customs are different.
Support in planning and creating a time table Use of realistic short-term goals for resuming
to manage increased responsibility in the aspects of self-care foster confidence in one's
future. abilities.
Avoid using coercive power when This approach may increase the patient’s
approaching the patient. feelings of powerlessness and result in
decreased self-esteem.
Render positive feedback for making Success promotes confidence in abilities and
decisions and engaging in self-care. sense of control. Recognition and positive
reinforcement for self-care are great
motivators for heightening self-esteem and
feelings of self-governance.
Evaluation: After hours of nursing intervention, the patient was able to create support system
and sense of control over the situation.
PROGNOSIS
Data Implication
Onset of illness Pain on the lower abdomen or POOR PROGNOSIS
pelvic region with light vaginal The early warning signs of
bleeding an ectopic pregnancy are
light vaginal bleeding and
pelvic pain. If blood leaks
from the fallopian tube, you
may feel shoulder pain or an
urge to have a bowel
movement.
It is possible for an early

ectopic pregnancy to end
in miscarriage on its own.
However, in most cases
it does not, and medical
intervention is needed. In
order to treat ectopic
pregnancy, the doctor will
recommend either a surgical
procedure or a medication
called methotrexate.
Age 36 years old POOR PROGNOSIS
Risk of an ectopic pregnancy
increases steadily with age.
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It is improbable that the

higher risk of EP in older age
cohorts is due to
chromosomal abnormalities
in the trophoblastic tissue.
Some researchers attributed
it to some age-related
factors, such as: Possible
tubal scarring from PID,
major gonococcal and
chlamydial epidemics and
changes in tubal function
leading to delay in ovum
transport and tubal
implantation. However,
these hypotheses need to be
investigated.
Gender Female POOR PROGNOSIS
Ectopic pregnancy cases
happens only on female
because structures that
involves ectopic pregnancy
is only present on females.
Complication History of previous ectopic POOR PROGNOSIS
pregnancy The most well-documented
risk factor for an ectopic
pregnancy is a previous
ectopic pregnancy. Women
with a prior ectopic
pregnancy have a 10-times
higher risk of recurrence.
After one ectopic pregnancy,
there is a 10% to 15%
chance of recurrence, which
increases to 25% in women
who have had two or more
ectopic pregnancies. After
one ectopic pregnancy,
there is a 10% to 15%
chance of recurrence, which
increases to 25% in women
who have had two or more
ectopic pregnancies.
(Sanya Ranchalc, MD,
FRCSC, 2021)
Attitude and willingness Mother shows cooperation GOOD PROGNOSIS
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towards needs and towards the treatment plan Cooperation from the mother
treatment increases the chance of
faster recovery.
Prognosis: 4 out of 5 were POOR however, since the mother shows cooperation on the
treatment, there is a big possibility of recovery for the mother.
DISCHARGE PLANNING
Medicine: Methotrexate (Trexall)  Methotrexate is given by a single injection in the arm.

 The patient will take her In certain situations, an infusion via a drip into the vein
prescribed drug unfailingly. may be required.
 This is done over one to two days and a short stay in
hospital is required. The doctor will discuss with you
which treatment option is best in your individual
situation. We will then need to check the pregnancy
hormone levels, as before, to ensure that they fall
appropriately. This will mean several blood tests over
the following month.
Environment:  Environment free from stressors that could precipitate
 The patient will live in an existing medical condition of the patient.
environment conducive to
faster recovery and health
maintenance.
Health Teaching:  Avoid heavy exercise
 The patient will learn about  To prevent infection during treatment and until the
ectopic pregnancy and will bleeding completely stops:
follow certain measures to ꟷ Don’t have sex for as long as your healthcare
avoid further complications provider tells you.
while on treatment. ꟷ Use sanitary pads instead of tampons.
ꟷ Don’t douche.
 Don’t use alcohol, any vitamins with folic acid (vitamin
B-9), or penicillin until your HCG level is back to zero.
 Don’t take aspirin or other anti-inflammatory
medicines such as ibuprofen and naproxen for 1 week
after methotrexate treatment or until your healthcare
provider says it’s OK.
 Don't eat gas-producing foods such as beans and
cabbage. These might make abdominal pain worse.
 Stay out of the sun during treatment. Methotrexate
may cause you to be sensitive to the sun.
 Use birth control for 4 to 6 months after treatment or
as long as your healthcare provider tells you to.
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Out Patient Follow Up:  Follow-up with your healthcare provider, or advised for
 The patient will recognize repeating hCg blood testing
any signs of deviations from  Call the doctor if any of the following occurs:
normal and will communicate ꟷ Pain in your lower abdomen that gets worse
with her health care provider ꟷ Heavy vaginal bleeding (soaking 1 new pad an
within the course of hour over 3 hours)
treatment. ꟷ Repeated vomiting or unable to keep down
fluids because of nausea
ꟷ Dizziness, weakness, or fainting
ꟷ Fever of 100.4°F (38°C) or higher, or as
directed by your healthcare provider
Diet:  Avoid foods that are rich in folic acid because folic

 The patient will identify due acid may decrease the effectiveness of the therapy.
diet for faster recovery Avoid these foods that are high in folic acid:
 Legumes:
1. Black, kidney, navy, or pinto beans
2. Black-eyed peas  Chickpeas
(garbanzo beans)
3. Lentils
4. Peanuts
 Grains:
1. Fortified breakfast cereal
2. Fortified oatmeal
3. Wheat Germ
 Fruits:
1. Oranges
2. Orange juice
3. Strawberries
 Vegetables:
1. Asparagus
2. Avocado
3. Brussels sprout
4. Broccoli or Cauliflower
5. Corn
6. Green peas
7. Okra
8. Spinach, Kale or other dark leafy
vegetables
 Meat:
1. Liver
 Limit the amounts of these foods; eat only small

amounts:
1. Bread/Rolls Grits
20
2. Crackers Flour tortillas

3. Noodles Cookies
4. Pasta Rice
Support System:  Take time to work through your feelings. If you feel
 The patient will be able to sadness or grief after pregnancy loss, it may help to
see the importance of having talk about your feelings with family and friends, or with
a support system to help her a counselor. Counseling may be helpful. Ask your ob-
with the course of treatment. gyn or other health care professional to recommend a
counselor. Online forums also can be a place to get
support from other women who have had ectopic
pregnancies.
REFERENCES
 Nursing Pocket Guide
 Essentials of Anatomy and Physiology
 Drug Handbook
 www.google.com
 http://www.scymed.com/en/smnxck/ckpgcbf1.htm
21

Case Study On Ectopic

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Case Study On Ectopic

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REPUBLIC OF THE PHILIPPINES

SULTAN KUDARAT STATE UNIVERSITY

CASE STUDY ON ECTOPIC PREGNANCY

ALHAMBRA, JULIANNE MIRAL

REVIEW OF SYSTEM/PHYSICAL ASSESSMENT 5

ANATOMY AND PHYSIOLOGY 6

NURSING CARE PLANS 13

Ectopic pregnancy, in essence, is the implantation of an embryo outside of the uterine

Antineoplastic ─ blocking the formation of neoplasms (growth that become cancer).

Ectopic Pregnancy - implantation of embryo outside of the uterine cavity.

Hemogram - a systematic report of the findings from a blood examination.

Methotrexate – a medication that destroys pregnancy-related tissue and hastens reabsorption of

Salpingitis - inflammation of the fallopian tubes.

REVIEW OF SYSTEM/PHYSICAL ASSESSMENT

headache and weakness.

ANATOMY AND PHYSIOLOGY

The female reproductive system performs the following functions:

Structure and function of the Female Reproductive System

o Greater vestibular glands

Invetigation: Serum B- hCG

Investigation: FBC (full blood count) test

Investigation: Pelvic exam

ANATOMIC OBSTRUCTION TO THE PASSAGE OF ZYGOTE

ABNORMALITIES IN THE MECHANISM FOR TUBAL MOTILITY

ECTOPIC PREGNANCY ABOVE 35 YEARS OLD

TRANSPERITONEAL MIGRATION OF THE ZYGOTE

PREVIOUS ECTOPIC PREGNANCY

DRUG (GENERIC INDICATION ACTION CONTRAINDICATION

Methotrexate Ectopic pregnancy  Reversibly  Contraindicated

IM; dihydrofolate hypersensitive

 Dizziness, CNS:  Methotrexate should be used only by

or both sides ulceration, GI and may regress upon discontinuing

NURSING CARE PLANS

NURSING CARE PLAN 1

(NBM or NPO) is necessary to prepare the

NURSING CARE PLAN 2

NURSING CARE PLAN 3

NURSING CARE PLAN 4

NURSING CARE PLAN 5

It is possible for an early

It is improbable that the

Medicine: Methotrexate (Trexall)  Methotrexate is given by a single injection in the arm.

Diet:  Avoid foods that are rich in folic acid because folic

 Limit the amounts of these foods; eat only small

2. Crackers Flour tortillas

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