Pines City Colleges

(Owned and operated by THORNTON`S INTERNATIONAL

STUDIES, INC.)
Magsaysay Ave. Baguio City 2600
College of Nursing

A Case Study On:

Ruptured Ectopic Pregnancy

Submitted By:
Group 1 BSN 2-1
Ambe, Francis
Babida, Hannah
Badang, Sophia
Balatbat, Kreshena
Barreyro, Alliah
Cacatian, Nayumi
Caga, Ibberly
Caramat, Derick
Carreon, Chainebee
Castuera, Johanna

Area and Date of Rotation:

BeGH, OB Ward
November 21-26, 2022
7-3 Shift

Submitted To:

College of Nursing

Date Submitted:
December 16, 2022

Definition of Terms:
a. ECTOPIC PREGNANCY
  In normal pregnancy the fertilized eggs attaches to the lining of uterus however in ectopic
pregnancy, fertilized eggs is implant and grows outside the main cavity of uterus. It is
commonly occurs in the fallopian tube.

b. LAPAROTOMY
 Laparotomy is performed on ectopic pregnancies that have ruptured which causes severe
internal bleeding. The fallopian tube is opened and the pregnancy tissue is removed while
the tube remains in place. After that, the tube heals on its own. Some ectopic tissue may
remain and continue to grow in 5% to 15% of cases. This can be treated with either
additional surgery to remove the tube or methotrexate therapy. When the ends of the
tubes (the fimbriae) appear healthy and the ectopic pregnancy is small, a partial
salpingectomy (also known as a segmental resection) to remove a middle segment of the
tube may be performed.  If only a small portion of the tube is removed, it can be rejoined
using microsurgery later. A total salpingectomy is performed if the fallopian tube is
severely damaged, the ectopic pregnancy is large, or the woman is bleeding excessively.
When an ectopic pregnancy involves the ovary, a portion of the ovary or the entire ovary
may be removed in rare cases.
c. HEMOPERITONEUM
 Hemoperitoneum, sometimes also called intra-abdominal hemorrhage or intraperitoneal
hemorrhage, is a type of internal bleeding in which blood gathers in your peritoneal
cavity. This is the space between your organs and the inner lining of your abdominal
wall.
d. SYNCOPE
 Another word for fainting or passing out.
e. SALPINGECTOMY
 Surgical removal of one or both fallopian tubes.
 I. PT. PROFILE
Name: Patient X
Age: 35
Sex: Female
Occupation: Delivery Services
Status: Single mom
Religion: Roman Catholic
Chief Complaint: Hypogastric Pain, accompanied by vaginal bleeding Extreme light-
headedness or fainting
Admission date: 11/23/22
Admitting Diagnosis: G4P1 PREGNANCY UTERINE 6-7 WEEKS AOG R/0 ECTOPIC
PREGNANCY
Principal Diagnosis: G4P1 (1031), ectopic pregnancy, cornual right at 6 to 7 weeks AOG,
ruptured with moderate hemoperitoneum s/p emergency exploratory laparatomy wedge
resection of cornual pregnancy with salpingectomy and peritoneal lavage

II. HEALTH HISTORY

a. History of Past Illness
-

b. History of Present Illness

In July 2016, the patient had a miscarriage during her second pregnancy and was confined at
Benguet General Hospital at four weeks AOG. The doctor prescribed take-home medications: Ferrous
Sulfate+Folic Acid and Celecoxib 200mg BID. In January 2018, patient X again had a miscarriage at four
weeks AOG accompanied by vaginal bleeding and hypogastric pain confined at BeGH and prescribed the
same medications last confinement: Ferrous Sulfate+Folic Acid and Celecoxib.

December 2020 patient was rushed to the hospital with the chief complaint of vaginal bleeding
and hypogastric pain associated with dizziness. The patient had undergone rapsa or dilatation and
curettage.

On November 2022, prior to admission, the patient experienced severe hypogastric pain with a
pain scale of 10/10 associated with vaginal bleeding. The patient was admitted to Benguet General
Hospital with a diagnosis of Ectopic pregnancy, preparing for operation emergency exploratory
laparotomy.

c. Family History
The patient has no family history of Hypertension, Diabetes, Asthma, Cancer, allergies and mental
disorders.

d. OB History
In July 2016, the patient had a miscarriage during her second pregnancy and was confined at
Benguet General Hospital at four weeks AOG. The doctor prescribed take-home medications: Ferrous
Sulfate+Folic Acid and Celecoxib 200mg BID. In January 2018, patient X again had a miscarriage at
four weeks AOG accompanied by vaginal bleeding and hypogastric pain confined at BeGH and
prescribed the same medications last confinement: Ferrous Sulfate+Folic Acid and Celecoxib.

December 2020 patient was rushed to the hospital with the chief complaint of vaginal bleeding
and hypogastric pain associated with dizziness. The patient had undergone rapsa or dilatation and
curettage.

Recently, on November 2022, before admission, the patient experienced severe hypogastric pain
with a pain scale of 10/10 associated with vaginal bleeding associated with dizziness as she verbalized,
“parang literal na nandilim paningin ko tapos sobrang hilo". Patient X felt bloater however she
verbalized, “hindi ko na pinansin yung bloating feeling kasi akala ko constipated ako”, indicating that
she did not know that she was having a complication. Also, The patient was admitted to Benguet
General Hospital with a diagnosis of Ectopic pregnancy, preparing for operation emergency
exploratory laparotomy.

III. DEVELOPMENTAL STAGE

A. Robert Havighurst
         Robert Havighurst emphasized that learning is basic and that it continues throughout life span.
Growth and Development occurs in six stages. Patient X is 34 years old and belongs to the middle age
stage.
DEVELOPMENTAL
TASKS IN THE STAGE OF ACCOMPLISHMENT
MIDDLE AGE (30-60 years
old)
 Achieving adult civic
and social
responsibility
 Assisting teenage
children to become
responsible and
happy adults
    
 Developing adult
leisure-time activities    
 Accepting and
adjusting to the
physiologic changes
or middle age
    
B. Erikson’s theory
         Erikson's theory focuses on how a person feels about them and where they fit in the world rather
than how well they can perform tasks that must conform to social norms. Erikson maintained that
STATUS OF JUSTIFICATION
(Met or unmet)
Patient X did not meet her civic and
social responsibility, as she said that she
doesn’t participate in activities in their
community because she is very busy with
Unmet her work. Patient X verbalized “Hindi
ako nakakapunta sa mga activities ng
barangay palagi kasi akong busy sa
trabaho ko.”
Patient X was able to meet with assisting
teenage children to become responsible
and happy adults where she is able to
care and assist her child in going to
           met school, who is currently a second grade
student. Patient verbalized “Kahit may
trabaho ako nagagawa ko parin na
manghatid at sunduin ung anak ko sa
skull nila at pag gabi naman bago kami
matulog kinakamustako kung kamusta
ang skull niya .”
      Unmet Developing adult leisure-time activities
was unable to be met by patient X, as she
verbalized that “Hindi ako masyado
lumalabas sa bahay unless may
idedeliver akong pagkain or susundo ng
anak”, as verbalized by the patient
indicates that she doesn’t go out
frequently and only goes out from their
house when she has errands.
Accepting and adjusting to the
physiologic changes of middle age were
partially met, as she stated when we
asked how she felt about her operation.
She states that “Nakakalungkot
kasipangatlong beses na akong nakunan”
   Partially met and she have been less active throughout
her hospital stay, and she feels
disheartened.
personality development is a predetermined order through eight stages of psychosocial development.
During each stage, the person experiences a psychosocial crisis, which could have a positive or negative
outcome for personality development.

         Failure to successfully complete a stage can result in a reduced ability to complete further stages
and, therefore, a more unhealthy personality and sense of self. These stages, however, can be successfully
resolved at a later time.

STAGE OF PSYCHOSOCIAL STATUS OF JUSTIFICATION

DEVELOPMENT ACCOMPLISHMENT

Intimacy Vs. Isolation Patient X partially satisfied the

intimacy vs. isolation stage because, as
- During this stage, the major Partially met she mentioned, she only lives with her
conflict centers on forming child and her husband has already
intimate, loving relationships passed away.
with other people. Successful
completion of this stage can
result in happy relationships and
a sense of commitment, safety,
and care within a relationship.

IV. 13 AREAS OF ASSESSMENT

A. Psychosocial
She is a non-smoker but verbalized that her friend is a smoker, which she visited daily. “Hindi
ako masyado lumalabas sa bahay unless may idedeliver akong pagkain or susundo ng anak”, as
verbalized by the patient indicates that she doesn’t go out frequently and only goes out from their house
when she has errands. Patient X also doesn’t participate in activities in their community because she
stated that she is very busy with her work and taking care of her child. Her family lives in Pangasinan,
including his relatives. Her child is studying at Lucban Elementary School Grade 2 student. Patient
verbalized, “Yung anak ko lng kasama ko sa bahay kaya mas natututukan ko siya tapos naibibigay ko
lahat ng gusto niya kaya mahal na mahal ko yung batang yun”. Also, she verbalizes, “Kahit may trabaho
ako nagagawa ko parin na manghatid at sunduin ung anak ko sa skull nila at pag gabi naman bago kami
matulog kinakamustako kung kamusta ang skull niya”, indicating that she had a good relationship with
her child as they are only the support system for each other. During her stay in the hospital, she is
cooperative such as complying with oral medications prescribed and responds well to the health teachings
of the healthcare provider.

B. Mental Status and Emotional Status

Patient X was oriented to time, place, and date upon assessment. She acts accordingly to her age
and responds accordingly to questions.

“Nakakalungkot kasi pangatlong beses na akong nakunan at wala akong ginawa para mabuhay
siya”, as verbalized by the patient. As observed, the patient is sad during our first duty in the hospital.
Also, she is less active and felt dishearted of her current situation. She admits that she lives alone with her
child and that during the duration of her admission, her friend frequently visits her for assistance.

C. Environmental status
During her stay in the hospital, the Patient is well-oriented to the environment and is familiar with the
room set-up. She has intravenous access to both her arms for her IV fluids, which may expose her to
infection, and lines may limit her general mobility. Bed rails are available, and her watcher is beside her.
The Patient and watcher claimed that they disposed of their garbage properly. Alcohol was available at
the bedside for disinfection. Patient X is admitted to the OB ward wherein it has a spacious bed for other
patients and has a proper distance from each other. Patients in the ward are separated wherein patient who
does not have result test for COVID-19 are in isolation while negative test are in the clean ward.
Also, she was placed near the large window, which makes the space adequately ventilated. No
unnecessary noise was noted. The floor was also well-maintained and non-slippery. Other than that, the
Patient has no complaints of uneasiness or discomfort concerning her environment.

D. Sensory Status
D.1. Visual
Patient has normal conjunctiva. She is able to move eyes without tenderness, pain or difficulty.
D.2. Auditory
Upon assessment, no visible lumps or lesions noted, there were no corrective devices used such as
hearing aids and discharges noted.

D.3. Olfactory
The patient has an intact sense of smell as manifested by the ability to distinguish familiar odor such
as alcohol during assessment. No epistaxis was noted. Nose was seen to be symmetrical,
proportionate and no lesions seen.
D.4. Gustatory
Patient is not using dentures. She has slightly dry lips and oral mucosa. There is no difficulty in
mastication and swallowing as verbalized. She has an intact gag reflex.
D.5. Tactile
Facial sensations are also intact and symmetrical on both sides. She is able to perceive heat, cold and
pain sensations.

E. Motor Status
Upon assessing the patient with the use of Range of Motion, the patient was able to perform the
ROM with precaution due to the incision site. During the first day of her stay in the hospital, she
verbalized, “Sa pag upo at pagtayo kailangan ko pa din ng alalay kasi medyo sumasakit yung sugat ko
kapag binibigla kong umupo or bumabangon at meron pa akong catheter kaya ndi pa ako nakalad”,
which indicates that she can sit with the need of assistant. However, on the second day, patient
verbalized “medyo nalang masakit ung sugat ko hindi na kagaya kahapon kaya nakakabangon na din
akong mag isa at kaya ko na din maglakad kahit pa onti onti” which indicates that upon removing the
catheter, she could ambulate on her own but with caution in movements due to the pain and since she
has both IVs in her arms. Moreover, the Upper extremities are symmetrical as well as lower
extremities. Upon palpating, radial and brachial pulses are present. No crepitus was noted upon
flexion of joints. Extremities are warm to the touch.

F. Nutritional Status
Patient was instructed for soft diet after she had undergone surgery but after defecating, doctor
instructed Patient X to have a full diet.
The patient has good skin turgor that quickly recovers; her skin appears to be hydrated. The scalp,
eyelashes, and eyebrows are noted to have terminal hairs free of parasite infestation. The patient has
oral mucosa and mildly dry lips. The patient has a healthy appetite and eats 50% of the food that is
given to her. The patient stated that she has no energy sources other than eating. She has no allergies
and any dietary restrictions imposed by religious practices.

G. Fluid and Electrolyte Status

DATE TIME ORAL FLUID AMOUNT INTRAVENOUS FLUID AMOUNT

INTAKE INTAKE

11/23/2022 8 AM D5LRS IL FD 1000cc

COFFEE
236cc
WATER
240cc

TOTAL 476cc
11/24/2022 12:20AM WATER 240cc D5LRS 1Lx 8hrs 1000cc

12:20AM PNSS 1L x 8 hrs 1000cc

8AM WATER 120cc D5LRS 1L x 130 ml/hr 1000cc

D5LRS 1L x 120 ml/hr

10 PM 1000cc

TOTAL 360cc

22/25/2022 WATER 120cc

TOTAL 120cc

H. Circulatory Status

DATE BP CR RR

11/23/2022 80/60 86 21

80/60 81 20

11/24/2022 90/60 98 20

90/70 87 21

120/90 90 20

110/70 70 24

100/80 85 20

110/ 90 82 20

100/90 69 21

100/90 70 21
 100/80 83 20

11/25/2022 110/70 70 20

100/70 70 21

110/70 70 23

130/80 70 20

130/90 83 20

110/80 70 21

120/80 65 19

120/ 80 71 21

 
The patient's highest recorded pulse rate ranges from 65- 98, which is consistent with typical
values given the patient's age. While the patient is lying on the bed, the blood pressure is measured,
and the range is 80/60 to 130/90. According to data on initial BP, the patient has an abnormal range
of blood pressure. However, there is a slight variation during the shift due to some interventions that
were given, which improved the BP status of the patient.

I. Elimination Status

DATE/ TIME OUTPUT AMOUNT

FLUID

11/23/2022

2 PM URINE 112cc

11/25/2022
URINE 800cc
10 AM
STOOL 1
2 PM
URINE 1
10 PM
STOOL 1

URINE 4
6 AM

J. Temperature Status
The patient’s temperature is 36.5 upon admission and 36.5 on the last taking of initial vital signs,
which is within normal range. The ward is adequately ventilated, and the patient used only one
blanket. Her clothes are made of cotton, not significantly affecting her temperature status.

DATE AND TIME TEMPERATURE ANALYSIS

11/23/22 10pm 36.8 Normal

11pm 36.6 Normal

11/24/22 12am 36.6 Normal

6:30am 36.8 Normal

10am 36.5 Normal

2pm 36.5 Normal

6pm 36.5 Normal

10pm 36.5 Normal

11/25/22 12am 36.7 Normal

2am 36.8 Normal

6am 36.7 Normal

11/26/22 8am 36.5 Normal

10am 36.5 Normal

2pm 36.9 Normal

6pm 36.5 Normal

 10pm 36.9 Normal

11pm 36.7 Normal

2am 37 Normal

6am 36.6 Normal

K. Respiratory Status

The normal respiratory rate for a healthy adult ranges from 12-20 breaths per minute while the
normal SPO2 ranges from 95%-100%.

The normal respiratory rate for a healthy adult ranges from 12-20 breaths per minute while the
normal SPO2 ranges from 95%-100%.

DATE AND TIME RESPIRATORY RATE ANALYSIS SPO2 ANALYSIS

Abnormal 95% Normal

11/23/2022 21

Normal 96% Normal

20

Normal 95% Normal

11/24/2022 20

Abnormal 98% Normal

21

Normal 97% Normal

20

Abnormal 97% Normal

24

Normal 98% Normal

20
 DATE AND TIME RESPIRATORY RATE ANALYSIS SPO2 ANALYSIS

Abnormal 95% Normal

11/23/2022 21

Normal 96% Normal

20

Normal 95% Normal

11/24/2022 20

Abnormal 98% Normal

21

Normal 97% Normal

20

Normal 96% Normal

20

Abnormal 99% Normal

21

Abnormal 99% Normal

21

Normal 97% Normal

20

Normal 98% Normal

11/25/2022 20

Abnormal 96% Normal

21

Abnormal 96% Normal

23

The patient's respiratory rate ranges from 19 - 24 bpm, which falls under normal to abnormal
ranges, while the SPO2 ranges from 91% - 98%, which falls under abnormal to normal ranges. No
use of accessory muscles was noted. The chest wall symmetrically expands with each respiration, and
no retractions are seen. The patient is sometimes exposed to secondhand smoke when she visits her
friend. Since there are abnormal SPO2 and respiratory rate, the patient reported no SOB or dyspnea
when asked by the student nurse.

L. Integumentary Status
The patient skin is brownish with paler skin color on seldom exposed skin. Skin is neither cold nor
hot, moist, and smooth, with a good skin turgor. The hair is a little messy without visible flakes, and the
hair color is black. Nails are short and clean. There is no noted swelling or tenderness upon palpation.
 M. Comfort and Rest Status
Patient was able to sleep 7 to 8 hours within 24 hours. Patient sleeps and experiences minimal
disturbance, as reported.

VI. DIAGNOSTICS/LABORATORY TEST

HEMATOLOGY REPORT
DATE PERFORMED: NOVEMBER 23, 2022
PURPOSE: To monitor or measure Hemoglobin and Hematocrit before discharge from the OB Ward.

Component Reference RESUL INTERPRETATI Component Reference RESUL INTERPRETATI

and Quality Values TS ON and Quality Values TS ON

Hemoglobin: Hematocrit:

Male:135- Normal values no Male: 0.40- Normal

180 g/L indication of 0.54
134 anemia. 0.40
Female: Female:
120-160 g/L 0.37-0.47

WBC count: 4.50-11.0 x 19.9 High white blood Platelet count: 150-450x10 239 Normal
10 9/L cell count usually 9/L
indicates: An
increased
production of
white blood cells
to fight an
infection.

Compensatory
mechanism of the
body due to post
operation.

Differential
count:

Neu 0.51-0.67 0.91 -Indication for

infection

Lymph 0.25-0.40 0.05 -Indication of

infection

Mono 0.02-0.08 0.03 Normal

Eos 0.01-0.03 0.01 Normal

Bas 0.00-0.01 Normal

 1.00

Clottting time: 3-5 mins

Bleeding time: 1-2 mins

Indication: Used to evaluate the overall health and wide cause of disorders.
Implication: Used to monitor the blood levels and the condition of the patient.

URINALYSIS 
DATE PERFORMED: NOVEMBER 23, 2022
PHYSICAL
EXAMINATION INTERPRETATION INTERPRETATION

Color: LIGHT Normal WBC: 1-2 /HPF Can be a sign of urinary tract
YELLOW infection

Transparency: The patient is slightly RBC: 0-2/HPF

SLIGHTLY dehydrated Since there is a moderate vaginal
TURBID bleeding RBC can be seen in the
urine

Epithelial cells:
Slighly acidic: MODERATE It may mean the sample has a sign
Ph: 5.0 NORMAL of minor infection

Sp. Gravity: 1.010 Normal Bacteria: FEW Can be a sign of developing UTI or
cystitis.

SEROLOGY REPORT
DATE PERFORMED: NOVEMBER 24, 2022

TYPES OF EXAMINATION RESULT

HBsAg SCREENING NONREACTIVE
SYPHILIS SCREENING NONREACTIVE

INTERPRETATION: It signifies that the patient is negative for Syphilis, one of the Sexually
Transmitted Infections. It indicates that Patient X is illegible for operation.

MISCELLANEOUS
DATE PERFORMED: NOVEMBER 24, 2022

ABO/Rh TYPING

ABO: O Rh: POSTIVE

IMPLICATION: RBC was prepared and administered during her laparoscopic salpingectomy and after
her operation to compensate for her blood loss.
VII. NURSING PRIORITIZATION
RAN
PROBLEM
Fluid Volume Deficit related to
internal bleeding as evidenced
by hypotension with initial BP
of: 80/60 mmHg and moderate
vaginal bleeding
Acute pain related to surgical
incision secondary to
laparotomy/salpingectomy
As evidenced by a pain scale of
7/10, (+) facial grimace and (+)
abdominal guarding behavior.
Complicated grieving related
to insufficient social support
secondary to ectopic
pregnancy
POTENTIA
ACTUAL JUSTIFICATION
K L
Fluid is categorized as a
physiological requirement in
Maslow’s Hierarchy, and a fluid
1 / volume deficit caused on by
severe bleeding linked to
changed blood pressure can
lead to serious complication
such hypovolemic shock and
dehydration.
Patient was diagnosed with
Ectopic Pregnancy leading to
Cesarean Delivery and
throughout her stay in the
hospital, she has an
insignificant BP of 80/60
Based on the assessment of the
general appearance of the
2 / Patient, show abdominal
guarding, and facial grimace in
pain. Patient verbalized
“masakit ung sugat ko”
The patient's level of activity,
mood and capacity for thought
may all be influenced by
unattended pain, according to
Manchester's protocol. Pain
management can reduce a
patient's risk of problems and
speed up their recovery.
Patient verbalized
“Nakakalungkot kasi
3 / pangatlong beses na akong
nakunan”. Due to her ectopic
pregnancy, she has been less
active throughout her hospital
stay, and she feels disheartened.
She admits that she lives alone
with her child and that during
the duration of her admission,
her friend frequently visits her
for assistance.
Risk for Infection related to Due to the patient's surgical
Surgical incision incision location, she is
1 / susceptible to infection that
might spread to her systemic
circulation and cause a major
problem or complication. Since
the patient is at risk regular
wound care and health
education are advised.

X. Evaluation/Referral
XI. Implication
XII. References