CASE PRESENTATION ON ECTOPIC PREGNANCY

BIOGRAPHIC DATA

 NAME :Deepanshi
 AGE :25years
 WARD NO. :PNC 1
 MRD NO. 7098
 MARITAL STATUS :Married
 EDUCATION :10th pass
 OCCUPATION :Homemaker
 INCOME :40-45 thousand
 RELIGION :Hindu
 LANGUAGE KNOW :Hindi
 ADDRESS :B- 32 suray nagar
 DIAGNOSIS :Ectopic pregnancy
 DATE OF ADMISSION :10-5-2022
 DATE OF DISCHARGE :17-05-2022
 DATE OF CARE STARTED :10-05-2022
 DATE OF CARE ENDED :14-05-2022
 INFORMANT : Patient

I) INTRODUCTION OF PATIENT
Mrs. Deepanshi , a 25 years was admitted to labour room due to severe pain in abdomen and
bleeding from 2 hours. She was 6 weeks of gestation. She came at 6am and immediately
laparotomy was done in the OT to diagnose the problem. She is primigravida.
She diagnosed with ectopic pregnancy and after laparotomy she is admitted in PNC1 for further
management and evaluation

II) SOCIOECONOMIC BACKGROUND

Mrs. Deepanshi belongs to middle class family .she lives in a small house maker with the basic
necessity.
III) FAMILY HEALTH HISTORY

a) Family composition
S.No Name Relationship Age Sex Education Occupation Health
to the status
patient
1. Mrs.Deep Patient 25y Female 10th pass Homemaker Sick
anshi ears
2. Mr.Ankit Husband 27y Male B.com Accountant Healthy
ears

b) Family medical history

No significant medical history
IV) HISTORY OF PRESENT ILLNESS

Present Obstetric History

The client was admitted in labour room with complaint of pain and bleeding. She was admitted
at 6weeks of gestation. Emergency laparotomy was done on 10-5-22.

Present Medical History:

Mrs. Deepanshi does not have any significant medical history.

Present Surgical History

She does not have any significant surgical history.

V) HISTORY OF PAST ILLNESS

Past obstetrical history

The client is a primigravida.

History of Past Medical Illness

The patient does not have any significant past history of medical illness.

History of Past Surgical Illness

There is no significant past surgical history.

VI) PERSONAL HISTORY

1. Personal habit : She is non- alcoholic and dos not smoke.

2. Diet : She is a vegetarian
3. Sleep and rest : She usually sleeps 5 hours at night and has
difficulty in falling asleep.
4. Activities of daily living :She does not have difficulty in activities of daily
living after 3 days of laparotomy
5. Elimination : Regular and normal
6. Bladder habits : She does not have any problem in micturition.
7. Hobbies and interest : sketching
8. Marital status : She is married since 1 years
9. Sexual history : No history of sexually transmitted disease.
10. Drug history : No drugs are she was taking in past.
11. Obstetric history : G1P0A0L0
12.
LMP: 07-4-22
EDD: 14-1-23
13. Psychiatric history : No significant of psychiatric illness.
 VII) HEAD TO TOE EXAMINATION

General Appearance
 Nourishment : Moderately nourished
 Body Built : Average body built
 Hygiene and Grooming : Clean
 Activity : Inactive
 Posture : Normal posture
 Movement : Normal movements

Mental Status Examination

 Consciousness :Conscious
 Look :Anxious
 Attitude :Cooperative
 Affect and Mood :Appropriate
 Speech :Clear
 Orientation :Oriented to time, place and
person
Vital Signs
 Temperature : 98.4F
 Pulse : 92/min
 Respiration : 26/min
 Blood Pressure : 120/70 mmHg

Weight and Height

 Height : 160 cm
 Weight : 57 kg
 BMI : 22.3 kg/m2

Head
 Shape : Normocephaly
 Scalp : Normal no dandruff
 Face : No swelling
 Subjective Symptoms : No complaints
Hair : evenly distributed and thick

 Texture : Oily
 Colour : Black
 Grooming : Groomed
 Subjective feelings : No complaints

Eyes
 Eyebrow : Normal and symmetrical
 Eyelids : Normal and equal
 Eyelashes : Equally distributed
  Pupil color : Black
 Size : 3 mm
 Reaction to light : PERLA
 Corneal reflex : Present
 Conjunctiva : Pink
 Lens : Transparent
 Pupil vision : Normal
 Extraocculor muscles : Normal
 Subjective symptoms : No complaints

Ear
 Position : Normal
 Otorrhoea : Absent
 Subjective complaints : No complaints

Hearing
 Response to normal voice tone : Normal voice tone audible
 Watch tick test : Watch tick heard in both ears
 Subjective symptoms : No complaints

Nose
 External : Symmetrical no discharge
 Nasal septum : Midline
 Patency of nasal cavity : Air moves in freely as client
breaths through nares
 Frontal and Maxillary Sinuses : Normal
 Olfaction : Normal
 Subjective symptom : No complaints

Mouth and Larynx

 Outer lips : Pink and moist
 Inner lips : Pink, moist and smooth
 Teeth : All 32 teeth. Teeth are stained
with no dental caries
 Gums : Brown colour and healthy
 Tongue : Central position, pink in colour
 Movement : Normal movement
 Palate : Dark coloured
 Uvula : Normal
 Tonsils : Not palpable
 Odour of mouth : No foul smell
 Pharynx : Gag reflex present
 Subjective data : No complaints
Neck
 Movement : Range of motion normal
 Trachea : Midline
 Lymph nodes : Not palpable
 Jugular vein : Not distended
 Carotid pulse : Palpable
 Thyroid gland : Not enlarged

Chest
 Transverse diameter is twice the anterior posterior diameter and Symmetrical
 Expansion of chest : Symmetrical
Palpation
 Tactile fremitus : Symmetrical

Auscultation
 Apical pulse : 98/ min
 Breath sounds : Normal vesicular sounds
 Cough : Absent
 Sputum : Absent
 Heart : S1 S2 sounds are heard
 Subjective symptom : No complaint

Breast and axilla

 Symmetry : Symmetrical
 Areola and nipples : Color dark brown and normal
 Hair distribution : Scanty
 Discharge : Absent
 Lesions and masses : Absent
 Axillary nodes : Not palpable
 Condition of breast : Secretory

Abdomen
 Inspection :Presence of Scar mark of
laparotomy
 Appetite : Normal
 Subjective symptoms : Pain present

Skin
 Color : Brown
 Texture : Dry
 Temperature : Normal
 Lesions : Absent
 Turgor : Normal
 Discoloration : Absent
Upper Extremities
 Symmetry : Symmetrical
 range of motion : Possible
 peripheral pulse : Brachial and radial pulse
Palpable
 reflexes :Biceps and triceps reflexes
Normal
 edema/swelling : Absent
 cyanosis : Absent
 joints : Normal
 deformity : Absent

Lower Extremities
 symmetry : Symmetrical
 nails : Capillary refill 2 sec
 range of motion : Normal
 peripheral pulse : Dorsalis pedis, posterior tibial
and popliteal pulses palpable
 reflexes : Patellar and ankle jerk present
and plantar reflex absent
 edema/ swelling : Present
 cyanosis : Absent
 joints : Normal
 deformities : No deformities
 subjective symptom : Pain in both legs
after Prolonged
standing

Nails
 shape :Convex shaped
 texture : Smooth
 nail bed colour : Pink
 tissue surrounding nails :Intact epidermis and dark
coloured
 capillary refill : 2sec

Genitals and rectum

 hemorrhoids : Absent
 vaginal discharge : Bleeding present
: Colour- red : lochia rubra
:Odour –fishy
:Clots-Absent

 labia majora and minora : Normal

 ABOUT THE CASE
Anatomy
Uterus, also called womb, an inverted pear-shaped muscular organ of the female reproductive
system, located between the bladder and the rectum. It functions to nourish and house a
fertilized egg until the fetus, or offspring, is ready to be delivered.

The uterus has four major regions: the fundus is the broad curved upper area in which
the fallopian tubes connect to the uterus. The uterus is 6 to 8 cm (2.4 to 3.1 inches) long; its wall
thickness is approximately 2 to 3 cm. The uterine cavity opens into the vaginal cavity, and the
two make up what is commonly known as the birth canal. Lining the uterine cavity is a
moist mucous membrane known as the endometrium. The lining changes in thickness during
the menstrual cycle, being thickest during the period of egg release from the ovaries. If the egg
is fertilized, it attaches to the thick endometrial wall of the uterus and begins developing.
 TITLE OF THE DISEASE/DIAGNOSIS

INTRODUCTION

Ectopic pregnancy still contributes significantly to the cause of maternal mortality and
morbidity. High risk cases, early diagnosis (even before rupture) with the use of TVS, serum beta
– HCG and laproscopy have significantly improved the management of ectopic pregnancy.

DEFINITION

An ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the
normal endometrial cavity.

RISK FACTORS
 History of PID
 History of tubal ligation
 Contraceptive failure
 Previous ectopic pregnancy
 History of infertility
 ART particularly is the tubes are patent but damaged
CLINICAL MANIFESTATIONS

BOOK PICTURE PATIENT PICTURE

 Salpingitis and pelvic inflammatory  IUD- CuT

disease
 Contraceptive failure
A. IUD
B. Sterilization operation
C. Use of progestin pill
 Tubal surgery
 Intrapelvic adhesions
 ART
 Others
A. Previous ectopic pregnancy
B. Prior induced abortion
C. Development defects
D. Tubal endometriosis

DIAGNOSTIC INVESTIGATION/SCREENING

In book

 Blood examination
 Culdocentesis
 Estimation of beta HCG
 Sonography
 Laparoscopy
 Dilatation and curettage
 Serum progesterone
 Laparotomy

INVESTIGATIONS DONE IN PATIENT

 History
 Blood examination
SNO TEST NAME RESULT NORMAL RANGE

HAEMATOLOGY
Hb 9.8mg/dl 11-15mg/dl
TLC 9,000/mm3 4-10,000/cm
Platelet count 1.06/cumm 1.5-4lakh/cumm
PCV 36% 37-47%

LFT
Serum bilirubin 0.4mg/dl 0.2-1.0mg/dl
SGPT 22IU/L 5-40IU/L
SGOT 5-40IU/L
28IU/L
KFT
Urea 20-45mg/dl
16mg/dl
Creatinine 0.6-1.0mg/dl
0.7mg/dl

MANAGEMENT

 Methotrexate
 Potassium chloride
 Prostaglandin
 Hyperosmolar glucose
 Actinomycin

MEDICAL MANAGEMENT DONE IN PATIENT

S NO NAME OF PHARMACOL ROUTE, DOSE ACTION

DRUG OGICAL NAME AND
FREQUENCY
1. Methotrexate Otrexup™ 50mg/M2 – IM The medicine removes fetal
cells left behind after surgery.

SURGICAL MANAGEMENT

 Laparotomy
 Salpingectomy
 Linear salpingostomy
 Linear salpingotomy
 Segmental resection
 Fimbrial expression
 NURSING CARE PLANS

Assessment Nursing Goal Planning Implementatio Evaluation

diagnosis n

Subjective Acute pain To reduce * Assess the *General *Patient pain was
data: patient related to the pain. general condition was reduced and she is
assessed.
complaint surgical condition of in left
about pain at incision as patient. comfortable
the site of evidenced *confortable position.
*To give the position was
laparotomy. by pain
comfortable given.
score as
position.
7/10.
*To provide *psychological
support was
psychological given to patient.
Objective support to the
data: patient patient.
pain as score
7/10 *To administer *Analgesic was
administered as
the analgesic
prescribed by
as prescribed doctor
by doctor.

Assessment Nursing Goal Planning Intervention Evaluation

diagnosis

Subjective Fluid Maintain the *Assess the * General condition Fluid volume is
data: patient volume fluid general condition was assessed maintained.
says muje deficient volume of patient
vomiting ho related to level
*Administer the *IV fluid was
rhi hai. vomiting as IV fluid. Administered.
evidence by
verbalization *Maintain the *Input output
input output charting was
Objective
charting. maintained.
data:
*Administer *Antiemetic was
*Nausea
antiemetic as administered as
*Vomiting
prescribed by
prescribed by
doctor.
doctor.
Assessment Nursing Goal Planning Intervention Evaluation
diagnosis

Subjective Altered To maintain *To check the *Vital signs were Patient feels
data: nutrition the body vital signs of checked. better than before.
patients status less requirement patient.
complaining than body and
*To encourage to *patient was
of weakness requirement nutritional have diet rich in encouraged to have
and fatigue. related to status protein. diet rich in protein.
lack of
knowledge *To instruct the *patient was
about patient to get instructed to have
postnatal extra 500 calories 500 calories in diet.
in diet.
needs as
evidenced *To provide *Nutritional
Objective by nutritional supplements were
data: patient generalized supplement as provided as
look weak weakness prescribed by the prescribed by the
and pale physician physician.

Assessment Nursing Goal Planning Intervention Evaluation

diagnosis

Subjective Risk for To reduce *To assess the *General condition Patient has
data infection the risk of general condition of was assessed. adequate
related to infection patient. knowledge
My patient inadequate related to
is *To provide *Educational was
knowledge education regarding provided regarding prevent
complaining about caring infection.
proper care of the proper care of the
‘she had for the wound. wound.
fever. wound.
*To instruct *Patient was
maintain proper instructed to
hygiene. maintain proper
Objective
hygiene.
data
*To administer *Antibiotic was
Fever antibiotics properly administrated as
as prescribed by the prescribed by
physician. doctor.
Assessment Nursing Goal Planning Intervention Evaluation
diagnosis

Subjective data: Activity To make * To assess the * General condition Patient was able to
intolerance patient able general condition was assessed. get up from bed.
Patient related to to do of patient.
complaining of laparotomy activities of
inability to do *To keep the *Articles of daily
as daily living articles of daily living use are kept in
activities of daily evidence living use near the patients reach.
living by the patient’s
inability to reach.
do activity *Psychological
of daily *Provide support was given.
psychological
living
support *Patient was
encouraged to walk
Objective data: *Encourage around.
ambulation of the
Fatigue patient.

Assessment Nursing Goal Planning Intervention Evaluation

diagnosis

Subjective data: Anxiety To reduce *To check the vital *Vital signs *Patient was less
related to the signs. was checked anxious than
My patient is and
knowledge anxiety before.
asking question recorded
deficit and
very frequently *To give the
disease health education *Health
condition to the patient education was
regarding disease given to the
and the courses of patient
treatment. regarding
Objective data: disease and the
courses of
-Anxiety treatment.
-She look very *To provide the
anxious psychological *Psychological
support to the support was
patient. given to the
patient.
 NURSES NOTES

Name = Deepanshi Diagnosis- ectopic pregnancy

Age = 25years ward -PNC 1
Reg.No.= 7098 Day-1
Date & Vital Time Medication Diet Stool Urine Remarks
time
10-5-22 Bp- 9:30am *Tab. Liquid ✖ ✓ 9:00-Vitals was checked and
120/70 calcium diet recorded.
9:00am T- *Tab.
99.8F Folic acid 9:30-Adminsited the medication
R- *Tab.
26b/m Voveran 10:00-Encourage to the patient
P- *Tab. for ADL.
98b/m Rantac
*Tab. 11:00-she took coconut water
PCM
12noon – she is in left
comfortable position

Vaishnavi

Name = Deepanshi Diagnosis- ectopic pregnancy

Age = 25years ward -PNC 1
Reg.No.= 7098 Day-2
Date & Vital Time Medication Diet Stool Urine Remarks
time
11-5-22 Bp- 9:30am *Tab. Semi- ✓ ✓ 9:00-Vitals was checked and
120/80 Calcium solid recorded.
9:00am T- diet
97.6F *Tab. 9:30-Adminsited the medication
R- Folic acid
24b/m 10:00-Encourage to the patient
P- *Tab. for ADL.
88b/m Voveran
11:00-she took coconut water
*Tab.
Rantac 12noon – Health was given
regarding care of wound and
maintain hygiene.

1-pm- patient is in left

comfortable position

Vaishnavi
Name = Deepanshi Diagnosis- ectopic pregnancy
Age = 25years ward -PNC 1
Reg.No.= 7098 Day-3
Date & Vital Time Medication Diet Stool Urine Remarks
time
12-5-22 Bp- 9:30am *Tab. Semi- ✓ ✓ 9:00-Vitals was checked and
110/80 Calcium solid recorded.
9:00am T- diet
97.4F *Tab. 9:30-Adminsited the medication
R- Folic acid
24b/m 10:00- Health was given
P- *Tab. regarding care and treatment.
84b/m Voveran
11:00-She took juice and lunch.
*Tab.
Rantac 12noon –. Encourage to the
patient for ADL.

1-pm- patient is in left

comfortable position

Vaishnavi

CONCLUSION

Mrs.Deepanshi , 25 years old female patient abort immediate laparotomy done on 10-5-22. She
is a case of ectopic pregnancy and now she is admitted in postnatal ward for further evaluation
and management.

BIBLIOGRAPHY

Konar.H. DC Dutta’s Textbook of Obstetrics: hemorrhage in early pregnancy .8th Edition. New
Delhi: Jaypee; 2015. P 207-218.