CASE STUDY:

Ectopic Pregnancy
MCN RLE

BY:
PAULIN, IVYGAIL KAREN K.
PAYANAY, FATIMA
PEPITO, CHRISMONTE KYLE
QUEDDENG, HENDRICK
QUIBAL, MARIA ABBIGAIL

MARCH, 2021
 INTRODUCTION
An ectopic pregnancy is one in which implantation occurred outside the uterine cavity. The most common site (in
approximately 95% of such pregnancies) is in the fallopian tube. On these fallopian tube sites, approximately 80% occur
in the ampullar portion, 12% occur in the isthmus, and 8% are interstitial or fimbrial (Jurkovic, 2012). With ectopic
pregnancy, fertilization occurs as usual in the distal third of the fallopian tube. Unfortunately, because an obstruction is
present, such as an adhesion of the fallopian tube from a previous infection (chronic salpingitis or pelvic inflammatory
disease), congenital malformations, scars from tubal surgery, or a uterine tumor pressing on the proximal end of the tube,
the zygote cannot travel the length of the tube. It lodges at a structured site along the tube and implants there instead of in
the uterus.

Approximately 2% of pregnancies are ectopic, and because at least minimal bleeding occurs, it is the second most
frequent cause of bleeding early in pregnancy. The incidence ofectopic pregnancy appears to be increasing, possibly
because of the increasing rate of pelvic inflammatory disease, which can lead to tubal scarring. The incidence is also
increased following in vitro fertilization (a woman might be having the in vitro fertilization because she has tubal
scarring) and also in women who smoke. Women who have one ectopic pregnancy have a higher chance of having a
subsequent ectopic pregnancy. This is because salpingitis generally leaves scarring, which is bilateral. Congenital
anomalies such as webbing (fibrous bands) that block a fallopian tube may also occur in both tubes. For unknown
reasons, oral contraceptives used before pregnancy reduce the incidence of ectopic pregnancy (Abatangelo, Okereke,
Parham-Foster, et al., 2010).
With an ectopic pregnancy, there are no unusual symptoms at the time of implantation. The corpus
luteum of the ovary continues to function as if the implantation were in the uterus so no menstrual
flow occurs. A woman begins to experience the usual nausea and vomiting of early pregnancy and a
pregnancy test for hCG will be positive. Many ectopic pregnancies are diagnosed because a woman
has an early pregnancy ultrasound to date the pregnancy. Magnetic resonance imaging (MRI) is also
effective to use for this. If not revealed by an ultrasound, at weeks 6 to 12 of pregnancy (2 to 8 weeks
after a missed menstrual period), the zygote grows large enough that it ruptures the slender fallopian
tube. Tearing and destruction of blood vessels and bleeding result. If implantation was in the
interstitial portion of the tube (where the tube joins the uterus), rupture can cause severe
intraperitoneal bleeding because of the large blood vessels in that part of the tube.
CHIEF
COMPLAINT
Complained of general lower abdominal pain which
was of sudden onset, continuous, not radiating and not
relieved by oral analgesia.
The pain was associated with Nausea and vomiting,
symptoms of anemia such as dizziness, shortness of
breath, but there was no history of loss of
consciousness, G1 or urinary tract symptoms.
PATIENT’S PROFILE
NAME N/I
AGE 38 years old
STATUS N/I
OCCUPATION N/I
CHIEF COMPLAINT "complained of general lower
abdominal pain which was of sudden
onset, continuous, not radiating and
not relieved by oral analgesia"
ADMITTING DIAGNOSIS Ectopic Pregnancy.
BRIEF CLINICAL HISTORY -complaining of acute onset of lower
abdominal pain associated with history
of gonorrhea for 3 months-She was
medically free of her past obs fetus hx
included normal uncomplicated
vaginal delivery, followed by CS
which was performed 4 years back.-
She has no allergies and was not taking
any medication or contraceptives
NURSING HISTORY
Clinical Findings and Significant Signs and Symptoms
The client manifested the following significant signs and
symptoms:
•Acute lower abdominal pain
•Nausea and vomiting
•Symptoms of anemia such as dizziness, shortness of breath

The client had the following significant laboratory and diagnostic

findings:
• Hemoglobin lower than normal
• HCG is higher than normal. Can be associated with:
o Multiple pregnancy (such as twins or triplets).
o Molar pregnancy or Down syndrome.
o Client may be further along in an early pregnancy than expected,
based on the last menstrual period.
Gordon’s Functional Pattern of Assessment
FUNCTIONAL BEFORE DURING ANALYSIS
PATTERN HOSPITALIZATION HOSPITALIZATION
HEALTH PERCEPTION - NO PREVIOUS -PATIENT LOOKED PALE - DUE TO HER
ANTENATAL FOLLOW AND DISTRESSED. CONDITION
UP

NUTRITIONAL - N/I - N/I - N/I

METABOLIC PATTERN

ELIMINATION - N/I - N/I - N/I

PATTERN
ACTIVITY AND - N/I - N/I - N/I
EXERCISE PATTERN
COGNITIVE/ - N/I -She complained of general -abdomen was generally
PERCEPTUAL lower abdominal pain which distended and tender on
PATTERN was of sudden onset, both superficial and deep
continuous, not radiating palpation
and not relieved by oral
analgesia.
SLEEP AND REST - N/I - N/I - N/I
SELF-PERCEPTION - N/I - N/I - N/I
AND SELF- CONCEPT
PATTERN
ROLE- RELATIONSHIP - N/I - N/I - N/I
PATTERN

SEXUALITY- -G3P2- She was unsure of -The possibility of ruptured NO PREVIOUS

REPRODUCTIVE the date of her last ectopic pregnancy.- A live ANTENATAL FOLLOW
PATTERN menstrual period and has no 13 weeks fetus was found UPDUE TO THE
previous antenatal follow and removed from the HISTORY OF
up pelvic cavity and the GONORRHEA
remains of the ectopic
PATHOPHYSIOLOGY
PRIORITIZATION AND PROBLEMS
PROBLEM PRIORITIZATION JUSTIFICATIONS
Fluid volume deficit r/t 1 As soon as the woman becomes
intrabdominal bleeding hypotensive from blood loss, she
will experience light- headedness
and a rapid pulse,signs of
hypovolemic shock
Hypotension 2 Her blood pressure is low and it
can deprive the body enough blood
and oxygen leading todamage of
heart and brain.
Anemia 3 Due to lack of healthy RBC to
carry adequate oxygen to the
body’s tissue, this may lead
toaltered gas exchange
Fear and anxiety r/t possible 4 The possibility of ruptured ectopic
pregnancy complications pregnancy was carefully explained
to thepatient by the doctor
 Name Dosage and Mechanisms Side Effects Nursing
Indication of Action Contraindications Resoonsibilities

Generic Dosage:lg/50m 1. Verification

DRUG Name:Ceftriaxo L or 2g/50mL

ne &
Azithromycin
250mg or
500mg
Inhibits
mucopeptide 2.
synthesis in 3.
1. Rash
Diarrhea
Nausea
1.
2.
3.
Arrhythmia
Hearing loss
Skeletal
and documentation
of use
2. Assess both the

STUDY
Brand Name: Indication: bacterial cell 4. Vomiting muscle feus and mother for
Rocephin& lower wall. Inhibits 5. Blood disorder complications on
Zithromax abdominal pain bacterial clots 4. Low blood and before
associated with protein 6. Dizziness potassium. administration.
history of synthesis by 7. Headache 5. Low blood 3. Provide client
gonorrhea binding to 23S 8. Constipati magnesium with comfort and
rRNA. on 6. Hypertensive education
4. Advise the

client to
usesunscreens.
Generic Dosage: 1. Verification
Name: Ferrous 220mg/5mL Binds with 1. Nausea 1. Iron and documentation
sulfate 300mg/5mL porphyrin and 2. Vomiting metabolism of use.
Brand Name: Indication: globin chains 3. Constipati disorders 2. Assess both the
Iron Tablets dizziness, to form on 2. Overload of feus and mother for
shortness of hemoglobin. 4. Diarrhea iron in the complications on
breath 5. Dark or blood and before
black poop 3. Hemolytic administration.
6. Stained anemta 3. Monitor lab
teeth. 4. Ulcer results and the
5. Gastritis bowel movements
 DISCHARGE PLANNING (M.E.T.H.O.D.S)
Medicines

•Advise to never discontinue the medications without physician's order.

•Instruct the client to follow the proper dosage and time for the administration of medications.

•Allow the client to be assisted by a guardian or companion during the first few weeks.

Exercise/Activity

•Have a sanitary space for simple exercise like walking.

•Avoid extraneous activities.

•Assistance during the first few weeks is highly recommended.

Treatment

•Instruct the client to have ample rest and fluid intake.

•Instruct the client to abstain from stress.

•Instruct the client to be allowed to have an assistant.

•Have a clean, sanitary environmentand hygiene.

Health Education

•Notify the client about the possible sources of her complications.

•Educate the client as to what to expect, health-wise, for herself and her infant.

•Possible risk factors should also be discussed.

Out Patient Department (Check-up)

•Advise the client to have regular maternal and newborn check-ups.

Diet

•Advise the client to have a healthy meal plan composing of fruit, vegetables, and ample amount of meat.

•Have the client drink at least 8 glasses of water per day.

•Allow the client to monitor the consumption of her newborns.

Spiritually

•In case the client is religious, advise them to pray frequently.

 DIAGNOSIS INFERENCE PLANNING IMPLEMEN- RATIONALE EVALUATION
TATION
Subjective: Acute lower Ectopic pregnancy Drawing of blood Laparotomy is Drawing of blood The right tube was
Client complains of abdominal pain has no unusual Sample performed by sample for successfully resected
sudden onset and associated with symptoms at the removing the hemoglobin level, and the specimen was
continuous acute lower possible ruptured time of Administratio n of pregnancy tissues. blood typing, cross sent to
abdominal pain ectopic pregnancy implantation. IV fluid as matching, and HCG histopathology.
Objective: A woman prescribed Blood Salpingectom y is level testing

NURSIN acute lower abdominal

pain associated with
nausea and vomiting,
symptoms of anemia
experiencing

will experience
transfusion as
ectopic pregnancy ordered
Administration of
symptoms same as oxygen as needed
performed by
completely
removing the
fallopian tube
intravenous fluid
using a large- gauge
Both Right and Left
Administration of ovaries worked
normally.

G CARE such as dizziness,

shortness of breath, but
there was no history of
loss of
that of a normal

nausea, vomiting, my
and positive HCG
Laparotomy and
pregnancy such as possiblesalpingecto
catheter to restore Client was discharged
Client received 5 intravascular volume home in a stable
units of PRBC and as prescribed
3 ‘n’ of fresh frozen
condition 5 days after
surgery.

PLAN
consciousness,G1or test. plasma. Blood may be
urinary tract symptoms. If undiagnosed, administered
General appearance= tearing and Client was through the same
pale and distressed destruction of blood transferred to the line as soon as the
Abdomen is distended vessels leading to surgical blood matches
and tender on both bleeding occurs. ICU,observed for 2
superficial and deep This is caused by days.
palpations Presence of the growing zygote
cervical motion that ruptures the Administered 6L of
Tenderness slender fallopian O2 via face mask.
tube. On Post-op day 3,
Empty uterus cavity, the client was
live fetus floating in transferred back to
mod GYNE ward.

Possible
Vital signs: Blood salpingectomy is
pressure: 90/40 mmHg performed by
Pulse rate: 110 bpm completely
removing the
Laboratory: HCG fallopian tube.
level= high HGB= 3.2
g/l
WBC= 7.5 g/l
 References
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● page 567
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