Professional Documents
Culture Documents
Ectopic Pregnancy
Capitol University
By:
Submitted to:
Mrs. Rochelle Y. Lamberang RN
Clinical Instructor
INTRODUCTION
Ectopic pregnancy affects about 1% of pregnancies. In a normal pregnancy, an egg is
fertilised by sperm in a fallopian tube (the tubes connecting the ovaries to the womb).
The fertilised egg moves into the womb, and implants itself in the womb lining, where it
grows and develops. An ectopic pregnancy occurs when a fertilised egg is implanted
outside the womb.
Over 95% of ectopic pregnancies occur in a fallopian tube, which is known as a tubular
pregnancy. Ectopic pregnancies can also occur in an ovary, in the abdominal space, or
in the cervix (neck of the womb).
If it's not treated, an ectopic pregnancy can be fatal. It can split (rupture) the fallopian
tube causing internal, abdominal bleeding that can lead to a life-threatening amount of
blood loss.
However, the number of ectopic pregnancies that result in death is small. For example,
from 2000 to 2002, there were 31,000 ectopic pregnancies in the UK. Of these, 11
(0.035%) resulted in death.
We had chosen this case presentation in order to identify and determine the general
health problems and needs of the patient with an admitting diagnosis of Ectopic
Pregnancy. One of the goals of this presentation also is to help our patient as well as
the significant others to promote health and medical understanding of this disease
condition through the application of the nursing theories and nursing skills.
• To raise the level of awareness of the patient and the family regarding the health
problems that are present.
• To facilitate patient in taking necessary actions to solve and prevent the identified
problems on his own and with the help of the family and other support groups.
• To motivate the patient and family to continue the health care provided by the
health workers in Northern Mindanao Medical Center most especially by the
students and Clinical Instructor of Capitol University.
• To add into the current case presentation output that has been collected for how
many years in the College of Nursing, Capitol University.
• And lastly, to help the RLE 7 students to be more knowledgeable in making and
conducting a case presentation in the higher years.
This case presentation would also try to develop the critical analysis of each case
presenter in order to come up with a very good output and a team effort.
ASSESSMENT
1. Client’s Profile
Her family was always supportive to her, most specially in problems regarding her
health. In times of distress, relaxation, such as walking and sleeping, is his best coping
strategy.
2. Vital signs
Upon assessment, the following data was obtained from Patient X: Blood
pressure=90/60 mm Hg; Axillary temperature= 36.1oC; Pulse rate= 110 beats per
minute; Respiratory rate= 30 counts per minute.
3. Chief complaints
Patient X complains a scant vaginal spotting.
A. Demographic Data
Name of Client _X___________________ Unit/Ward _NMMC - DR___ Bed ____4____
Age __28_______ Sex __Female_______ Civil Status _Single___ Religion __Iglesia Filipina Independente__________
Date of Admission ___July 9, 2010______ Medical Diagnosis: Ectopic pregnancy________________________
Examiner : ______________________ Information given by patient herself
B. Vital Signs
Temp _36.6_ oral axilla rectal BP: 90/60 mmHg___ lying sitting standing
Pulse __110_beats/ min. regular irregular Resp _ 30 _c/ min. regular irregular
Height _5”4_____ cm. Weight 62 kg.
C. Health Patterns Assessment: Complete information, including patient’s words. Indicate N/A if non-applicable. Circle,
code, or check all findings as appropriate.
Tobacco use: Yes No Used to smoke _1-2_________ packs/day for _____5_____ years
Alcohol use: Yes No Amount: _500-800 ml (approxi.) Frequency: _occasionally__ Duration: _up to the present
Coffee/Cola/Tea Intake: Yes No Amount: _4 cups__ Frequency: every day_ Duration: _ up to the present ___
Recreational/Illicit Drug use: Yes Specify: _____________________ No
Allergies: Yes (list with reaction experienced) No
Food: __________________________________________ Medications:_____________________________________
Others: ________________________________________________________________________________________
Medications:
NAME DOSE SCHEDULE INDICATIONS
Methotrexate
Leucovorino
Mifeprestone
Have you been taking your medication(s) as prescribed?
Yes__________________________________________________________________________________________
OTHER PERTINENT DATA:
_____________________________________________________________________________________________
_
_____________________________________________________________________________________________
_________
2. Nutrition and Metabolic Pattern
Special diet? _Low fat_low fat_,_____________________________________ Supplements: Vitamins rich in folic acid
Pattern of daily food/fluid intake (describe amount/quantity) __3 times a day minimum quantity______________________
Appetite: _good_____________________________________ Wt. loss/gain? _unassessed___________________________
Nausea/Vomiting: nausea and vomiting every morning_________________ Hematemesis Coffee-ground vomitus
Neck: Trachea: midline R/L deviation Cervical lymph nodes: lymphadenopathy tenderness
Thyroids: non-palpable enlarged Others: neck enlargement normal ROM neck rigidity
Skin: General Color: pinkish pallor jaundice dusky cyanotic flushed mottled
Texture: smooth rough others: __ ________________________
Turgor: supple firm dehydrated others: _ __________________________
Temperature: warm cool others: ______________ Moisture: dry moist/clammy oily
Others: petechiae ecchymosis hematoma lesions/rashes: ____________________________________
edema: ____ pitting ____ non-pitting ____ pedal: R/L ______ bipedal Grading: _______
Wounds/drains/dressings: _______________________________________________________________________________
Intravenous fluids:_____________________________________________________________________________________
OTHER PERTINENT DATA: ___________________________________________________________________________
3. Elimination Pattern
Usual bowel pattern (describe character of stool, frequency, discomforts) __brown in color, foul smelling, defecates once a
day_______________
_________________________________________________________________ Date of last BM: 2/4/10________________
Melena Hematochezia
Any problems with hemorrhoids/incontinence? __none_______________________________________________________
Use of anything to manage bowels (e.g. laxatives, enema, suppositories, “home remedies” anti-diarrheals): none________
___________________________________________________________________________________________________
Abdomen: General : superficial veins straie scars/lesions: right lower abdominal quadrant_______
Configuration: symmetrical asymmetrical flat globular protuberant scaphoid
Bowel Sounds: normoactive hyperactive hypoactive absent
Percussion: tympanitic hypertympanitic dullness at _________________________________
fluid wave shifting dullness
Palpation: muscle guarding direct tenderness rebound tenderness bladder distention
organomegaly: ___ liver ___ spleen masses at _____________________________________
Usual urinary pattern (describe frequency, character, amount, problem in control, etc.): Urinates at least 10 times a day, the
urine color varies from light yellow to dark-yellow with blood.
dysuria hematuria nocturia retention flank pain polyuria oliguria anuria
Excess perspiration/nocturnal sweats: _______________________________________________________________________
OTHER PERTINENT DATA:_____________________________________________________________________________
______________________________________________________________________________________________________
4. Activity – Exercise Pattern
Exercise Pattern? (Type, Regularity) _deep breathing exercises __________________________________________________
Leisure Activities? _walking _________________________________________________________________
Respiratory Status: Breathing Pattern: regular irregular eupnea hyperpnea tachypnea bradypnea
dyspnea: rest / exertion use of accessory muscles ICS retractions/bulging pain on respiration
Shape of Chest: Anterior-Posterior-Lateral Ratio AP_2____: L__1___ barrel chest funnel pigeon
Lung Expansion: symmetrical R / L decreased/lag
Vocal/Tactile Fremitus: symmetrical decreased / increased at _________________
Percussion: resonant dullness at ___________________ hyperresonant at ___________________
Breath Sounds: vesicular bronchovesicular at _________________ bronchial at __________________
rales/crackles at______________ wheezes at ___________________ rhonchi pleural friction rub
Cough: productive non-productive Sputum: color _________ amount________ consistency __________
O2 supplement/ventilatory assistance:none_______________________________________________________________
Resp. tubes (e.g. ET, trach, chest tube – describe
secretions/drainage)__none___________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
____________________________________________________________________________________________________
Activities of Daily Living/ Mobility Status: Use the Activity Level Code below to assess ADL & mobility status
ADL Status Mobility Status
0 – total independence Feeding __0______ Meal Preparation_0____ Bed mobility __0___________
1 – assist with device Bathing __0______ Cleaning _0_________ Chair/toilet transfer_0_______
2 – assist with person Dressing __0_____ Laundry _0_________ Ambulation ____0__________
3 – assist with device & person Grooming _0_____ Toileting _0_________ R.O.M. _______0__________
4 – total dependence
Reasons for ADL/Mobility limitation ______________________________________________________________________
Device used for assistance
_none_______________________________________________________________________________
Exercise pattern (describe type, regularity) _walking every morning______________________________________________
Back and Extremities: Range of Motion: full symmetrical decreased ROM (specify joint) _________________
Joint tenderness/pain joint swelling at ________________ varicose veins deformities _____________
Muscle tone and Strength: equally strong symmetrical in size R / L Upper / Lower Atrophy
R / L Upper / Lower Paresis R / L Upper / Lower Paralysis
Spine: midline Kyphosis Lordosis Scoliosis
Gait: coordinated smooth uncoordinated shuffling staggering
OTHER PERTINENT DATA _____________________________________________________________________________
______________________________________________________________________________________________________
Ears: External Pinnae: normoset symmetrical tenderness lesions gross abnormalities ______________
External Canal: discharge: ___foul smelling ___ serous ___ purulent ___mucoid Cerumen: ____impacted
Tympanic Membrane: intact
Gross Hearing: normal decreased symmetrical R / L deafness
Nose: alar flaring shallow nasolabial fold Septum: midline deviated perforated
Mucosa: pinkish pale reddish Discharge: serous mucoid purulent bloody
Patency: both patent R / L obstruction masses/lesions: describe __________________________________
Gross Smell: normal/symmetrical R / L olfactory deficiency
Sinuses: tenderness: ____ maxillary ____ frontal
Cognition: Primary language _Bisaya __________ Speech deficit _none_______________________________
Educational attainment _College level______________________________________________________
Any learning difficulties? _none________________________________________________________________________
Any change in memory lately? ________________________________________________________________________
Pain: no problem problem (describe location, type, intensity, onset, duration of pain): left lower abdominal quadrant,
stabbing pain, pain scale of 8/10
Methods of pain management: _rest_______________________________________________________________________
ROUTE:
FREQUENCY:
NURSING
DRUG ORDER MECHANISM OF CONTRAINDICATIO ADVERSE EFFECTS RESPONSIBILITIES/
(Generic name, brand ACTION NS OF THE DRUG PRECAUTIONS
name, classification, INDICATIONS
dosage, route,
frequency)
GENERIC NAME: Interferes with folicAlone with other Hypersensitivity, CNS: dizziness,
Methotrexate acid metabolism. treatment modalities pregnancy or drowsiness,
Result to inhibition in the treatment: lactation. headaches, malaise
NAME: of DNA synthesis trophoblastic EENT: blurred
BRAND Trexall and cell neoplasm,leukemias, vission,
reproduction. breast cancer, head RESP: pulmonary
CLASSIFICATION: carcinoma, neck fibrosis,
Antieoplastics, Therapeutic effects: carcinoma, lung GI: anorexia,
antirheumatics, death of rapidly carcinoma, treatment hepatoxicity, nausea
immunosuppresants replicating cells, of svere psoriasis, stomatitis, vomiting
particularly and rheumatoid GU: infertility
DOSAGE: malignant ones, arthritis, DERM: alopecia
and unresponsive to HEMAT: aplastic
ROUTE: immunosuppresant conventional therapy. anemia, anemia,
PO s. Treatment of leukopenia,
mycosis fungoides. thrombocytopenia
FREQUENCY: METAB:
hyperurecemia
MISC: nephropathy
NURSING
DRUG ORDER MECHANISM OF CONTRAINDICATIO ADVERSE EFFECTS RESPONSIBILITIES/
(Generic name, brand ACTION NS OF THE DRUG PRECAUTIONS
name, classification, INDICATIONS
dosage, route,
frequency)
FREQUENCY:
DISCHARGE PLANNING
Medication
EXERCISE
• Demonstrate ROM exercise as tolerated to promote and maintain join function
and prevent further deterioration.
• Demonstrate the types of exercise like pelvic rock exercise, tailor’s sitting,
abdominal breathing and kegel’s exercise.
Economic Status
• Tell the patient to visit the nearest Health Center for free check up
• Encourage the patient to avail services from government like philhealth.
Treatment
• Provide proper care and optimal infection control measures should be used.
Healthteachings
• Identify signs and symptoms that require medical evaluation (e.g increase
temperature, tachycardia, rashes and changes in bladder function.
• We also give her advices not to overworked and have a complete rest.
Out Patient
Diet
• Emphasized the importance of proper nutrition like the best sources for iron, are
in lean red meat, beef and pork and in plant broccoli and other leafy vegetables.
Spiritual
• Encourage patient to pray always and ask for the guidance from God.
• Asked for divine providence for Faster Recovery
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