ECTOPIC

GROUP B BLOCK AAA

CASE PRESENTATION
PREGNANCY
PATIENT’S
PROFILE
DEMOGRAPHIC DATA
 Pt. CL is a 28-year old woman, a
housewife who is married and has 4
children. Stands 5’2 and weighs 52
kgs. She lives in Baraas, Iligan City
and is a Roman Catholic. She was
admitted because of her chief
complaints of abdominal pain.
HEALTH HISTORY
CHIEF COMPLAINT

Abdominal pain

ADMITTING DIAGNOSIS

The impression/admitting diagnosis

was t/c ectopic pregnancy.
HISTORY OF PRESENT
ILLNESS
5 days prior to admission pt felt pain in
the entire abdomen and also a stabbing
knife-like pain in the supraclavicular
area. Pt. took up pain medications but it
did not take effect so it prompted
admission.
HISTORY OF PAST ILLNESS
This was the first time pt was admitted
in the hospital. In the past she had no
infectious disease acquired, has
completed all her immunizations and
prenatal for all her 4 children.
Pt. CL is not a chain smoker, does
not drink alcoholic beverages and has
no medications taken regularly.
HEALTH HABIT/S

FREQUENCY AMOUNT PERIOD

TOBACCO NONE NONE NONE

ALCOHOL NONE NONE NONE

OTC DRUGS; NONE NONE NONE

NONPRESCRIPTION DRUG
SPECIFY
FAMILY HISTORY
HISTORY OF HERIDO-FAMILIAL DISEASES:
Cancer _____
DM __X__
Asthma _____
Hypertension _____
Cardiac Disease _____
Mental Disorder _____
 GENOGRAM
Mother’s Side Father’s Side

 Legend: - Male; - Female; - Patient; -DM

Grandma
REVIEW
OF SYSTEMS
GENERAL
 Pt’s appearance is appropriate w/
age, oriented, awake, and
coherent, normal and
symmetrical facial features,
brown skin color. She appears
weak and has drooping eyelids.
HEENT
 Head: normocephalic w/ thick
hair, long and coarse and evenly
distributed
 Eyes: her eyes are symmetrical,

black in color, almond shape,

PERRLA, size 3mm, EOMS intact,
brows and lashes present, blinks
involuntarily
HEENT(cont…)
 Ears: skin intact, no discharges
present, flicked fingers heard
bilaterally, symmetrical in size
and shape
 Nose: symmetric, nares present,

septum in midline, no swelling

of mucous membrane and
presence of nasal hairs were
seen.
 Throat: pink mucosa, soft
INTEGUMENTARY
 Brown skin, dry and warm to touch,
even pigmentation, good skin turgor,
hair on skin evenly distributed,
presence of clubbing in nails is
noted, CRT is more than 4
seconds. Bipedal edema w/ 2+ is
noted
 Face is slightly edematous
RESPIRATORY
 26 respirations per minute,
dyspneic upon supine
position, breaths w/ accessory
muscles, no tenderness upon
palpitations in the chest
CARDIOVASCULAR
 Pulse rate is 106 bpm, heart rate
100 bpm, CRT – more than 4
seconds, PMI @ 5th intercostal
space left midclavicular line, s1
is louder @ base, S2 is heard
best @ apex
 Intact pulses @ different sites
DIGESTIVE
 Decreased appetite
 Tender, rounded abdomen, cold to touch

 bowel sounds present

 I and O

 hypoactive
EXCRETORY
 Urinates 3-4x/day, light yellow, clear
about 100-200ml
 Defecates 1-2x/day, brown, semi-

formed amount varies, bipedal

enema of 2+ noted
 States that she has no problem with

urinating and defecating

MUSCULOSKELETAL
 2/5 muscle strength
 since hospitalization pt reports of

general weakness
 ADLs are limited such as grooming

one’s self, bathing, and dressing up

 Passive ROM performed
NERVOUS
 Oriented, coherent, slightly lethargic,
speech appropriate, no memory
problems, facial movements
symmetric, intact sensation, hearing
is equal bilaterally, able to swallow,
w/ gag reflex, can shrug shoulders,
can sense light touch
 Referred pain is felt on

shoulders (phrenic nerve)

ENDOCRINE

 No history of diabetes, or thyroid

diseases, decreased appetite,
gets thirsty sometimes, has
equal hair distribution,
appropriate height and weight
for age, face is not oily
 GORDON’S
FUNCTIONAL HEALTH

PATTERNS
NURSING ASSESSMENTS II
 Activities- Rest Pattern
 Pt. CL is a housewife and she
does the typical house chores
such as cooking and cleaning.
Before hospitalization, she
regularly sleeps for about 7 hours
, takes a nap every afternoon for
about 3o minutes to one hour.
 Activities- Rest
Pattern(cont…)
 During hospitalization, she
appears weak and is confined to
bed, she verbalizes she sleeps
around 8pm and wakes up
around 4am. “Sige raman ko ug
katulog diri”, added by patient.
Able to have enough rest most of
the time. She can ambulate but
 Nutritional-Metabolic
Pattern
 Typical intake is rice for about 3
cups w/ favorite viand fish w/ 1-2
cups of vegetables seldom eats
meat. Has a regular diet and has
no restrictions. Drinks 3-4 glasses
of water daily about 150 – 200ml.
She verbalizes she does not know
her weight but she feels that she
 Nutritional-Metabolic
Pattern(cont…)
 She has no medications or
supplements taken regularly.
During hospitalizations, pt was
weighed she weighed 52 kgs pt
was ordered NPO but post-op she
was able to drink soups and sips
of water. She was given Vit. K.
 Elimination Pattern
 Pt before hospitalization urinates 4-
5x/day about 50-100ml, light yellow,
clear.
 Defecates 1-2x/day w/ formed brown

stools.
 Elimination Pattern(cont…)
 During hospitalization, pt CL states
“panagsa raman ko maka-ihi ug
makalibang diri sa ospital”. She
urinates 2x/day for about 50ml. she
added her urine is still the same like
before. Light yellow, clear urine w/ no
odious odor. August 28, 2009, she
was able to defecate for only once.
Stool was brown semi-formed.
 Ego-Integrity Pattern

 Perception of self - “ulawon man

ko nga pagkatawo” as verbalized
by patient.
 Coping mechanism – to relieve or

let go of problems she discusses

it w/ her husband or mother
 Ego-Integrity Pattern(cont…)

 Support Mechanism – her

husband and her mother are the
persons she would run to in times
when she needs them most
 Mood/affect – pt is not expressive

in feelings but shows strong

feelings when angry. Upon
admission she was irritable.
 Neuro-Sensory Pattern

 Mental state – mentally balanced

and is a coherent person. She is
oriented to time, age, place, has
good memory. During
hospitalization, she was slightly
lethargic but still able to interact
 Neuro-Sensory Pattern(cont…)

 Condition of 5 senses
 sight – able to see far and near problems

without any strain felt

 hearing – both ears can hear normally,

 smell – can detect odors and has no

problem with distinguishing them

 taste – able to differentiate taste

sensations
 touch – she can feel light touch and has

no problems feeling things around her

 Oxygenation & Vital Signs
 Before hospitalization pt doesn’t
have the idea about her vital signs.
Now her vital signs are RR – 26 rpm,
Pulse rate – 106 bpm, BP – 100/50
mmHg
 Pt’s lung sounds are fine crackles all

over. She tells us she has no history

of respiratory aside from having
common flu and cough seldom
Pain-Comfort
 Pt was admitted due to her
abdominal pain
 P – sudden movement
 Q – throbbing
 R – it radiates in the entire
abdomen, relieved by rubbing of
hands in the abdomen
 S – pt verbalizes of a pain scale of
10
 T – intermittent w/ an interval of 10
 Hygiene
 Pt’s is not well groomed, noted w/
presence of body odor, unwashed
hands and feet, uncombed hair
and dirty fingernails and toenails.
Sexuality-Reproductive

 Pt’s menarche happened when

she was still 12 years old
 she states she has no problem
w/ her sexual life
 her LMP was on July 2, 2009 but
she had spotting on August 2,
2009
 she already has 4 children
 obstetric history: GTPALM -
SUMMARY OF
MEDICATIONS
DRUG STUDY
SUMMARY OF MEDICATION
Date Medication Remarks
8 - - 09 Penicillin G 5, 000, 000 “u” IVTT q Given & Tolerated
6H ANST
Given & Tolerated
8 - - 09 Chloramphenicol 1 g IVTT q 8H
ANST
8 - - 09 Cefuroxime 750 mg IVTT q 8H Given & Tolerated
8 - - 09 Paracetamol 300 mg IVTT now then Given & Tolerated
q 4H PRN
8 - - 09 Ranitidine 50 g IVTT q 8 H Given & Tolerated
8 - - 09 Metronidazole 1g supp per rectum q Given & Tolerated
12H
Given & Tolerated
8 - - 09 Tranexamic Acid 500mg IVTT Given & Tolerated
8 - - 09 Bisacodyl 2 adult supp per rectum
8 - - 09 Ciprofloxacin 500mg tab BID Given & Tolerated
8 - - 09 Ferrous Sulfate 500mg tab BID Given & Tolerated
8 - - 09 Vitamin K amp (IM) q 12H Given & Tolerated
Nalbuphine 5 mg IVTT q 4H x Given & Tolerated
6doses
 GENERIC NAME PRESCRIBED AND MECHANISM INDICATION CONTRAINDICATIO ADVERSE NURSING
BRAND NAME RECOMMENDED OF N REACTION RESPONSIBILITIE
CLASSIFICATION DOSAGE, ACTION S
S FREQUENCY, AND
ROUTE OF
ADMINISTRATION

Ranitidine 33 doses H2 antagonist Duodenal and Should not be GI: diarrhea or >Use
(Histamine-2 selectively gastric ulcer used with constipation cautiously in
antagonist) blocked (short term known allergy to CNS: pts. with
treatment; any drugs of dizziness, hepatic
Histamine-2
hypersecretor this class. headache, dysfunction.
receptor sites. Adjust dosage
This blocking y conditions Caution should hypotension
in pt. with
leads to a such as be used during EENT: blurred
impaire renal
reduction in Zollinger- pregnancy per vision function
gastric acid Ellison lactation or Hepatic: >Assess pt.
secretion and syndrome. renal jaundice for abdominal
reduction in dysfunction that Other: burning pain. Note
overall pepsin would interfere and itching at presence of
production. with drug infection site blood in
metabolism and emesis, stool,
excretion. or gastric
aspirate
>Ranitidine
may be added
to total
parenteral
nutrition
solutions.
 GENERIC NAME PRESCRIBED MECHANISM INDICATION CONTRAINDICATI ADVERSE NURSING
BRAND NAME AND OF ON REACTION RESPONSIBILITIE
CLASSIFICATIONS RECOMMENDED ACTION S
DOSAGE,
FREQUENCY,
AND ROUTE OF
ADMINISTRATIO
N
Bisacodyl 10-15mg Stimulates Relieve Hypersensiti Central >Use as a
Dulcolax peristalsis by constipation vity to nervous temporary
Laxatives directly and prepare bisacodyl or system: measure.
irritating the the bowel for any Vertigo
>Have the
smooth diagnostic or component Endocrine &
tablet be
muscle of the surgical of the metabolic:
swallowed
intestine, procedures formulation; Electrolyte
whole.
possibly the requiring the abdominal and fluid
>Do not
colonic bowel to be pain, imbalance
drink drug
intramural empty. obstruction, (metabolic
within one
plexus; alters nausea or acidosis or
hour of
alkalosis,
water and vomiting drinking
hypocalcemi
electrolyte other drugs.
a)
secretion >Report
producing net Gastrointesti sweating,
intestinal fluid nal: Mild flushing,
accumulation abdominal muscle
cramps, cramps, and
and laxation
nausea, excessive
vomiting, thirst.
rectal
burning
 GENERIC NAME PRESCRIBE MECHANISM INDICATION CONTRAINDIC ADVERSE NURSING
BRAND NAME D AND OF ATION REACTION RESPONSIBILITIES
CLASSIFICATIONS RECOMMEN ACTION
DED
DOSAGE,
FREQUENCY
, AND
ROUTE OF
Paracetamol 300 mg
ADMINISTR Paracetamol To relieve Hypersensi Side effects are ~ Monitor for S&S
ATION
Brand Name: tab BID is usually mild to tivity to rare with of: hepatotoxicity,
Biogesic classified moderate pain acetaminop paracetamol when even with
Classifications along with due to things hen or it is taken at the moderate
: nonsteroidal such as phenacetin; recommended acetaminophen
Non-opioid antiinflammat headache, use with doses. Skin doses, especially
in individuals with
analgesic ory drugs muscle and alcohol. rashes, blood
poor nutrition.
(NSAID), but joint pain, disorders and
~ Do not take other
is not backache and acute inflammation medications (e.g.,
considered period pains. of the pancreas cold preparations)
one. It is also used have occasionally containing
to bring down occurred in people acetaminophen
a high taking the drug on without medical
temperature. a regular basis for advice; overdosing
a long time. and chronic use
can cause liver
damage and other
toxic effects.
 GENERIC NAME PRESCRIBE MECHANISM INDICATION CONTRAINDIC ADVERSE NURSING
BRAND NAME D AND OF ATION REACTION RESPONSIBILITIES
CLASSIFICATIONS RECOMMEN ACTION
DED
DOSAGE,
FREQUENCY
, AND
ROUTE OF
Paracetamol ADMINISTR Its main For this One advantage of ~ Do not use for
ATION
Brand Name: mechanism reason, paracetamol over fever persisting
Biogesic of action is paracetamol aspirin and longer than 3 d,
Classifications the inhibition can be given NSAIDs is that it fever over 39.5° C
: of to children doesn't irritate the (103° F), or
Non-opioid cyclooxygena after stomach or recurrent fever.
analgesic se (COX), an vaccinations causing it to bleed, ~ Do not give
enzyme to prevent potential Side children more than
(CONTIBUATI responsible post- effects of aspirin 5 doses in 24 h
ON) for the immunisation and NSAIDs. unless prescribed
production of pyrexia (high by physician.
prostaglandin temperature).
s, which are Paracetamol
important is often
mediators of included in
inflammation, cough, cold
pain and and flu
fever. remedies.
 GENERIC NAME PRESCRIBED MECHANISM INDICATION CONTRAINDICAT ADVERSE NURSING
BRAND NAME AND OF ION REACTION RESPONSIBILITIES
CLASSIFICATIONS RECOMMENDE ACTION
D DOSAGE,
FREQUENCY,
AND ROUTE OF
ADMINISTRATI
Tranexamic acid 500 mg inhibits anti- hypersensitivi dizziness, check for doctor's
ON
brand name: IVTT breakdown hemorrhagi ty, pt's headache, order, should not be
Hemostan of fibrin c and exposed with nausea, given if positive skin
clots; antifibrinoly prolonged vomiting, test, advise pt to
classification: inhibits tic for thrombosis, anorexia, report any discomfort
anti- activation effective active diarrhea, on the IV insertion
hemorrhagic of hemostasis intravascular hypotension, site, monitor v/s,
plasminoge in various clotting thromboembol administer via slow
n, thereby surgical ism, injection, monitor
preventing clinical thrombosis clotting time, caution
the cases, pts to avoid products
conversion traumatic containing aspirin or
of injuries, NSAIDS w/o
plasminoge hematuria; consulting health care
n to prevent professionals, should
plasmin excessive not be used in pts
bleeding with active
intravascular clotting.
 GENERIC NAME PRESCRIBED AND MECHANISM INDICATION CONTRAINDICATI ADVERSE NURSING
BRAND NAME RECOMMENDED OF ON REACTION RESPONSIBILITIE
CLASSIFICATIONS DOSAGE, ACTION S
FREQUENCY, AND
ROUTE OF
ADMINISTRATION
750 mg IVTT Semisynthetic Moderate to Hypersensitivit BODY AS A >inspect IM
Cefuroxime q 8H second- severe y to WHOLE: and IV
Sodium generation infections cephalosporin thrombophlebi injection sites
Cefuroxime cephalosporin s and related tis; pain, frequently for
Axetil antibiotic with antibiotics; burning, signs of
structure pregnancy cellulites; phlebitis.
superinfection
similar to that (category b), >report onset
s, positive
of he lactation. of loose stools
Coomb’s test.
penicillins. GI: diarrhea, or diarrhea.
Resistance nausea, >monitor for
against beta- antibiotic- manifestations
lactamase- associated of
producing colitis. hypersentivity.
strains SKIN: rash Discontinue
exceeds that pruritus, drug and
of first- urticaria report their
generation UROGENITAL appearance
cephalosporin : increased promptly.
s. serum
creatinine and
BUN,
decreased
creatinine
clearance.
 GENERIC NAME PRESCRIBED MECHANISM INDICATION CONTRAINDICATI ADVERSE NURSING
BRAND NAME AND OF ON REACTION RESPONSIBILITIE
CLASSIFICATIONS RECOMMENDE ACTION S
D DOSAGE,
FREQUENCY,
AND ROUTE OF
ADMINISTRATI Antimicrobial >monitor I&O
ON
Cefuroxime spectrum of rates and
Sodium activity pattern:
Cefuroxime Axetil resembles especially
that of the important in
(CONTINUATION penicillin- severely ill
binding
) patients
proteins
receiving high
located on
cell walls of doses. Report
susceptible any significant
organisms. changes.
This inhibits >report loose
third and stools or
final stage of diarrhea
bacterial cell promptly.
wall
synthesis,
thus killing
thus
bacterium.
 GENERIC NAME PRESCRIBED AND MECHANISM INDICATION CONTRAINDICATI ADVERSE NURSING
BRAND NAME RECOMMENDED OF ON REACTION RESPONSIBILITIE
CLASSIFICATIONS DOSAGE, ACTION S
FREQUENCY, AND
ROUTE OF
ADMINISTRATION
500 mg tab Synthetic >UTI Known GI: nausea, >monitor urine
Ciprofloxacin bid quinolone that hypersensitivit vomiting, pH; it should
Hydrochloride is a broad y to diarrhea, be less than
spectrum ciprofloxacin cramps, gas 6.8, especially
bactericidal or quinolones, METABOLIC: in the older
agent. Inhibits pregnant transient adult and
patients
DNA-gyrase, women increases in
receiving high
an enzyme (category c), liver
doses of
necessary for lactation, and transaminases ciprofloxacin,
bacterial DNA children. , alkaline to reduce the
replication and phosphatases, risk of
some aspects lactic crystalluria.
of dehydrogenas >monitor I&O
transcription, e, and ratio and
repair, eosinophilia patterns:
recombination count. patient should
, and MUSCULOSK be well
transposition. ELETAL: hydrated;
tendon rupture assess for
S&S of
crystalluria
 GENERIC NAME PRESCRIBED AND MECHANISM INDICATION CONTRAINDI ADVERSE NURSING
BRAND NAME RECOMMENDED OF CATION REACTION RESPONSIBILITIE
CLASSIFICATIONS DOSAGE, ACTION S
FREQUENCY, AND
ROUTE OF
ADMINISTRATION
CNS: headache, >do not give
Ciprofloxacin vertigo, malaise, an antacid
Hydrochloride seizures (especially within 4h of
with rapid IV infusion) the oral
(CONTINUATION SKIN: rash, phlebitis, ciprofloxacin
) pain, burning, pruritis, dose.
>discontinue
and erythema at
other IV
infusion site.
infusion while
SPECIAL SENSES: infusing
local burning and ciprofloxacin
discomfort, crystalline or infuse
precipitate on through
superficial portion of another site.
cornea, lid margin >for patients
crusting, scales, wit renal
foreign body impairment,
sensation, itching, oral and IV
and conjunctival doses are
hypereremia. lowered
according to
creatinine
clearance.
 GENERIC NAME PRESCRIBED AND MECHANISM INDICATION CONTRAINDICATI ADVERSE NURSING
BRAND NAME RECOMMENDED OF ON REACTION RESPONSIBILITIE
CLASSIFICATIONS DOSAGE, ACTION S
FREQUENCY, AND
ROUTE OF
ADMINISTRATION
1g Synthetic Anaerobic Control of BODY AS A >discontinue
Metronidazole supp/rectum compound infections essential WHOLE: therapy
Q 12H with direct hypertension. hypersensivity immediately if
trichomonacid Safety during (rash, symptoms of
al and pregnancy urticaria, CNS toxicity
amebicidal (category c), pruritus, develop.
flushing), >report
activity as well lactation, or in
fever, fleeting appearance of
as children <12y
joint pains, candidiasis or
antibacterial is not overgrowth of its becoming
activity against established. Candida more
anaerobic CNS: vertigo, prominent with
bacteria and headache, therapy to
some gram- ataxia, physician
negative confusion, promptly.
bacteria. irritability, >adhere
depression, closely to the
restlessness, established
weakness, regimen
fatigue, without
drowsiness, schedule
insomnia, interruption or
paresthesia, changing the
sensory dose.
constipation
 GENERIC NAME PRESCRIBED MECHANISM INDICATION CONTRAIN ADVERSE NURSING
BRAND NAME AND OF DICATION REACTION RESPONSIBILITIES
CLASSIFICATIONS RECOMMEND ACTION
ED DOSAGE,
FREQUENCY,
AND ROUTE
OF
ADMINISTRA GI: nausea, >instruct patient to
TION
Metronidazole vomiting, anorexia, refrain from intercourse
epigastric distress, during therapy for
(CONTINUATION abdominal cramps, trichomoniasis unless
) diarrhea, male partner wears a
constipation, dry condom to prevent
mouth, metallic or reinfection.
bitter taste, >instruct patient not to
proctitis. drink alcohol during
UROGENITAL: therapy; may induce a
polyuria, dysuria, disulfiram-type reaction.
pyuria, Avoid alcohol or
incontinence, alcohol-containing
cystitis, decreased medication for at least
libido, dyspareunia, 48h after treatment is
dryness of vagina completed.
and vulva, sense of >report symptoms of
pelvic pressure. candidal overgrowth:
SPECIAL furry tongue, color
SENSES: nasal changes of tongue,
congestion glossitis, stomatitis;
CV: ECG changes vaginitis, curd-like milky
(flattening of T vaginal discharge;
wave) proctitis. Treatment with
a candidacidal agent
may be indicated.
 GENERIC NAME PRESCRIBED AND MECHANISM INDICATION CONTRAINDICATI ADVERSE NURSING
BRAND NAME RECOMMENDED OF ON REACTION RESPONSIBILITIE
CLASSIFICATIONS DOSAGE, ACTION S
FREQUENCY, AND
ROUTE OF
ADMINISTRATION
`
Penicillin G 5, 000, 000 “u” Bactericidal: Indicated to Contraindicate CNS: ~ Assess for
Brand Name: IVTT q 6H Inhibit treatment of d with allergy Lethargy, patient’s
Pfizerpen ANST synthesis of severe to penicillins, Hallucinations, history with
Classifications cell wall of infections cephalosporin seizures allergies to
: sensitive caused by s,imipinem, GI: Glossitis, penicillins,
stomatitis, cephalosporin
Antibiotic microorganis sensitive beta-lactinase
gastritis, sore s, procaine,
Penicillin ms, causing microorganis inhibitors and
mouth, furry other
cell death. ms. other tongue, black allergies, renal
Treatment to allergens, hairy tongue, disorders,
syphilis, Use cautiously nausea, pregnancy
gonococcal with renal vomiting, and lactation.
infections diseases, diarrhea, ~ Do physical
pregnancy, abdominal assessment
lactation, (may pain, bloody by culturing
cause diarrhea, infection, skin
diarrhea or enterocolitis, color, lesions,
candidiasis of pseudomeme adventitious
the infant) branous sounds, bowel
colitis, none- sounds.
specific
hepatisis
 GENERIC NAME PRESCRIBED AND MECHANISM INDICATION CONTRAINDICA ADVERSE NURSING
BRAND NAME RECOMMENDED OF TION REACTION RESPONSIBILITIE
CLASSIFICATIONS DOSAGE, ACTION S
FREQUENCY, AND
ROUTE OF
ADMINISTRATION
Penicillin G ` GU: Nephritis--- ~ Administer
Brand Name: oliguria, by IM route
Pfizerpen proteinuria, only.
Classifications hematuria, ~ Continue
: casts, azotemia, therapy for at
Antibiotic pyuria least 2 days
Hematologic: after infection
Penicillin
Anemia, has
thrombocytopen disappeared,
(CONTINUATI ia, leucopenia, usually 7 to 10
ON) neutropenia, days.
prolonged ~Administer
bleeding time IM injection in
Hypersensitivity upper outer
reactions: Rash, quadrant of
fever, wheezing, buttock. In
anaphylaxis infants and
Local: Pain, children,
phlebitis, midlateral
thrombosis at aspect of the
injection site, thigh may be
Jarisch- preferred.
Herxheimer
reaction when
used to treat
syphilis
 GENERIC NAME PRESCRIBED AND MECHANISM INDICATION CONTRAINDIC ADVERSE NURSING
BRAND NAME RECOMMENDED OF ATION REACTION RESPONSIBILITIE
CLASSIFICATIONS DOSAGE, ACTION S
FREQUENCY, AND
ROUTE OF
ADMINISTRATION

Chloramphen 1 g IVTT q 8H Bacteriostatic Systemic: Contraindic CNS: headache, ~ Assess

icol ANST effect against ~ Serious ated to mild depression, patient for
Brand Name: susceptible infections for allergies to mental allergies to
Chloromycetin bacteria; which no chloramphe confusion, chloramphenic
Classifications prevents cell antibiotic is nicol delirium ol, renal or
effective GI: Nausea,
: replications. Use hepatic failure,
~ Acute vomiting,
Antibiotic cautiously pregnancy
infections stomatitis,
caused by with renal glossitis, and lactation.
Salmonella failure, diarrhea ~ Observe for
typhi hepatic Hematologic: side effects
~ Serious failure, Blood such as
infections G6PD dyscariasis nausea,
caused by deficiency, Other: Fever, vomiting,
Salmonella, intermittent Macular rashes, diarrhea,
Haemophilus porphyria, urticaria, headache,
influenza and pregnancy anaphylaxis, confusion, and
lympho- and gray baby superinfection
granuloma. lactation. syndrome s.
( abdominal
distention, pallid
cyanosis),
superinfections
 GENERIC NAME PRESCRIBED AND MECHANISM INDICATION CONTRAINDICATI ADVERSE NURSING
BRAND NAME RECOMMENDED OF ON REACTION RESPONSIBILITIE
CLASSIFICATIONS DOSAGE, ACTION S
FREQUENCY, AND
ROUTE OF
ADMINISTRATION

Chloramphen ~ Report sore

icol throat,
Brand Name: tiredness,
Chloromycetin unusual
Classifications bleeding or
bruising,
:
numbness,
Antibiotic
tingling, pain
in the
(CONTINUATI extremeties,
ON) pregnancy
and
discomfort at
IV site.
~ Reduce
dosage in
patients with
renal or
hepatic
disease.
~ Monitor
serum levels
periodically as
indicated in
the dosage
section.
 GENERIC NAME PRESCRIBED AND MECHANISM INDICATION CONTRAINDICATI ADVERSE NURSING
BRAND NAME RECOMMENDED OF ON REACTION RESPONSIBILITIE
CLASSIFICATIONS DOSAGE, ACTION S
FREQUENCY, AND
ROUTE OF
ADMINISTRATION
Nalbuphine 5 mg IVTT q 4 Binds with ~Management Contraindicate CNS: ~ Reassess
Brand Name: H (then 6 opiate of moderate to d in patients Sedation, patient’s level
Nubain doses) receptors in severe pain hypersensitive dizziness, of pain at least
Classifications the CNS, ~ Preoperative to drug vertigo, 15 and 30
: altering and Use cautiously headache, minutes after
Opioid perception of postoperative in patients agitation, parenteral
with history of confusion, administration
agonist- and emotional analgesia
drug abuse crying, ~ Nalbuphine
antagonist response to supplement to
and in those depression, acts as an
analgesic pain. balanced with emotional dysphoria, opioid
anesthesia instability, euphoria, antagonist
~ Obstetrical head injury, faintness, and may
analgesia increased floating cause
during labor ICP, impaired feeling, withdrawal
and delivery ventilation, MI hallucinations, syndrome. For
accompanied heaviness patients who
by N/V, feeling, have received
upcoming hostility, log-term
biliary surgery, nervousness, opioids, give
and hepatic or numbness, 25% of the
renal disease restlessness, usual dose
seizures, initially. Watch
tingling, for sings of
unreality, withdrawal.
unusual
dreams
 GENERIC NAME PRESCRIBED MECHANISM INDICATION CONTRAIN ADVERSE NURSING
BRAND NAME AND OF DICATION REACTION RESPONSIBILITIES
CLASSIFICATIONS RECOMMENDE ACTION
D DOSAGE,
FREQUENCY,
AND ROUTE
OF CV: Bradycardia, ~Alert: Drug causes
ADMINISTRATI
Nalbuphine ON
hypertension, respiratory depression,
Brand Name: hypotension, which at 10mg is equal to
Nubain tachycardia respiratory depression
Classifications: EENT: Blurred produced by 10 mg of
Opioid agonist- vision, dry mouth morphine
GI: Nausea,
antagonist
vomiting, biliary ~ Monitor circulatory and
analgesic
tract spasms, respiratory status, bladder
constipation and bowel function. If
(CONTINUATIO cramps, respirations are shallow
N) dyspepsia or rate is below 12
GU: Urinary breaths/minute, withhold
urgency dose and notify prescriber
Respiratory: ~ Constipation is often
Respiratory severe with maintenance
depression, therapy. Make sure stool
asthma, softener or other laxative
dyspnea, is ordered.
pulmonary ~ Psychological and
edema physical dependence may
Skin: Burning, occur with prolonged use.
clamminess, ~ Remind patient not to
diaphoresis, confuse Nubain with
pruritus, uticaria Navane.
 GENERIC NAME PRESCRIBED AND MECHANISM INDICATION CONTRAINDICATI ADVERSE NURSING
BRAND NAME RECOMMENDED OF ON REACTION RESPONSIBILITIE
CLASSIFICATIONS DOSAGE, ACTION S
FREQUENCY, AND
ROUTE OF
ADMINISTRATION
Vitamin K 1 amp (IM) q Vitamin K is ~Vitamin K ~In patients Decreased ~ If pt. take
Brand Name: 12 H required for deficiency receiving appetite; warfarin (a
AquaMephyto synthesis of ~Those with anticoagulants decreased blood thinner),
n Mephyton prothrombin bruising and (blood movement or you should
Classifications and three bleeding. thinners) as activity; know that
: other clotting ~Vitamin K is vitamin K difficulty in vitamin K or
decreases the foods
Clotting Agent factors. routinely given breathing;
effects of containing
to newborn enlarged liver;
these drugs. vitamin K can
infants to ~ Pregnancy general body affect how the
prevent —Vitamin K swelling; drug works.
bleeding has not been irritability; ~ Vitamin K
problems. reported to muscle deficiency is
cause birth stiffness; very rare. It
defects or paleness; occurs when
other yellow eyes or the body can't
problems in skin. properly
humans. absorb the
~When taken vitamin from
during the intestinal
pregnancy tract.
jaundice and
other
problems in
the baby.
 GENERIC NAME PRESCRIBED MECHANIS INDICATIO CONTRAINDICATION ADVERSE NURSING
BRAND NAME AND M N REACTION RESPONSIBILITIES
CLASSIFICATIONS RECOMMENDE OF
D DOSAGE, ACTION
FREQUENCY,
AND ROUTE OF
ADMINISTRATI .Breast-feeding— Less common: ~ Vitamin K
ON
Vitamin K Vitamin K taken by Difficulty in deficiency can
Brand Name: the mother has not swallowing; fast or also occur after
AquaMephyto been reported to irregular breathing; long-term
n Mephyton cause problems in lightheadedness or treatment with
Classifications nursing babies. fainting; shortness of antibiotics.
You should check breath; skin rash, ~ If pt. are
:
with your doctor if hives and/or itching; taking
Clotting Agent
you are giving your swelling of eyelids, anticoagulant
baby an unfortified face, or lips; medicine (blood
(CONTINUATI formula. In that tightness in chest; thinners), the
ON) case, the baby troubled breathing amount of
must get the and/or wheezing. vitamin K in
vitamins needed Blue color or flushing your diet may
some other way. or redness of skin; affect how well
Children—Children dizziness; fast and/or these medicines
may be especially weak heartbeat; work. The
sensitive to the increased sweating; doctor or health
effects of vitamin low blood pressure care
K, especially (temporary). professional
menadiol or high Rare: Flushing of may
doses of face; redness, pain, recommend
phytonadione. This or swelling at place changes in your
may increase the of injection; skin diet to help
chance of side lesions at place of these medicines
effects during injection (rare); work better.
treatment. unusual taste.
 GENERIC NAME PRESCRIBED AND MECHANISM INDICATION CONTRAINDICATI ADVERSE NURSING
BRAND NAME RECOMMENDED OF ON REACTION RESPONSIBILITIE
CLASSIFICATIONS DOSAGE, ACTION S
FREQUENCY, AND
ROUTE OF
ADMINISTRATION
Ferrous 500 mg tab *Mineral for Preventing or Allergy to any Constipation, Administer
Sulfate BID antianemia treating low ingredient in upset vitamins with
Brand Name: *Vital for levels of iron Ferrous stomach, food to
Ferrous hemoglobin in the blood. It Sulfate black or dark- prevent GI
sulfate regeneration, also may be High levels of colored stools, upset.
(Feosol, Fer- specifically it used for other iron in your temporary *Caution on
enables the intake of
Iron) conditions as blood staining of the
RBC chamomile,
Ferrous determined by teeth. Signs of
development feverfew,
gluconate and oxygen your doctor. an allergic peppermint
(Fergon, transport via reaction: and St. John’s
Fertinic) hemoglobin hives; difficulty wort for it
Ferrous It elevates the breathing; interfere with
fumarate serum iron swelling of the absorption
(Feostat, concentration, your face, lips, of iron and
Fumerin) which then tongue, or other
Classifications helps to form throat. minerals.
: Hgb or *Increadead
trapped in the effect of iron
reticuloendoth with viatmin C;
elial cells for decreaded
storage and effect of
eventual tetracycline,
conversion to antacids,
a usable form penicillamine
of iron.
 GENERIC NAME PRESCRIBED AND MECHANISM INDICATION CONTRAINDICATI ADVERSE NURSING
BRAND NAME RECOMMENDED OF ON REACTION RESPONSIBILITIE
CLASSIFICATIONS DOSAGE, ACTION S
FREQUENCY, AND
ROUTE OF
ADMINISTRATION
Ferrous *Inform clients
Sulfate of side-effects
Brand Name: like nausea
Ferrous and vomiting,
sulfate diarrhea,
(Feosol, Fer- constipation,e
Iron)
pigastric pain
Ferrous
and refer to
gluconate
(Fergon, the attending
Fertinic) nurse upon
Ferrous occurrence for
fumarate management.
(Feostat, *Monitor for
Fumerin) adverse
Classifications reactions like
: pallor and
drowsiness.
(CONTINUATI
ON)
SUMMARY OF
INTRAVENOUS
FLUID
 Date Started IV Fluids, Volume, Indication
Drop Rate
8 - 21- 09 | 9:00 PM #1 D5LR; 1L @ 30 For fluid and electrolyte
10: 20 PM drops/min replenishment and caloric
# 2 PNSS; 1L @ 40 supply
8 - 22- 09 | 12:25 AM drops/min To replace fluids in
| 10:00 AM dehydration, go with
| 4:10 PM #3 PNSS; 1L @ 40 blood transfusions,
drops/min hyponatremia, and burn
8 - 23 - 09 | 9:30 PM #4,5 PNSS; 1L @ 40 victims. It is isotonic,(
drops/min same osmolarity as our
8 - 24- 09 | 10: 45 AM #6 PNSS; 1L @ 40 body fluids)
| 6:45 PM drops/min To replace fluids in
dehydration, go with
8 - 25- 09 | 7:00 PM #8,9,10 PNSS; 1L @ 40 blood transfusions,
drops/min hyponatremia, and burn
8 - 25- 09 | 12:50 AM BT S# 0908-186 A+ WB victims. It is isotonic,(
8 - 25- 09 | 3:30 PM #11 PNSS; 1L @ 40 same osmolarity as our
drops/min body fluids)
To replace clotting factors
BT S# 0908-183 A+ WB (e.g after multiple
D5LR; 1L @ 30 drops/min transfusions or reverse
BT S# 0908-187 A+ WB the effects of Coumadin)
BT S# 0908-193 A+ WB For fluid and electrolyte
replenishment and caloric
LABORATORY &
DIAGNOSTIC
PROCEDURE
HEMATOLOGY
NORMAL VALUES RESULT IMPLICATION NURSING
RESPONSIBILITIES
Hemoglobin
August 21,’09 Explain test purpose
120-150 g/L and procedure
Hematocrit
-Interpret test
0.37-0.45 Hgb 35 Decreased
outcome and
WBC Hct .10 Decreased monitor
5-10 x109/L
WBC Normal appropriately
Neutrophil 9.2
Normal -Watch carefully for
0.55-0.65
Neutrophil signs and symptoms.
Lymphocyte Normal
0.59 -Have the patient
0.25-0.40 Increased avoid excessive
Lymphocyte
Eosinophil exercise before the
0.29
0.01-0.05 test.
Bleeding Time Eosinophil
0.12 -Avoid over
Up to 6 mins.
hydration or
Clotting Time Platelet dehydration.
5-8 mins. 228
-Note any
Platelet Count
medication the
patient is taking.
HEMATOLOGY(cont…)
NORMAL VALUES RESULT IMPLICATION NURSING
RESPONSIBILITIES
Hemoglobin
8-24-09
120-150 g/L Hgb 54 Decreased
Hematocrit

0.37-0.45 Hct 0.16 Decreased

WBC
WBC 10.60 Normal
5-10 x109/L

Neutrophil
Neutrophil Decreased
0.55-0.65
0.46
Lymphocyte Normal
0.25-0.40 Lymphocyte
Eosinophil 0.38 Increased
0.01-0.05
Eosinophil Normal
Bleeding Time
0.16
Up to 6 mins.
Normal
Clotting Time
Bleeding time
5-8 mins. 2’ Normal
Platelet Count

Clotting time
HEMATOLOGY(cont…)
NORMAL VALUES RESULT IMPLICATION NURSING
RESPONSIBILITIES
Hemoglobin
8-25-09
120-150 g/L Hgb 71 Decreased
Hematocrit 8-26-09
Hgb 100 Decreased
0.37-0.45

WBC
Hct 0.30 Decresaed
5-10 x109/L

Neutrophil

0.55-0.65

Lymphocyte

0.25-0.40

Eosinophil

0.01-0.05

Bleeding Time

Up to 6 mins.

Clotting Time

5-8 mins.

Platelet Count
Hgt/ Blood Glucose Test
NORMAL VALUES RESULT IMPLICATION NURSING
RESPONSIBILITIES
Hgt
72-128 mg/dL 8-21-09 -Explain test purpose
8:25pm and blood drawing
Hgt 120 mg/dL Increased procedure.
11:00pm -Tell patient that the
Hgt 115 mg/dL Increased test requires an
overnight fast; water
5:00am Increased is permitted.
Hgt 116 mg/dL -Note the last time
8-24-09 the patient ate in the
5:00pm record and on the
Hgt 101 mg/dL Normal laboratory
requisition.
-Tell the patient that
she may eat and
drink when blood is
drawn.
-Interpret result and
monitor appropriately
for hyperglycemia
Cross Matching

8-22-09/ 10:00pm 8-26-09

 Blood Type “A”  Blood Type “A”
 RH (+)
 RH (+)
 Extract Date 8-10-09
 Expire Date 9-13-09  Extract Date 8-25-
 Volume 250, Whole Blood 09
 Slide Method, Compatible  Expire Date 9-19-09
8-24-09  Volume 500, Whole
 Blood Type “A”
Blood
 RH (+)
 Slide Method
 Extract Date 8-22-09
 Expire Date 9-14-09 Compatible
 Volume 250, Whole Blood
 Slide Method, Compatible
 Ultrasound of Abdomen
8-26-09
 Sonography normal liver, gallbladder, biliary

ducts, pancreas, spleen, urinary bladder and

uterus.
 Normal sized kidneys with suggestive

pyelonephrotic changes.
 No definite intrauterine gestation.

 Presence of a small (3.9cm) complex mass

at the left adnexal area. This may suggest a

small ovarian mass- however ectopic
gestation with intraperitoneal blood cannot be
 Ultrasound of Abdomen
(cont…)
 Minimal pleural fluid, bilateral. May be
due to reactive pleurons. Suggest chest x-
ray.
 Noted is a small complex mass seen

left supero-lateral to the uterus.

Measures 3.5 x 3.9 x 3.9 cm. no
significant tenderness noted. However 1
moderate to massive intraperitoneal
fluid was noted.
Pregnancy Test
8-23-09
RESULT: positive
ANATOMY &
PHYSIOLOGY
OF THE FEMALE
INTERNAL
REPRODUCTIVE SYSTEM
 The internal reproductive anatomy
includes the uterus, two ovaries,
two fallopian tubes. The ovaries
are the female reproductive glands
where the 400,000 ova or egg
cells are stored. The fallopian
tubes tube-like a structure that
convey the ovum from the ovaries to
the uterus and provides a place for
fertilization of ovum by sperm.
 It is divided into four parts the interstitial
portion that lies within the uterine wall,
the isthmus that is cut or sealed during
BTL, the ampulla where fertilization of an
ovum occurs and the infundibular
portion which is funnel-shaped structure
and its rim is covered by fimbria(small
hairs) that helps to guide the ovum into
the fallopian tube. The lining of entire
fallopian tube is composed of mucous
membranes which contains both mucus-
secreting and ciliated (hair-covered)cells.
 The uterus is a hollow, muscular
pear-shaped organ located at the
lower pelvis posterior to the bladder
and anterior to the rectum. It
receives ovum from the fallopian
tube and provide place for
implantation and nourishment during
fetal growth.
 It has three divisions the corpus (body)
which the lining of the cavity is
continuous with the fallopian tube which
enter the upper aspect (cornua), the
isthmus which enlarges greatly to aid in
accommodating the growing fetus during
pregnancy, the cervix the lower portion
of the uterus which contains a small
opening called the os. Semen travels
through the os into the uterus and the
fallopian tubes following ejaculation
 Fertilization is the meeting of sperm
cell and the fertilized ovum. It can only
occur if intercourse takes place before
the time of ovulation that usually
occurs mid-cycle or about 14 days
before the woman's next menstrual
period. At the time of ovulation, the
ovum is released from the ovary and
transported in the fallopian tube where
it remains for about 24-48 hours.
 Sperm cells remain viable within the
female reproductive tract for about
72 hours. Only a single sperm cell
is needed to fertilize the ovum, even
though the average ejaculation
contains approximately 300 million
sperm.
 During fertilization, the sperm enters
the cell membrane of the ovum so the
nuclei of the sperm and egg cells
combine to form a zygote. The zygote
will remain in the fallopian tube for
approximately three days before it
travels to the uterus through the help
of the hair like structures called cilia
where it will remain for approximately
four to five days before implantation or
PATHOPHYSIOLOGY
Predisposing Precipitating
Age: Above 25 PID; Infertility; Use of
Gender: IUD;
Female Tubal Surgery;
Previous Smoking; Tubal
Ectopic Ligation
Pregnancy
Signs and symptoms:
Clinical presentation of ectopic pregnancy
occurs at a mean of 7.2 wks. After the last
menstrual period with range of 5-8 wks.
 
Pain in the lower Abdomen and inflammation
Pain while urinating
Pain and discomfort. A corpus luteum on the
ovary
In a normal pregnancy mat
give very similar symptoms.
Vaginal bleeding, usually mild. An ectopic
pregnancy is usually a failing pregnancy and
falling levels of progesterone from the corpus
luteum on the ovary cause withdrawal
bleeding.
Pain while having a bowel movement.
 Patients with a late ectopic pregnancy
typically experience pain and bleeding, this
bleeding will be both vaginal and internal
and has two discrete pathophysiologic
mechanism.
1. External bleeding- due to falling
progesterone levels.
2. Internal bleeding- due to
hemorrhage from the affected tube.
 
 
Severe internal bleeding may cause:
Lower back, abdominal, or pelvic pain.
Shoulder pain, This is caused by free blood
tracking up the abdominal cavity and
irritating the diaphragm, and is an eminous
sign.
Cramping or even tenderness on one side of
the pelvis.
Can mimic diseases such as appendicitis
MANAGEMENT
MEDICAL MANAGEMENTIDEAL ACTUAL

Another option administer August 21, 2009; 9PM

methrotrexate Please admit under the Dep’t of
surgery
-Pt. must be hemodymically stable, NPO
have no active renal or hepatic V/S q 4hours
disease, have no evidence of Administer:
thrombocytopenia or leukopenia, and # 1 P5NSS ; 1L @ 40 drops/min
have a very small, unruptured ectopic #1 D5LR; 1L @ 30 drops/min
pregnancy on ultrasound LABS:
CBC
-no fetal cardiac activity, no active U/A
bleeding, and a beta-hCG level of < XRAY- Abdomen flat plate and
2000 mIU per ml epigastric
-administered intramuscularly or UTZ whole abdomen
orally, maybe treated with intratubal MEDS:
injection of methotrexate Ranitidine 200mg
Cefuroxime 50mg
Side effects: Insert NST and open to drain
Abdominal cramping, mucositis, and 10:15 AM
renal and hepatic damage, allergic Check HGT q 6 hours
reactions have occurred in pt. (3AM-11AM-6PM-11PM)
receiving high dosages 10:20 PM
Change present IVF to # 2 PNSS; 1L
@ 40 drops/min
MEDICAL
MANAGEMENT(cont…)
IDEAL ACTUAL

Complete Blood Count August 22, 2009; 12:35 AM

Renal and hepatic function tests IVF TF c #3 PNSS; 1L @ 40
Blood typing drops/min
Pt is advised to refrain from alcohol, 10:00AM
intercourse and vitamins containing Pregnancy test
folic acid because it may exacerbate IVF TF #4,5 PNSS; 1L @ 40
the adverse effects of methotrexate drops/min
Pt. may expect abdominal which 4:10PM
occurs within 5 to 10 days, it IVFTF c #6 PNSS; 1L @ 40
indicates termination of pregnancy drops/min
Serum level of beta-hCG should Paracetamol 500mg IVTT q 4
gradually decreased upon monitoring hours
Ultrasound should also be used for 7:20PM
monitoring May have DAT
No dark colored foods
Stop when abnormal when
abdominal pain recurs
August 23,2009; 9:30PM
IVFTF c #8,9,10 PNSS; 1L @ 40
drops/min
Follow up pregnancy test
MEDICAL
MANAGEMENT(cont…)
IDEAL ACTUAL

August 24, 2009;

Refer to OB-Gyne (r/t EP)
8:10PM
For 2nd UTZ now
Request CBC, Platelet, Bleeding
time, Clotting time
*** UTZ – (+) pregnancy test for
transfer of service to OB
10:00AM
May transfer to OB-Gyne WARD
10:45AM
Follow up blood
Request HGT Lab today
Schedule for Pelvic Lap
Secure Consent
Request RBC
NPO for 4hours
6:45PM
Keep NPO
Request HGT level
IVFTF #11 PNSS; 1L @ 40 drops/min
Follow up blood
MEDICAL
MANAGEMENT(cont…)
IDEAL ACTUAL

August 25, 2009

Prepare for Pelvic Lap
Keep NPO
1 Ranitidine 50 mg q 8hours
IVTT
3:45PM
For Culdocentesis now
Follow up blood
1 Vit K 1 amp IM for 12hours
*** (-) abdominal pain, (+)
distension fallopian tube, (+)
direct tenderness
7:00 PM
UTZ – upper abdomen &
transvaginal
IVFTF D5LR; 1L @ 30 drops/min
Culdocentesis *no blood
withdrawn
10:00PM
Keep NPO
Metronidazole 1 gm Suppository
MEDICAL
MANAGEMENT(cont…)
IDEAL ACTUAL

August 26, 2009

Follow-up UTZ (abdominal &
transvaginal)
Repeat hgb and hct 6 hours post
bilateral tubal ligation
Keep NPO
Continue meds
Refer to OB – on call in case of
fluctuation
*** abdomen: distended, non-tender,
soft, tympanic, (-) vaginal bleeding
9:30am
UTZ of whole abdomen now
FBC attached to urobag - For
bladder filling prior to UTZ
11:00am
Repeat hgb, hct count @ outside lab
Repeat pregnancy test
11:20am
For paracentesis,
Please secure consent for explore
lap/pelvic lap
Secure blood for OR use
SURGICAL MANAGEMENT
IDEAL ACTUAL

Resection of the involved fallopian PREOP CHECKLIST:

tube with End to end Anastomosis
“Milking” an ectopic pregnancy
from the tube
Salvaging the tube with a
salpingotomy which involves opening
and evacuating the tube and
controlling bleeding
salpingectomy
Salpingo-oophorectomy
After surgery pt. is given
methotrexate to treat any remaining
embryonic or early pregnancy tissue
as indicated by a persistent or
increasing beta-hCG level
Repeat beta-hCG test every two
weeks after surgery to ensure that
the level is decreasing
Informed consent (BTL and pelvic
lap)
Sponge bath done
Jewelry : dentures, prosthesis
removed
Proper attire: Hospital gown without
underwear
Nails cleaned and polish removed
FBC inserted
Operative record
AUGUST 26,2009
Pre Dx: acute abdomen t/c ectopic
pregnancy, ruptured
Post Dx: Left cornual pregnancy,
ruotured,hemorrhage secondary to
severe anemia
Operation performed: repair of the
ruptured left cornua,BTL
SURGICAL
MANAGEMENT(cont…) IDEAL
Surgical interventions:
Preoperative Interventions
1. Check vital signs as indicated
(depending on severity).
2. Check amount of vaginal bleeding.
3. Check for signs of shock such as
tachycardia, drop in blood pressure, and
cool clammy skin. (During pregnancy, signs
of shock are not manifested until there has
been at least a 40 % blood volume loss.
4.Check state of mental acuity/level of
consciousness.
5.Keep an accurate record of intake and
output.
•Urinary output during pregnancy is the
best noninvasive indicator of circulatory
volume.
•Diminished cardiac output causes a
shunting of blood away from the skin,
kidneys, and skeletal muscles in order to
ensure blood delivery to heart and brain.
6.Start an intravenous infusion with an 18-
gauge intracatheter and maintain as
ordered.
ACTUAL
Surgical techniques/ findings
Induction of spinal anesthesia-
asepsis/antisepsis. Midline
infraumbilical incision , deepened
down
 Intra Op: Hemoperitoneum = 2L
(suction), the left cornua has point of
rupture = 1-2 cm with desidual time/
blood noted; active bleeding at the
site. Cornual resection at the left is
started with double osshner clamp,
rescted and excised then sutured
using chromic 2-0, hemostasis is
observed.BTL done. Abdominal wall
is closed layer by layer.
SURGICAL
MANAGEMENT(cont…) IDEAL ACTUAL

7.      Obtain blood as ordered for Blood loss(hemoperitoneum) = 2L

• a complete blood count,
• prothrombin time, Transported to PACU per gurney in semi
• partial thromboplastin time, conscious state
• Rh antibody screen, and
• type and cross match for 2 to 4 units Post Op:
of blood. spinal anesthesia
8.      Administer oxygen at 8 to 10 L by (+) spinal headache
mask as needed. (+) prolonged motor blockade
9.      Carry out such preoperative protocol (+) paralysis
as giving the patient (+) lumbar / back pain
• nothing by mouth,
• giving no enemas or cathartics since
they could stimulate a tubal ectopic
pregnancy to rupture,
•being prepared to insert a Foley
catheter as ordered, and
•get the permit signed for surgery.
10.  Notify the attending physician of any
changes in
•vital signs,
•decreasing urinary output,
•blood pressure that falls 10 mmHg or
SURGICAL
MANAGEMENT(cont…)
IDEAL ACTUAL
11.  If the patient presents in shock, be prepared to
assist with central line placement. The internal
jugular and subclavian veins are less likely to
collapsed.
12.  Be prepared to administer blood
replacement therapy if
•the hemoglobin level is below 7 g/dl or
•the patient is manifested signs of shock.
Postoperative Interventions
1. Check blood pressure, pulse, and respiration
•every 15 minutes, eight times;
•every 30 minutes two times;
•every hour, two times;
•every 4 hours, two times; and then
routinely.
2. Assess vaginal bleeding by pad count.
3. Check dressing
•every hour four times and then
•every shift for bleeding
4. Refer to laboratory work, such as hemoglobin
and hematocrit.
5. Keep an accurate intake and output records.
6. Assess for cyanosis.
7. Reinforce or change dressing as needed.
SURGICAL
MANAGEMENT(cont…)
IDEAL ACTUAL

9. Once the gastrointestinal tract

resumes normal function, instruct
regarding the importance of
•a high protein,
•high-iron diet for body repair
and replacement of blood loss.
10.  Notify physician if
blood pressure drops to less than
90 systolic,
•pulse rises to greater than
120 bpm, or
•anemia develops.
NURSING MANAGEMENT IDEAL ACTUAL

Nursing Diagnoses with corresponding

interventions
Acute pain r/t progression of the tubal
pregnancy
•Relieving pain by providing
preanesthetic medications if the pt. is
to undergo surgery
•Postoperatively analgesic agents are
administered liberally
Anticipatory grieving r/t loss of pregnancy
and effect on future pregnancies
•Supporting the grieving process by
listening and providing support and
encouraging pts partner to participate
in this process
Deficient knowledge r/t treatment and
effect on future pregnancies
•Teaching patient self-care by
explaining the procedures in terms that
the distressed and apprehensive pt can
understand including the pts partner
when possible
•Addressing pts. Questions and
NURSING
MANAGEMENT(cont…) IDEAL ACTUAL

•Instruct to report early signs and

symtoms of recurrence
•Review signs and symptoms with the
pt and instruct her to report abnormal
menstrual period promptly PLS. REFER TO OUR NURSING CARE PLANS
•Pt. teaching is based on the needs of
the pt and partner and must take into
considerations their distress and grief.
Monitoring and managing potential
complications by assessing carefully to
detect the development of this
complications (shock and hemorrhage)
•by continuous monitoring of v/s, level
of consciousness, amount o bleeding,
intake and output
•bed rest is indicated
•monitor hematocrit, hemoglobin and
blood gas levels to assess
hematologic status and adequacy of
tissue perfusion
•blood component therapy may be
required if blood loss has been rapid
and extensive
 NURSING
CARE PLAN
Identified Problem:
Nursing Diagnosis: Activity Intolerance r/t generalized weakness
secondary to anemia
CUES OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

Subjective Short term Monitor Vital To provide

Cues: Objectives: signs regularly. baseline data.
“Maglisod ko   Check patency To prevent
ug lihok sa Within 8 hours of IV. complications.
laing of nursing Monitor intake Symptoms may
posisyon,” as interventions, and output. be result of/or
verbalized by patient will be Note client’s contribute to
patient. able to reports of intolerance of
  demonstrate weakness, activity.
  identified fatigue, pain and To determine
Objective techniques to difficulty of effect of activity.
Cues: enhance accomplishing May be
  activity tasks. increasing the
Dyspnea tolerance such Assess effects of an
Pallor as proper cardiopulmonary illness or might be
Increased positioning response to the result of being
heart rate every after 2 physical activity. forced into
Level 4 hours, Assess inactivity.
functional balancing rest emotional/ To determine
level periods and psychological current status and
evidenced by progressively factors affecting needs associated
dyspnea and increasing current situation. with participation
fatigue at rest activity level in needed/ desired
CONTINUATION
Nursing Diagnosis: Activity Intolerance r/t generalized weakness
secondary
CUES toOBJECTIVES
anemia INTERVENTIONS RATIONALE EVALUATION

Long Term Ascertain ability to To provide safety.

Objectives: stand and move about To prevent over
  and degree of exertion of effort.
Within 3 days
of nursing
assistance To reduce fatigue.
interventions, necessary/use of To enhance ability
patient will equipment. to tolerate activities.
report Increase exercise/ Prevent bed sores
measurable activity level gradually and promote activity.
increase in by taking frequent To determine
activity rests and asking SO to current status and
tolerance.
assist patient in needs associated with
performing ADLs. participation in
Raise the side rails. needed/ desired
Adjust level of activities.
activities by reducing To conserve energy
intensity level or and promote rest.
discontinue activities To provide safety.
that cause undesired To prevent over
physiological changes. exertion of effort.
Plan care to carefully To reduce fatigue.
balance rest periods To enhance ability
with activities. to tolerate activities.
Perform passive Prevent bed sores
Identified Problem:
Nursing Diagnosis: Acute Pain r/t abdominal pressure secondary to
distention
CUES of fallopian tube
OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

Subjective Short term  Monitor vital To provide

Cues: objectives: signs regularly. baseline data.
“Sakit akong pus- Within 8  Check IV fluids To prevent
on,” as hours of and regulate at complications.
verbalized. rendering
prescribed rate. To determine
P- distension of nursing care,
fallopian tube patient will  Monitor intake what measures
Q- Sharp be able to and output. worked best in
stabbing pain verbalize  Assess patients the past.
R- Pain at non- past coping Observations
McBurney’s pharmacolog mechanisms to may/may not be
point. ic methods
wards pain. congruent with
S- Pain scale of that provide
 Observe verbal reports or
10 relief.
T- Intermittent;   nonverbal may be only
felt most when Long term cues/pain indicator present.
moving. objectives: behaviors and This will impact
Objectives Within 3 other objective on patient’s
Cues: days of defining perception of the
Facial grimace nursing care,
characteristics, effectiveness of
Guarding patient will
behavior be able to as noted the treatment
Irritability and report that  Assess modality and
restlessness pain is patient’s willingness to
CONTINUATION
Nursing Diagnosis: Acute Pain r/t abdominal pressure secondary to
distention
CUES of fallopian tube
OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

 Accept Pain is a
client’s subjective
description experience and
of pain and cannot be felt
acknowledg by others.
e the pain To distract
experienced attention and
and convey release tension.
acceptance To prevent
of client’s pain in the
response to affected part.
pain. To promote
 Encourage non-
use of pharmacologica
relaxation l pain
techniques management.
such as To relieve
breathing pain.
exercises, To prevent
and fatigue.
CONTINUATION
Nursing Diagnosis: Acute Pain r/t abdominal pressure secondary to
distention
CUES of fallopian tube
OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

 Limit
movement
and support
patient.
 Provide
comfort
measures
such the use
of
therapeutic
touch and
repositionin
g every 2
hours.
 Administer
medications
such as
analgesics,
prn.
 Encourage
Identified Problem:
Nursing Diagnosis: Self-care deficit [hygiene] r/t decreased energy level
secondary to anemia
CUES OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

Subjective  Monitor vital To provide

Cues: Short term signs baseline data.
“Dili nako kaya objectives: regularly. To prevent
maligo,” as Within 8 hours  Check complications.
verbalized by of caring, patency of IV To know
patient. patient will  Note barriers to
Objectives verbalize concomitant activity
Cues: understanding medical tolerance.
•Inability to of the need to problems or To measure
bathe and groom maintain existing whether care
independently proper conditions needs to be
•Inability to put hygiene. that may be stressed longer
clothing on upper Long term factors for or amount of
and lower body objectives: care such as care needed.
independently. Within 3 days increased BP Enhances
•Inability to of nursing and pain. commitment to
ambulate interventions,  Note whether plan, optimizing
independently. patient will be deficit is outcomes, and
•Foul body odor able to perform temporary or supporting
•Unkempt hair self-care permanent, recovery and/or
CONTINUATION
Nursing Diagnosis: Self-care deficit [hygiene] r/t decreased energy level
secondary
CUES to anemia
OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

 Promote To
client’s/SO’s encourage
participation in client and
problem build on
identification and successes
desired goals and To promote
decision making. hygiene.
 Provide privacy and To enhance
equipment within proper
easy reach during grooming.
personal care
activities.
 Assist with
necessary
adaptations to
accomplish ADLs.
Begin with familiar,
easily accomplished
tasks.
 Advise SO to provide
Identified Problem:
Nursing Diagnosis: Sleep deprivation r/t prolonged physical discomfort
secondary
CUES to pain OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

Subjective Short-term  Monitor vital To provide

cues: objectives: signs baseline data.
“Dili ko katulog Within 8 hours regularly. To prevent
tungod sa of nursing care,  Check IV complications.
kasakit,” as patient will be fluids and Provides
verbalized by able to regulate at comparative
Patient. participate in prescribed baseline.
Objective ways to rate. These factors
cues: promote sleep  Determine are known to
•Restlessness such as client’s usual disrupt sleep
•Irritability balancing rest sleep patterns.
•Slowed periods, proper pattern and Enhances
reaction positioning, and expectations expenditure of
•Prominent adequate . energy/ release
eyebags noted exercise.  Encourage of tension so
•Frequent Long-term client to that client feels
yawning objectives: restrict ready for sleep.
Within 3 days of caffeine, Because they
nursing care, alcohol and impair ability to
patient will be other sleep at night.
able to report stimulating
CONTINUATION
Nursing Diagnosis: Sleep deprivation r/t prolonged physical discomfort
secondary
CUES to pain
OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

 Promote To reduce

adequate stimulation and
physical exercise promote
activity during relaxation.
the day. Helps identify
 Suggest appropriate
abstaining from interventions.
daytime naps. To promote
 Recommend sleep.
quiet activities To monitor
such as reading, effect of
listening to interventions.
soothing music.
 Determine
client’s
intervention that
has been tried in
the past.
 Distinguish
client’s
beneficial
Identified Problem:
Nursing Diagnosis: Ineffective breathing pattern r/t body position
CUES OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

Subjective Short-term  Monitor vital To obtain

cues: objectives: signs regularly. baseline data.
“Kung Within 8 hours  Check patency To prevent
maghayang ko of nursing care, of IV. complications.
kay maglisod patient will be  Note To monitor
ko ug able to concomitant barriers for
ginhawa,” as participate in medical effective
verbalized by techniques to problems or breathing.
patient. improve existing Respiratory
Objective breathing by conditions that rate and rhythm
cues: proper may be factors changes are
•Dyspnea positioning and for care such early warning
•Alterations in breathing as pain and sign of
depth of exercise. respiratory impending
breathing Long-term deviation. respiratory
•Tachypnea objectives:  Assess for distress.
•Difficulty Within 3 days respiratory For optimal
breathing in of nursing care, rate and depth breathing
supine position patient will be by listening to pattern.
•Pallor able to breath sounds So that the
establish at least every appropriate
CONTINUATION
Nursing Diagnosis: Ineffective breathing pattern r/t body position
CUES OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

 Position patient To prevent

with proper body dyspnea
alignment resulting from
 Ensure that oxygen fatigue.
delivery system is To facilitate
applied to the pt . adequate
 Pace and schedule clearance of
activities providing secretions.
adequate rest Appropriate
periods. breathing
 Teach pt the techniques
significance of during exercise
appropriate are important in
breathing, maintaining
coughing, and adequate gas
splinting exchange.
techniques. Pt will then
 Teach pt. when to know when to
inhale and exhale limit activities
while doing active in terms of her
Identified Problem:
Nursing Diagnosis: Deficient knowledge [Learning Need] regarding condition
r/t inadequate understanding of disease process
CUES OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

Subjective Short-term  Determines Individual

cues: objectives: client’s ability/ may not be
“Wala ko’y Within 8 hours of readiness and physically,
hanaw sa nursing care, barriers to emotionally, or
akong patient will be learning. mentally
kahimtang able to exhibit  Assess ability capable at this
karon,” as increase interest to learn or time.
verbalized by for more perform Cognitive or
the patient. information by desired physical
Objective asking more health-related impairments
cues: questions. care. need to be
•Questioning Long-term  Be alert to identified so
members of objectives: signs of an appropriate
the health Within 3 days of avoidance. teaching plan
care team nursing care,  Assess can be
•Verbalizes patient will be motivation designed.
inaccurate able to identify and Client may
information relationship of willingness of need to suffer
•Refusal to signs and pt or SO to consequences
follow symptoms to the learn. of lack of
CONTINUATION
Nursing Diagnosis: Deficient knowledge [Learning Need] regarding condition
r/t inadequate understanding of disease process
CUES OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

 Provide positively To prevent

enforcement and avoid information
criticisms. overload.
 Provide an atmosphere To encourage
of respect, openness, continuation of
trust and collaboration. efforts.
 Give clear and To promote
thorough explanation understanding.
and demonstration. To prevent
Encourage questioning confusion and
 Discuss one topic at a misinterpretati
time. Avoid giving too on.
much information in To enhance
one session. emotional
 Include emotional understanding.
counseling in the Such
teaching if necessary. information is
 Provide information necessary for
about reproductive the client’s
health, family planning, situation.
Identified Problem:
Nursing Diagnosis: Ineffective tissue perfusion [cardiopulmonary and
peripheral] r/t decreased hemoglobin concentration in blood secondary to
anemia
CUES OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

Subjective Short-term  Monitor vital To obtain

cues: objectives: signs baseline data.
•“Maglisod ko Within 8 hours  Check IVF and For hydration
ug ginhawa,” of nursing regulate it at Suggest
as verbalized care, patient prescribed treatment
by patient. will be able to rate. options.
•Chest pain participate in  Monitor intake That may be
Objective ways to and output. impacting tissue
cues: promote  Identify health.
•Capillary refill circulation underlying Improve tissue
time of >4 such as proper conditions perfusion/ organ
seconds positioning, involve in function.
•Nail beds are active ROM tissue injury. Conserves
pail and relaxation  Note poor energy/ lowers
•Edema on techniques. hygiene and tissue oxygen
face, legs and health demands.
hands of practices. Enhances
edema grade 2.  Identify venous return.
changes To increase
related to gravitational
CONTINUATION
Nursing Diagnosis: Ineffective tissue perfusion [cardiopulmonary and
peripheral] r/t decreased hemoglobin concentration in blood secondary to
anemia
CUES OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

• Weak Long-term  Evaluate for When at risk

pulses objectives: signs and for embolus.
• Decreased Within 3 days infection Drugs used to
blood of nursing especially improve tissue
pressure. care, patient when immune perfusion also
• Pallor will be able to system is carry risk of
• Altered maintain compromised. adverse
sensations optimal tissue  Investigate responses.
• Altered perfusion in reports of chest
respiratory peripheral and pain; note
rate cardiopulmon precipitating
outside of ary as factors;
acceptable evidenced by changes in
parameter strong characteristics
s peripheral of pain
pulse, episodes.
absence of  Determine
edema, alert cardiac rhythm
LOC, and note
decreased presence of
CONTINUATION
Nursing Diagnosis: Ineffective tissue perfusion [cardiopulmonary and
peripheral] r/t decreased hemoglobin concentration in blood secondary to
anemia
CUES OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

 Assist with treatment

of underlying
conditions as
indicated.
 Encourage quiet
restful atmosphere.
 Note signs of
ischemia secondary
to drug effects.
 Perform assistive/
active ROM exercises.
 Encourage early
ambulation when
possible.
 Discourage
sitting/standing for
long periods, wearing
constrictive clothing,
crossing legs.
 Elevate HOB at night
DISCHARGE
PLAN
MEDICATION Instruct pt to take medication within prescribed time and dosage religiously to
maintain health improvement.

EXERCISE Encourage pt to exercise as tolerated. Educate pt on the benefits of exercise towards

health particularly to improvement of tolerance activities.

DIET A high-protein, high-calorie diet is recommended for the patient as well as iron-rich
foods. Patient should also avoid foods that are high in sodium.
Patient’s Name: Date of Discharge:
Condition upon Discharge:
HEALTH Educate the pt on the nature of Ectopic pregnancy
TEACHING

SCHEDULE Instruct pt to return 1 week after discharge for follow up check-up. Emphasize
FOR NEXT importance of follow up check ups.
VISIT

SPIRITUAL Encourage pt to continue trusting God, to pray. Explain to pt that everything happens
for a reason and they’re still alternatives to having children.

LIFESTYLE Encourage pt to take adequate rest and take proper meals. Socializing with people
and having a healthy relationship with friend may help divert patient’s attention from
his vices, and restore her love for life. Reuniting with her family may also help her
psychological condition.
REFERRAL Refer to a female reproductive specialist such as obstetrician or gynecologist for
further consultation or go to a nearest health center or hospital.