STI College of Nursing

Sta. Cruz, Laguna

Submitted to:
Ms. Aurea Celino, RN, MAN
Clinical Instructor

Submitted by:
GROUP II
Members:

Bernardino, Michelle S.

Bernas, Nikki Lou

Ching, Judith U.

De Ramos, Robert Immanuel

Ingalla, Charmaine

Matienzo, Evangeline N.

Monteseña, Roselle Ann

Sotomayor, Karen

July 2010
TABLE OF CONTENTS

1
 I. Introduction ------------------------------------------------------------------------------------2
A. Objectives -------------------------------------------------------------------------------3
B. Background of the Study ------------------------------------------------------------3
C. Rationale for Choosing the Case --------------------------------------------------4
D. Significance of the Study ------------------------------------------------------------4
E. Scope and Limitations ----------------------------------------------------------------4

II. Clinical Study ------------------------------------------------------------------------------------5

A. Demographic Data ----------------------------------------------------------------------5
B. Physical Assessment -------------------------------------------------------------------7
C. System Affected --------------------------------------------------------------------------9
D. Laboratory and Diagnostic Exam ----------------------------------------------------9

III. Clinical Discussion ----------------------------------------------------------------------------11

A. Anatomy and Physiology -------------------------------------------------------------11
B. Pathophysiology ------------------------------------------------------------------------14
C. Nursing Care Plan ----------------------------------------------------------------------15
D. Drug Study -------------------------------------------------------------------------------20
E. Course in the Ward --------------------------------------------------------------------29
F. Discharge Plan --------------------------------------------------------------------------30
G. Evaluation --------------------------------------------------------------------------------32
H. Summary ----------------------------------------------------------------------------------33
I. Recommendation -----------------------------------------------------------------------34
J. Bibliography ------------------------------------------------------------------------------35

I. Introduction

2
 ECTOPIC PREGNANCY

The BSN level III students were given the opportunity to have a hospital
exposure at Laguna Provincial Hospital – Delivery Room; and on that day found a
commendable case reasonable to be presented for case study. The patient, to be
mentioned in this paper as J.S, housewife, G2P1 (T1-P0-A0-L1), was one of the
patients admitted to the Delivery Room. She was 33 years of age. Her LMP is June 10,
2010 and her EDC is March 17, 2011. She was admitted due to ectopic pregnancy.

An ectopic pregnancy occurs when the baby starts to develop outside the womb
(uterus). The most common site for an ectopic pregnancy is within one of the tubes
through which the egg passes from the ovary to the uterus (fallopian tube). However, in
rare cases, ectopic pregnancies can occur in the ovary, stomach area, or cervix. Ectopic
Pregnancy occurs in about 1 in 250 pregnancies amounting to approximately 70 000
cases annually, 5,833 per month, 1,346 per week, 191 per day, 7 per hour. In the
Philippines, unpublished reports have estimated the incidence to be just about 22, 194
each year.

An ectopic pregnancy is commonly referred to as a tubal pregnancy because 95

percent occur in a fallopian tube. An ectopic pregnancy needs to be treated immediately
to avoid fallopian tube damage or life threatening blood loss. When identified early,
ectopic pregnancies are treatable with medication that stops the pregnancy. If the
pregnancy is further along, laparoscopy is usually performed to remove the ectopic
tissue and repair the fallopian tube.

If the ectopic pregnancy has ruptured or bleeding persists, salpingectomy is a

very common option. This procedure involves excision of segment of the Fallopian tube
involved in the ectopic pregnancy. The tubal segment to be removed is coagulated and
cut off with bipolar forceps. The group chose J.S. as our subject primarily because her
case posed as a very intricate case requiring due understanding and knowledge. The
group recognizes their partial knowledge about ectopic pregnancy and the surgical

3
procedures involved in such condition, thus making this case a good avenue to broaden
the proponents’ knowledge about the disease and the surgical procedures involved.

A. OBJECTIVES

• To define what ectopic pregnancy is, trace the pathophysiology and

enumerate the signs and symptoms of ectopic pregnancy.
• To identify and understand different types of medical treatment necessary
for the treatment of ectopic pregnancy.
• To formulate and apply nursing care plan utilizing nursing process.
• To learn new clinical skills, as well as sharpen our current clinical skills
required in the management of the patient with ectopic pregnancy.
• To develop our sense of unselfish love and empathy rendering nursing
care to our patient so that we may be able to serve future clients with
higher level of holistic understanding, as well as individualized care.

B. BACK GROUND OF THE STUDY

This is a case of a patient, named J.S, 33 years old from Binan Laguna, who has
been diagnosed with Ectopic Pregnancy. The patient has a maternal history of
G2P1T1P0A0L1. The patient was complaining from pain in right lower quadrant of her
abdomen. The patient has been admitted at the Delivery Room then transferred to OB –
Gyne Ward last July 22, 2010 at 5:30am. Upon internal examination there was a
tenderness also the patient experienced scanty vaginal bleeding. The result of her
ultrasound indicates Ectopic Pregnancy. She has undergone series of diagnostic tests
and undergone operation for Exploratory Laparatomy (EXLAP) and right
salphingectomy.

We decided to present this case due to our eagerness to learn and explore new
knowledge and information about this type of condition. Our group wants to
formulate a correlation among the conditions that manifests in patient JS. We believe
that this can be of great help in performing appropriate nursing interventions to the

4
 patient. Our group also wants to focus on ectopic pregnancy, which is uncommon
among pregnant mothers. It is a significant topic for the mothers especially those
who are in their pregnancy stage. It is of great advantage that they have knowledge
on this condition.

C. RATIONALE OF CHOOSING THE CASE

This case has been chosen by the group due to the following reasons:
A. To conduct further studies about Ectopic Pregnancy.
B. To have a further knowledge about this complication and how it can occur.
C. To know the possible risk of the one who has this kind of complication and how it
can be treated.
D. To be able to present the case study of our chosen client that would provide a
comprehensive discussion of the pathological mechanism of the complication to
yield significant information for the case study.

D. SIGNIFICANCE OF THE STUDY

This study is done for the benefits of the following:
• To the relatives and client – to help them to understand the present condition
and its complication.
• Student Nurse – to enhance the level of our knowledge and appropriate nursing
care about Ectopic Pregnancy
• Reader – acquire more understanding about Ectopic Pregnancy and its sign and
symptoms.

E. SCOPE AND LIMITATION

This study covers and focuses on the following:
 A brief discussion of the disease and its pathophysiology

 A drug study of medications prescribed to patient

 Nursing Care Plans which would present nursing analysis, diagnosis, plan, and
appropriate interventions that would aid in patients recovery.

5
  Discharge plan which presents follow-up care and treatment after confinement.

II. Clinical Study

A.DEMOGRAPHIC DATA

Patient Name: Ms. JS

Age: 33 years old
Birth Date: April 9, 1977
Civil Status: Single
Occupation: None
Address: Binan, Laguna

Maternal history:
LMP: June 10, 2010
EDC: March 17, 2011
G2P1 T1P0A0L1

Clinical/ Admitting Data:

CC: Abdominal pain

Internal Examination: with tenderness, with scanty vaginal bleeding
Date of Admission: July 22, 2010
Time of Admission: 5:30am
Attending Physician: Dra. Estela Galvez
Admitting Diagnosis: Ectopic pregnancy G2P1 T1P0A0L1
Proposed Surgical procedure: EXLAP and Right Salpingectomy

Vital Signs on admission:

T= 37.2 °C
PR= 105bpm
RR= 22cpm

6
BP= 90/60mmHg

Family Background:
 2nd among 5 children
 With 2 year old baby girl
 Partner: Mr. EP
 Partner is a smoker

History of Past Illness

 She seldom get sick but experiences fever sometimes due to weather conditions
 No information about her immunizations.
 No known allergy

History of Present Illness

 The patient is not aware of her pregnancy.
 During the 6th week of pregnancy, the patient experienced scanty vaginal
bleeding and abdominal pain which made her seek for medical help.
 She went to one of the hospital in Binan, Laguna, she was advised to have an
ultrasound.
 The findings of the ultrasound indicate that the patient has ectopic pregnancy and
they were referred in LPH.

7
B. PHYSICAL ASSESSMENT

- with facial grimace

- with guarding behavior
- weak and pale looking
General Appearance - with foul breath
- conscious and coherent
- with IVF hooked on right hand
- on NPO
- normocephalic
Head - symmetrical in shape
- no masses, no lesions
- evenly distributed over the scalp
Hair - with black, straight and thick hair
- dandruff is present
- lids close symmetrically
Eyelids
- no edema, and no discharges
Sclera - whitish
- symmetrical in size
Iris
- round and dark brown
- Symmetrical in movement
- round and dark brown in color
Pupils
- PERRLA (Pupils Equally Round And React To
Light and Accommodation)
- equal in size
- auricles are smooth and symmetrical
Ears
- pinna recoils after it is folded
- with dry cerumen
Nose - the external nose is symmetrical and straight
- color is the same with the entire face
- lesions and tenderness were both absent
- nasal mucosa was pinkish
- both left and right nares were patent

8
 - the nasal septum is intact and in midline without
deviations
- cilia present in internal nares
- absence of nasal discharge
- appear dry and pale
- tongue was located at the midline, pink in color,
Mouth slightly dry and furry with whitish coating
- tounge moves freely
- uvula is in midline
- neck movement was coordinated and difficulty in
Neck moving was not noted
- free from lumps and no tenderness
- no masses and tenderness upon palpation
Thorax - no adventitious breath sounds upon auscultation on
both left and right lung fields
- round in shape, no lumps, no masses
Breast - areola dark brown in color
- nipples round, equal in size
- same color of the body
Abdomen - with presence of stretch marks
- with throbbing pain in RLQ
- good range of motion was noted
- no lesions, no presence of abnormalities, no
Upper extremities
tenderness
- can extend arms without difficulty
- skin uniform in color
Lower extremities - no varicose
- with limited movement
Genitalia - With scanty vaginal bleeding

C. SYSTEM AFFECTED

 Reproductive System

9
D. LABORATORY AND DIAGNOSTIC EXAM

Complete Blood Count

July 22, 2010

BLOOD RESULT NORMAL INTERPRETATION SIGNIFICANCE

COMPONENTS VALUE
Hemoglobin 11.0 g/dl 13-19g/dl Decrease Decrease
hemoglobin will
result to
bleeding
White Blood 11.8 K/uL 4.1 – 10.9 Increase Increase WBC
Cells (WBC) k/uL signifies
infection in the
body.
Hematocrit 32.8% 35 – 45% Decrease Decrease
hematocrit
indicates that
the mass of
RBC is
decrease

July 24, 2010

BLOOD RESULT NORMAL INTERPRETATION SIGNIFICANCE

COMPONENTS VALUE
Hemoglobin 11.5 g/dl 13-19g/dl Decrease Decrease
hemoglobin will
result to
bleeding
White Blood 11.3 K/uL 4.1 – 10.9 Increase Increase WBC
Cells (WBC) k/uL signifies
infection in the
body.
Hematocrit 35% 35 – 45% Normal

Ultrasonography

D DIAGNOSTIC NORMAL RESULT IMPRESSION

10
A
T EXAM RESULT
E
J Obstetric No anatomic or The uterus is ENLARGED
u ultrasono- functional anteverted measuring UTERUS.
l graphy abnormalities about 8.01 cm in THICKENED
y exist. The organs length x 7.0 cm in ENDOMETRIAL
are normal in width x 5.3 cm in STRIPE
2 shape, size, thickness. The
1 contour and endometrial stripe is COMPLEX MASS
, position. The about 1.4 cm in RIGHT ADNEXAE
internal structures thickness. CONSIDERATION
2 of the organs and S ARE:
0 nearby tissues A complex mass TUBO-OVARIAN
1 are within normal measuring about 5.12 OATHOLOGY
0 limits. cm x 5.12 cm is seen RIGHT
at the right adnexae. EXTRA-UTERINE
CONCEPTION
RIGHT

III. CLINICAL DISCUSSION

A. ANATOMY AND PHYSIOLOGY

11
 The female reproductive organs consist of the ovaries, uterine tubes (or fallopian

tubes), uterus, vagina, external genitalia, and mammary glands.

Ovaries – the two ovaries are small organs suspended in the pelvic in the pelvic

cavity by ligaments. Ovaries are the female reproductive glands where the 400,000 ova

or egg cells are stored. The outer part of the ovary is made up of dense connective

tissue and contains ovarian follicles.

Fallopian tubes – the uterine tubes extend from the area of the ovaries to the

uterus. They open directly into the peritoneal cavity near each ovary and receive the

oocyte. The opening of each uterine tube is surrounded by long, thin processes called
12
fimbrae. It is a 4 inches long from each side of the uterus (fundus). It transports the

mature ova form the ovaries to the uterus and provide a place for fertilization of the ova

by the sperm in it’s outer 3rd or outer half. Parts:

• Isthmus – portion that is cut or sealed in a tubal ligation.

• Ampulla – widest, longest portion that spreads into fingerlike projections/fimbriae

and it is where fertilization usually occurs.

• Infundibulum - rim of the funnel covered by fimbriated cells (hair covered

fingerlike projections) that help to guide the ova into the fallopian tube.

Uterus - is as big as a medium-sized pear. The part of the uterus superior to the

entrance of the uterine tubes is called fundus. The uterine wall is composed of three

layers:

• The outer layer called the serous layer or perimetrium of the uterus

• The middle layer called the muscular layer or myometrium

• The innermost layer of the uterus is the endometrium.

The uterus is supported by the broad ligament and the round ligament

Vagina – is a female organ of copulation and functions to receive the penis

during intercourse. It also allows menstrual flow and childbirth. The superior portion of

the vagina is attached to the sides of the cervix so that a part of the cervix extends into

the vagina.

External Genitalia – also called vulva or pudendum of the vestibule and its

surrounding structures. The vestibule is the space into which the vagina and urethra

open. The vestibule is bordered by a pair of thin, longitudinal skin folds called the labia

13
minora. A small erectile structure called clitoris. The two labia minora unite over the

clitoris to form a fold skin called the prepuce. Lateral to the labia minora are two

prominent, rounded folds skin called labia majora. The space between the labia majora

is called the pudendal.

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.

B. Pathophysiology

Predisposing Factor:
Female, 33 years of age

Matured ovum release from ovary ready for fertilization

Matured egg pick-up by fallopian tube

14

Sperm
Single
Division
cell
cell
Fision
and
become
ofegg
cellscell
zygote
fused
 Sperm cells enter to uterine cavity and migrate to fallopian tube

Only one best & healthiest sperm will reach the ovum

Cluster of cell

Morula

Blocks movement of fertilized egg to the uterus

Fertilized egg attaches and implants in the

fallopian tube

Moderate amount, Distention and irritation

dark red vaginal Abdominal pain
of fallopian tube
bleeding

Ectopic Pregnancy

15
 A. Nursing Care Plan

Subjective Objective Analysis Planning Intervention Rationale Evaluation

“Sumasakit - with pain Acute pain After 8 hours Used pain rating To assess the rate of Goal met.
ang puson scale of 8 out related to of nursing scale the intensity, quality After 8 hours
ko” as of 10 distention of intervention, appropriate for and frequency of of nursing
verbalized by -with facial the fallopian the patient will age/ condition . pain. interventions,
the patient. grimace tube as verbalize and the patient
-irritable evidenced by show relief of Obtained client’s To rule out able to
-with weak verbal pain lessened assessment of worsening of verbalized and
and pale reports of from 8/ 10 to pain to include underlying showed relief
looking discomfort 6/ 10 in pain location, condition/developme of discomfort,
- with and pain scale characteristics, nt of complications. pain lessened
guarding onset/duration, from 8/10 to
behavior frequency, 6/10 in pain
- with limited quality, intensity, scale
movement and precipitating
factors.
V/S: Reassessed
BP-90/60 each time pain
mmHg occurs/is
RR- 22 bpm reported.
T- 37.2 C
Provided comfort To promote
measures such nonpharmacological
as touch, pain management.
repositioning,
use of cold
packs, nurse’s
presence and
quiet
environment and
calm activities.

16
 Instructed and To distract attention
encouraged use and reduce tension.
of relaxation
techniques such
as focused
breathing,
imaging.

Administered To decrease pain at

analgesics, as tolerable level.
ordered. Notify physician if
regimen is
inadequate to meet
pain control goal.

DAY 1: JULY 22, 2010

17
 Subjective Objtive Analysis Planning Intervention Rationale Evaluation

“Namumula - with reddish 4 Risk for After 8 hours of Noted risk To serve as After 8 hours of
ang tahi ko”, inches surgical infection nursing factors for basis in nursing
as verbalized incision due to related to interventions, infection providing interventions
by the patient. exploratory inadequate the patient will including skin preventing the patient was
lapatoromy. primary and be able to integrity, actions. able to
- with unhealthy secondary identify environmental identified the
environment for defenses interventions to exposure and health
postoperative secondary to prevent or laboratory teachings
patient wound exploratory reduce risk of results. given to
- with pale and laparotomy as infection. prevent or
weak looking evidenced by Observed for To assess reduce risk of
- incision site is reddish localized signs physical signs infection.
warm to touch incision site. of infection as that manifest
-no swelling the surgical infection.
wound.
V/S:
-RR= 22 bpm Maintained To prevent
-Temp.= 37.2 C clean technique bacterial
-Hgb= 11.3g/dL when doing colonization.
wound
dressing.

Cleansed To maintain a
incision sites clean surgical
daily and as wound and
needed with reduce the risk
appropriate of infection.
cleaning
solution.

18
 Changed To maintain
dressings as adequate
ordered protection and
prevent
contamination.

Encouraged the To strengthen

client to take the patient’s
nutritious foods immune system
and increase this decreasing
fluid intake the patient’s
such as meat susceptibility to
and fish. infection.

Maintained a To promote an
clean and environment for
healthy faster wound
environment. healing.

Administered To prevent
antibiotics as infection and
ordered. fast healing of
wounds.

DAY 2: JULY 23, 2010

19
 Subjective Objective Analysis Planning Intervention Rationale Evaluation
“Hindi ko alam -asking Knowledge After 8 hours of Determined Client’s
kung questions deficit related nursing client’s readiness will After 8 hours of
mabubuntis pa about her to the interventions, ability/readiness help the nursing
ako uli” as condition treatment and the patient will and barriers to barriers to interventions
verbalized by -anxious effect on future be able to learning. learning. the patient was
the patient. pregnancies increase able to
as evidenced knowledge Provided To prevent verbalized
by verbal about Ectopic information overload of understanding
reports of the pregnancy and relevant only to information of her condition.
patient. treatment. the situation.

Listened to
client’s So that client
perception of feels competent
need. Relate and respected.
information to
client’s personal
desires/needs
and
values/beliefs.

Begun with
information the Can arouse
client already interest/limit
knows and move sense of being
to what the client overwhelmed.
does not know,
progressing from
simple to
complex.

DAY 3: JULY 24, 2010

20
 B. DRUG STUDY

Drug Name Dosage Classification Mechanism Indication Contraindication Adverse Nursing

of Action Effects Responsibilities

Generic Name: 45mg IV Second- Bactericidal: Peri- with allergy to Headache, Advise patient
CEFUROXIME q 8 hours generation inhibits operative cephalosporins dizziness, receiving IV drug to
SODIUM x 4 doses Cephalospho synthesis of prophylaxis or penicillins lethargy, report any discomfort
(-) ANST rin bacterial abdominal in the injection site to
Brand Name: (After cell wall, pain, check if there is a
Zinacef Negative causing cell flatulence, problem on the site.
Skin death decreased
Test) WBC and Inform the patient that
hematocrit this drug is given to
inflammation treat infection.
at IV site
Follow the ten rights
of the medication and
administration.

Skin test of IV drug

before administration.

Advice patient to report

signs of
hypersensitivity such
as itchiness and
rashes.

21
 Drug Name Dosage Classification Mechanism Indication Contraindication Adverse Nursing
of Action Effects Responsibilities

Generic Name: 1g IV q 12 Third- Bactericidal: Peri-operative with allergy to Headache, Advise patient
CEFTRIAXONE hours generation inhibits prophylaxis cephalosporins dizziness, receiving IV drug
SODIUM (-) ANST Cephalosphorin synthesis of for patients or penicillins diarrhea, to report any
bacterial undergoing lethargy, discomfort in the
Brand Name: cell wall, potentially abdominal injection site to
Rocephin causing cell contaminated pain, check if there is a
death surgical flatulence, problem on the
procedures decreased site.
WBC and
hematocrit Do not mix
inflammation ceftriaxone with
at IV site any other
antimicrobial drug.

Skin test of IV
drug before
administration.

22
 Drug Name Dosage Classification Mechanism Indication Contraindication Adverse Nursing
of Action Effects Responsibilities

Generic Name: 50mg IV Analgesic Binds to mu- Relief of With allergy to Vertigo, Control
TRAMADOL q 6 hours opioid moderate tramadol or opioids headache, environment
HYDROCHLORIDE receptors and to or acute intoxication confusion, (temperature,
inhibits the moderately with alcohol, sweating, lighting) if
Brand Name: reuptake of severe pain opioids, or tachycardia, sweating or
Ultram norepinephrin psychoactive drugs bradycardia, CNS effects
e and pallor, occur.
serotonin; constipation
causes many Advise patient
effects similar to report severe
to the opioids nausea,
– dizziness, dizziness,
somnolence, severe
nausea, constipation.
constipation –
but does not Withdrawal
have the symptoms may
respiratory occur if drug is
depressant stopped
effects abruptly.
Reduce dosage
gradually.

Inform patient
the side effects
that he may fall
asleep/
lethargic

23
 Drug Name Dosage Classification Mechanism Indication Contraindication Adverse Nursing
of Action Effects Responsibilities

Generic 625mg Combination Combination of For post- Hypersensitivity Indigestion, Obtain patient’s history of
Name: cap BID with beta- amoxicillin, a β- surgical to penicillin, rash, allergy.
CO- per orem lactamase lactam infections, possible cross Stevens-
Johnson Inform patient that
AMOXICLAV inhibitor antibiotic; with prophylaxis sensitivity with
amoxicillin may cause
clavulanic acid, against other β-lactams syndrome,
side effects.
Brand Name: β lactamase infectious erythema
Amoclav inhibitors results associated Assess patient for
Augmentin in an antibiotic with major previous sensitivity
Augmex with an surgical reaction to penicillin or
increased procedures other cephalosporin to
spectrum of determine any allergic
action and reactions.
restored efficacy
against β Assess for allergic
reaction during treatment:
lactamase
rash, urticaria, pruritus,
producing chills and fever.
amoxicillin-
resistant Assess bowel pattern
bacteria and sign of dehydration.
If severe diarrhea occurs
drug should be
discontinued.

Advise patient to
discontinue drug if
hypersensitivity reaction
occurs.

24
 Drug Name Dosage Classification Mechanism of Indication Contraindication Adverse Nursing
Action Effects Responsibilities

Generic Name: 500mg Analgesic Anti-inflammatory, Relief of with allergy to Somnolenc Be aware that
IBUPROFEN cap BID NSAID analgesic, and mild to ibuprofen, e, fatigue, patient may be at
per orem Propionic acid antipyretic activities moderate salicylates, or tiredness, increased risk of
Brand Name: derivative largely related to pain other NSAIDs palpitations, GI bleeding.
Advil inhibition of arrhythmia,
Genprin prostaglandin pruritus, Advise patient to
Ibutab synthesis; exact rash, administer drug
Menadol mechanisms of sweating with food or after
Midol action are not meals if GI upset
Motrin known. Inhibits both occurs.
cyclooxygenase
(COX) 1 and 2. Advise patient to
Ibuprofen is slightly discontinue drug if
more selective for hypersensitivity
COX-1 reaction occurs.

Assess for allergic

reaction during
treatment: rash,
urticaria, pruritus,
chills and fever.

25
 Drug Name Dosage Classification Mechanism of Indication Contra- Adverse Nursing
Action indication Effects Responsibilities

Generic Name: 500mg 1 Iron Elevates the serum Prevention With allergy to Acidosis, Confirm that
FERROUS cap OD Preparation iron concentration, and any ingredient; anorexia patient does have
SULFATE per orem which then helps to treatment hemolytic iron deficiency
form Hgb or of iron- anemias anemia before
Brand Name: trapped in the deficiency treatment.
Feozol reticuloendothelial anemias With normal iron
Fer-gen-sol cells for storage balance Advise patient to
Fer-in-sol and eventual Dietary give drug with
conversion to a supplement meals (avoiding
usable form of iron for iron milk, eggs, coffee,
and tea) if GI
discomfort is
severe.

Inform patient that

stool may be dark
or green.

Advice patient to
arrange for
periodic monitoring
of Hct and Hgb
levels.

26
 Drug Dosage Classification Mechanism of Indication Contraindication Adverse Nursing
Name Action Effects Responsibilities

Generic Name: 25mg IM Antiemetic Blocks cholinergic Prevention with Dizziness, Give IM injections
Promethazine Antihistamine receptors in the and control hypersensitivity headache, deep into muscle.
Hydrochloride (Pre-Op Anti-motion- vomiting center that of nausea to vertigo, dry
Meds.) sickness drug are believed to and antihistamines mouth Do not administer
Brand Name: Dopaminergic mediate the nausea vomiting or subcutaneously;
Phenadoz blocker and vomiting associated phenothiazines tissue necrosis
Phenergan Phenothiazine caused by gastric with may occur.
Sedative- irritation, by input anesthesia
hypnotic from the vestibular and Do not administer
apparatus (motion surgery intra-arterially;
sickness, nausea arteriospasm and
associated with Preoperativ gangrene of the
vestibular neuritis), e, limb may result.
and by input from postoperati
the chemoreceptor ve, or
trigger zone (drug- obstetric
and radiation- sedation
induced emesis)

27
 Drug Name Dosage Classification Mechanism of Indication Contraindication Adverse Nursing
Action Effects Responsibilities

Generic Name: 10mg IM Opioid Acts as an agonist Pre- with Sweating, Keep opioid
Nalbuphine agonist- at specific opioid operative hypersensitivity headache, antagonist and
Hydrochloride (Pre-Op antagonist receptors in the analgesia, to nalbuphine confusion, facilities for
Meds.) analgesic CNS to produce as a vertigo, assisted or
Brand Name: analgesia and supplement floating controlled
Nubain sedation but also to surgical feeling, respiration
acts to cause anesthesia numbness available in case of
hallucinations and respiratory
is an antagonist at depression.
mu receptors

28
 Drug Name Dosage Classification Mechanism of Indication Contraindication Adverse Nursing
Action Effects Responsibilities

Generic Name: 40mg Antiflatulent Defoaming action Relief of With allergy to Nausea, Give after each
SIMETHICONE 2 tabs disperses and symptoms components of vomiting, meal and at
after prevents the and the product belching, bedtime.
Brand Name: meal now formation of mucus- pressure of passing of
Disflatyl per orem surrounded gas excess gas flatus, Advise patient that
Degas BID pockets in the GI in the constipation she may
Flatulex tract; changes the digestive experience
Mylanta Gas surface tension of tract; increases belching
Mylicon gas bubbles in the postoperati and passing of
Phazyme stomach and small ve gaseous flatus as gas
intestine, enabling distention disperses.
the bubbles to and pain
coalesce, allowing
gas to be more
easily freed by
belching or flatus

29
C.COURSE IN THE WARD

Date Time Vital Sign Observation

July 22, 2010 6:30am T – 37.2 oC

- with pain scale of 8 out of
P – 105 bpm
R – 22 cpm 10
BP– 90/60
-with facial grimace
mmHg
-irritable
-with weak and pale looking
- with guarding behavior
- with limited movement
- with foul breath
- conscious and coherent
- with IVF hooked on right
hand
- on NPO

7:30am T – 37.3 oC
P – 80 bpm
R – 20 cpm
BP– 110/70
mmHg

8:30am T – 36.5 oC
P – 89 bpm
R – 22 cpm
BP– 100/70
mmHg

9:30am T – 37 oC
P – 88 bpm
R – 23 cpm
BP– 110/60
mmHg

10:30am T – 36 oC
P – 85 bpm
R – 25 cpm
BP– 100/70
mmHg

30
 11:30am T – 37.2 oC
P – 91 bpm
R – 22 cpm
BP– 110/70
mmHg

12:30nn T – 37.2 oC
P – 91 bpm
R – 22 cpm
BP– 110/70
mmHg

1:30pm T – 36.8 oC
P – 87 bpm
R – 24 cpm
BP– 110/60
mmHg

DISCHARGE PLAN

Medications:
 Take ferrous sulfate 500mg 1 tablet each day for 6 months preferably before bed
time; Co-amoxiclav 500mg 2 times a day for seven days every 12 hours, 1 tablet
7AM and 1 tab in 7PM, do not take with empty stomach; Ibuprofen 500mg 1tab
for 3 days for pain only
Exercise and Environment:
 Do light exercises like stretching or walking slowly and carefully; seek assistance
for safety measure
 Encouraged the mother to keep an environment clean and conducive to health
for her rapid recovery and to avoid infection and keep environment quiet to make
the patient comfortable
Treatment:
 Explain to the client that becoming pregnant again may be difficult because
fertilization takes place only on the side of the remaining tube after ovulation of

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 the remaining tube of the ovary on the same side and at higher risk for a
subsequent ectopic pregnancy as well as infertility.
 Emphasized to the mother the importance of regular follow-up check-ups and as
instructed by physician

 Advised the mother to seek medical advice if any strange arises

 Encouraged the mother to let her be monitored by the health care provider until
complete recovery is met
Health Teachings:

 Emphasized to the mother the importance of proper hand washing and proper
hygiene

 Educate the client to recognize some signs and symptoms of pregnancy if

occurs, aside from the absence of menstrual period and morning sickness she
should visit her OB or nearest health center for proper assessment & check-ups.
 Advice the client to engage in safe sexual practices like proper hygiene before
intercourse to prevent from STDs and pelvic infections that could cause further
damage to the fallopian tubes.
 Refrain from sexual intercourse for at least 6 weeks until the follow-up
appointment with the physician.
Out Patient:
 Reminded the mother that even though she feels better, it is important to have
the doctor monitor her progress. The patient is scheduled for her follow up check
up one week after her discharge from the hospital in Out-Patient Department in
Laguna Provincial Hospital (LPH) to evaluate her recovery.
Diet:

 Encourage to eat nutritious food and drink natural fruit juices for fast recovery.
 Get plenty of rest. Increase fluid intake. Keep the incision clean.
Spirituality:
 Encouraged the mother to continue to seek God’s guidance and to continue to
have a positive outlook in life

 Emphasized the importance of prayers in healing

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  Encouraged the mother to pray for her fast recovery and gave words of
encouragement

EVALUATION

A pregnant woman with vaginal bleeding must be evaluated promptly. Once a

diagnostic of ectopic pregnancy is made and surgery is scheduled, start an IV as
ordered and begin preoperative teaching. Immediately report the signs of developing
shock. If the patient experiences severe abdominal pain administer analgesics and
evaluate the effectiveness and patient’s response.

Regardless of the treatment used, the prescribed therapy for the post operative
procedure such underwent Salphingectomy operation, the patient should be at complete
bed rest, abstinence from sex, religious intake of medication and emotional support from
the family.

However, though the group had rendered not enough time to handle the case
completely because of conflicting schedule, the nursing intervention we had during the
confinement for the patient like aseptic wound cleansing of the incision site, mild
assistance in ambulation and health teaching with regards to continuous prescribed
meds, proper hygiene, eat well and strengthens faith in God provided the client with
much ease and comfort that the client exhibits early recovery and may go home order.

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SUMMARY

Our patient Ms. JS, 33, a G2P1, plain housewife, was admitted on July 22, 2010
@ 8:00 in the morning with the chief complaint of abdominal pain. She obtained medical
consultation in Binan Hospital, Binan, Laguna and then was advised/referred to Laguna
Provincial Hospital, Sta. Cruz, Laguna for prompt surgery. Upon assessment Ms. JS
happened to have scanty vaginal bleeding, pale and weak. She presented an UTZ
result which came out to her to undergo Salphingectomy (excision of segment of the
Fallopian tube) that is involved in the ectopic pregnancy. Ms. JS has no family or past
history of present illness, no known history of illness, no known allergies and reportedly
without recognizing that she was 6th weeks pregnant. Her husband is a driver and they
were blessed with a 2-year old female child. Her husband known to be a responsible
and good provider but a chain smoker, they were not married.

At the course of the ward, necessary surgical procedure was done, consent letter
was signed, IVF hooked such as 1L D5LR; Voluven 500ml (side drips); 1L D5 NSS;
prescribed medication such as antibacterial (Co-amoxiclav, Cefuroxime, Ceftriaxone);
Analgesic (Tramadol & Ibuprofen); Pre-Op anesthesia (Promethazine & Nalbuphine);
For iron supplement (Ferrous sulfate); Anti-flatulence (Disflatyl); For laboratory study:
CBC, urinalysis and “For Exlap”. Post-Op: sponge bath, apply abdominal binder and
clear liquid tee and crackers for diet then diet as tolerated once bowel movement occur;
Ambulate; change of dressing or wound care.

Upon interviewing the client, other concerns we gather, she was not a stressful
housewife and only do light household chores. Though their budget is limited they still
manage to eat a balanced diet and able to provide their child’s needs.

The etiology of ectopic is unknown but then our case has revealed that an aging
woman is prone for this kind of condition and if not prompted damage of fallopian tube
will occur or life threatening blood loss is at risk.

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RECOMMENDATION

This case study has provided us with important information about the patient’s
ectopic pregnancy condition and its proper nursing care intervention prior to pre-and-
post surgical procedure. In order to ensure that optimal health is restored and
maintained, the group would like to recommend the following:

To the patient:
Whenever there is, the onset of a certain condition it implies one to contribute her
cooperation and willingness to be responsible for her own health, such as:
• The patient must be sensitive of her own needs and be able to expect liability for
her actions.
• She is also encouraged to verbalize her own thoughts and feelings concerning
how she perceives her condition affect her life and her expected duration of her
recovery.
• She is advised to take part in complying with therapeutic regimen designed for
her recovery.
• She should realize the importance of complying with her medication and the
benefits this practice would bring to the improvement of her well-being. Moreover,
she must not hesitate on seeking medical assistance whenever she feels signs
and symptoms, which may be due to other health illness.

To the patient’s family:

The patient’s family plays an important role in the patient’s recovery.
• The family should make themselves physically present so that the patient would
somehow feel their support and concern.
• They are encouraged to be the patient’s source of strength and inspiration as she
undergoes painful, traumatic and harrowing procedures. In addition, it is of prime
importance that they are oriented and educated basic facts regarding the
patient’s condition so that they will understand her even better and assist him in
his daily activities.

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To our fellow nursing students:

It is encourage as much as possible to have a complete nursing care in the span

of confinement of your client, it starts from the assessment, admission and up to the full
recovery of the client that includes the discharge or may go order and follow-up check-
ups so that every actual scenario can be studied and experienced of the given
appropriate nursing intervention done. Since the goal of giving nursing care is promote
wellness, prevent from or further illness and restore health, thorough handling for this
kind of case must be given prior attention, time and effort.

For Future Researcher:

It is recommend that you must have an actual case handle because every patient
has a case-to-case basis nevertheless this case may guide you to have comparison
although case-to-case basis but then depending on how and what kind of person is
giving care to a certain patient to have a fulfilled nursing care.

BIBLIOGRAPHY

Medical-Surgical Nursing, Brunner and Suddarth’s, 12th ed., Vol. 1, p. 299

Medical-Surgical Nursing, Brunner and Suddarth’s, 12th ed., Vol. 2, p. 1432

Fundamental of Nursing, Kozier and Erb’s, 8th ed., Vol. 2, p. 1455

Nursing Drug Guide, Lippincott’s, 2009, pp. 259, 257, 998, 832, 1170, 607, 508, 1074

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