CASE PRESENTATION

ON
ECTOPIC PREGNANCY

SUBMITTED TO: SUBMITTED BY:

Prof. Mrs. Tapati Saha Itismita Biswal

Additional Dean Obstetrics & gynaecological Nursing

HOD, Community Health Nursing M.Sc. nursing 1st year Student

SUM Nursing College,BBSR SUM Nursing College,BBSR

SUBMITTED ON:
STUDENT NAME—Miss Itismita Biswal

HOSPITAL—IMS & SUM HOSPITAL , BBSR.

YEAR OF STUDY—2019

IDENTIFICATION DATA

NAME OF THE PATIENT—Mrs. Ramamani Das

NAME OF THE HUSBAND—Mr. Ghanashyam Das

AGE— 28years

SEX— Female

MARITAL STATUS— married

HOPITAL REGISTRATION NO— 190219025

ICU/BED NO— SICU / Bed No- 5

ADRESS— At- Charichaka, Po- Brahmakundi, Ps- Nimapada, Dist- Puri

RELIGION— Hindu

EDUCATION— Higher Secondary

ADMISSION DATE— 19/02/19

DIAGNOSIS – Ectopic pregnancy (ruptured)

NAME OF THE DOCTOR—Dr.Sasmita Das

OCCUPATION — House Wife

MONTHLY FAMILY INCOME—Rs- 25,000

WEIGHT— 68 kg

HIGHT—152 cm

CHIEF COMPLAINTS WITH DURATION —

 Abdominal pain since 4.00 am on 19.2.19

 Vomiting

HISTORY OF PAST ILLNESS—

There is no past medical history of TB, HTN, DM

she has not undergone any surgical procedure.

FAMILY HISTORY—

She belongs to a nuclear family having 4 numbers . Her husband is the only supporting
person in her family. The monthly income of her family is nearly about Rs 25,000. There is
no history of any disease like TB,HTN, DM &hereditary disease , twin pregnancy in her
family.

HEALTH FACILITY NEAR HOME—

There is a CHC near to her village at a distance of about 7-8km.Transportation facility

available like bicycle & motorcycle.

HOUSING—

She lives in a pucca house having 3 numbers of rooms with adequate ventilation. They use
sanitary latrine for toileting. Electricity supply is available. They use municipality water for
drinking.

PERSONAL HISTORY—

 PERSONAL HYGIENE—She is maintaining her oral hygiene by brushing daily and

taking bath once daily with soap & normal water.
 DIET—She takes both vegetarian & non-vegetarian diet & She takes meals 3-4 times
a day. She don’t have any addiction of consumption of alcohol & tobacco. She drinks
about 3-4 lts of water per day. She takes rest of about 8 hrs during night time. She
takes no drugs for sleep.
 ELIMINATION—She has a regular bowel & bladder habits
 MOBILITY & EXERCISE— She has regular walking habits of ½ km in morning and she
was doing moderate activity like normal house hold work.

MENSTRUAL HISTORY—

She got menarche at 14 year of age with regular cycles of 28-30 days interval & 3-4 days
duration with average amount of bleeding. Her LMP is 15/12/18 and EDD is 22/09/19.

SEXUAL & MARITAL HISTORY—

She is married since 1 year & She has satisfactory relationship with her spouse. General
health of her spouse is good.

OBSTETRICAL HISTORY—

 PAST OBSTETRIC HISTORY—

Nothing significant as she is Primigravida.
  PRESENT OBSTETRIC HISTORY-
She is now having ectopic pregnancy with period of gestation 8wk 4 day, She is a
registered case and one antenatal visit has done.

INVESTIGATIONS—

 Hb = 9.2 gm%
 Urine for HCG = Positive
 Blood group— ‘B’ positive
 Sickling – Negative
 Urine test=Albumin- Not Present
=Sugar---Not Present
 VDRL = Negative
 HIV = Negative
 HbsAg = Negative
 HCV = Negative
 USG= done on 19/2/19 showing rupture ectopic pregnancy in right fallopian tube.

OBSERVATION & ASSESSMENT—

 Her general appearance is good

 Patient is conscious & anxious
 She has no foul body odour & foul breath

PHYSICAL XAMINATION—

VITAL SIGN—

i. Temp –98.40 F
ii. BP—110/70 mmhg
iii. Pulse – 84 beat/min.
iv. Respiration – 22 breath/min.

HEAD TO TOE EXAMINATION—

 Her skin colour is normal

 Hair & scalp are clean &healthy. No dandruff & pediculosis is present
 In eye ,no Jaundice& Pallor is seen
 Mouth is clean
 Tongue is hydrated
 Gum is healthy
 Total no of teeth is 32
 Nose, ear, throat are clear
 In neck, no abnormal enlargement of lymphnode & glands.
  In breast, no secondary areola are formed & nipple are normal like non pregnant.
 Liver & spleen are normal, No enlargement found.
 Leg ,spine & back are normal

OBSTETRICAL EXAMINATION ( Post Operative Examination )—

INSPECTION—

 No undue enlargement of the Uterus.

 Skin condition—healthy & no discolouration.
 Linea nigra as well as striae gravidarum are absent.

PALPATION—

 Uterus is not palpable as there is Laparatomy surgery was done.

P/V EXAMINATION—

Vulva – Normal, No Oedema

Perineal area & Anus – Clean

DEPENDENCY LEVEL OF PATIENT –

Patient is partially dependent while doing her daily activities.

CLINICAL EXAMINTION & NOTES

DIAGNOSIS— Ectopic pregnancy (rupture) in right fallopian tube

INTRODUCTION — If the pregnancy is not occur in normal part of uterus mainly occurs in
fallopian tube that can cause more complications which leads to increase maternal
morbidity rate.

DEFINITION — An ectopic pregnancy is one in which the fertilized ovum is implanted &
develops outside of the normal endometrial cavity.

CLASSIFICATION-

According to sites of implantation it is of 2 types i.e.

1. Extrauterine
2. Uterine

1. Extrauterine is further classified into 3 types i.e.

a. Tubal (97%)
b. Ovarian (0.5%)
c. Abdominal (1%)
a. Tubal is classified into 4 types i.e.

i. Ampulla (55%)
ii. Isthmus (25%)
iii. Infundibulum (18%)
iv. Interstitial (2%)

c. Abdominal is classified into 2types i.e.

i. Primary

ii. Secondary

Secondary is classified into 2types i.e.

 Intra-peritoneal(common)
 Extra- peritoneal

2. Uterine is classified into 4types i.e.

 Cervical(<1%)
 Angular
 Cornual
 Caesarean scar(<1%)

INCIDENCE –

Ectopic pregnancy occurs in 1 in 300 to 1 in 150 deliveries.

ETIOLOGY—

IN BOOK IN CLIENT
In majority, causes are not known. Idiopathic
Possible causes are - ( Causes are not known)
 Salpingitis & pelvic inflammatory disease(PID)
 Contraception failure such as IUD, Sterilization operation,
Use of progestin only pill etc.
 Tubal surgery
 Intrapelvic adhesion following pelvic surgery
 ART such as IVF-ET, GIFT
 Others such as
- Previous ectopic pregnancy
- Developmental defect
SIGNS & SYMPTOMS—

1. Acute

IN BOOK IN CLIENT
Persistent unilateral uneasiness Absent
Abdominal pain Present
Appearance of vaginal bleeding Absent
Vomiting & fainting attack Present
Pallor skin & becomes cold & clammy Absent
Lower abdomen becomes tense& tender, no Absent
mass is felt
Extreme tenderness on fornix Absent
2. Unruptured

IN BOOK IN CLIENT
Continuous uneasiness on one side of the Not occurs because it is a rupture case
flank /colicky pain
Presence of delayed period

3. Sub-acute
IN BOOK IN CLIENT
Amenorrhoea Amenorrhoea
Lower abdominal pain Not occur
Vaginal bleeding is more dark & continuous

DIAGNOSIS –

IN BOOK IN CLIENT
Blood examinations such as Haemoglobin, Grouping & Rh typing, Total Done
WBC count, Differential count, ESR etc.
Culdocentesis Not done
Urinary hCG test Done
Ultra sonography Done
Laparoscopy Not done
COMPLICATION

IN BOOK IN CLIENT
Rupture Present
Internal bleeding Present
Maternal death Absent
MANAGEMENT
In Acute cases:
IN BOOK
Hospitalization
Ringer’s solution is started
Blood transfusion done
Laparotomy with Salpingectomy, Oophorectomy, sub-total
hysterectomy
In Sub-acute or chronic cases:
IN BOOK
Hospitalization
Laparotomy
In Unruptured cases:
IN BOOK
Drugs such as Methotrexate, Prostaglandin are given for
salpingocentesis
Linear Salpingostomy
DAY – Post Operative Day 1 (19/02/2019)
GENERAL CONDITION OF
MOTHER--
 Patient conscious
 Pallor (- ve)
 Pulse= 80bpm
 BP= 100/70mmhg
 Chest/CVS== NAD
 P/A==Soft
 P/V = No active
bleeding
IN CLIENT
Hospitalization was
done
RL infusion started
Blood transfusion
done
Laparotomy with Rt.
Salpingectomy
IN CLIENT
Management done
according to acute
type
IN CLIENT
It is an acute case
ADVICE NURSING INTERVENTION
 Bed making done
Medications given:  Soft diet given
• Inj. Monobact  Mouth care given
1.5gm IV BD  Vital sign checked
• Inj. Pan 40 IV OD  I/O chart maintain
• Inj. Dynapar Aq(75)  Bleeding P/V checked
with 100ml NS IV BD  Medication given in
• Inj. Tramadol 1amp duetime
in 100ml NS IV SOS
• Inj. Ondem 4mg IV
SOS
DAY—Post Operative Day 2 (20/02/19)

GENERAL CONDITION OF ADVICE NURSING INTERVENTION

MOTHER--

Patient conscious Tab.Taxim-0 Bed making done

Pallor (- ve) BD×5days Normal diet given
Pulse= 82bpm Tab. Zerodol P Mouth care given
BP= 110/80mmhg BD×5days Vital sign checked
Chest/CVS== NAD Tab. Pan 40 I/O chart maintain
P/A= soft OD×5days Bleeding P/V checked
P/V = No active Medication given in time
bleeding

DAY –Post Operative Day 3 (21/02/19)

GENERAL CONDITION OF ADVICE NURSING INTERVENTION

MOTHER--

Patient conscious Bed making done

Pallor (-ve) Normal diet given
Pulse= 82bpm Tab.Taxim-0 Mouth care given
BP= 110/70mmhg BD×4days Vital sign checked
Chest/CVS== NAD Tab. Zerodol P I/O chart maintain
P/A= soft BD×4days Bleeding P/V checked
P/V = No bleeding Tab. Pan 40×4days Medication given in
found time

DAY –Post Operative Day 4 (22/02/19)

GENERAL CONDITION OF ADVICE NURSING INTERVENTION

THE MOTHER
 BP- 110/80mmhg  Tab. Taxim-0 BD×3d  Bed making is done
 Pulse-82 b /min  Tab.Zerodol P BD×3d  Normal diet given
 Chest- NAD  Tab. Pan 40 OD×3d  Vitals are checked
 P/A=soft  I/O chart maintained
 Bowel sound= +ve  Drainage tube was
removed
 Medication given in
time
DAY—Post Operative Day 5 (23/02/19)

GENERAL CONDITION OF ADVICE NURSING INTERVENTION

MOTHER
 BP- 110/70 mm  Tab. Taxim-0 1 tab  Bed making done.
hg BD×2d  Vital sign checked.
 Pulse- 82bpm  Tab. Zerodol P 1tab  Normal diet given
 Respiration- BD×2d  All medication given in due
23bpm  Tab.Pan 40 1tab time.
 CVS=NAD OD×2d
 P/A- soft
 Bowel sound -+ve

CARE PLAN OF ECTOPIC PREGNANCY(POST-OPERATIVE)

Assessment Nursing Expected Intervention Evaluation

diagnosis outcome
Subjective data Pain related to To reduce patient’s level of Patient will
Mrs.Ramamani surgical the level of pain, severity, have reduce
says that i am procedure as pain. duration of pain pain after 1
having pain on evidenced by was assesed. days
surgical area. visualization of Comfortable
Objective data facial position given.
Facial expression. Vital sign checked.
expression Calm and quiet
i.e. tiredness environment
Provided.
 Visitors restricted.
Analgesic
administered as
per doctors order

Subjective data Risk of infection To reduce the Incision site The risk of
She said I am related to the risk of getting assesed. getting
not able to take surgical incision infection. Daily care of infection was
care of the as evidenced by the incision reduced a
incision site. observation of site. little.
Objective data the site. Antibiotic
Swelling of the medication is
site given to
Local reduce the risk
tenderness of infection.

SUMMARY—

Mrs Ramamani is a primigravidahaving ruptured Ectopic pregnancy, is admitted in hospital

due to rupture of the ectopic pregnancy at 8wk 4day & Salpingectomy surgery was done&
daily nursing care was given as per the need. The care giver established a good IPR with the
client & her trust & confidence was gained. The client revealed all her problems, thus the
care giver was able to provide care to meet the need up to an optimum level. During this
period she gains knowledge on different aspects like care of herself, regarding possible
complications,regular follow up, which makes her more confident & her anxiety was
reduced & due to this she is now able to cope to any stressful situation . She was also
educated on nutrition, personal hygiene& regular follow up.

CONCLUSION—

Effect of my care—

After providing nursing care, the client has improved her self confidence .She feels relaxed
& no anxiety is there. The client & family members are very co-operative & they have trust
on me.

BIBLIOGRAPHY—

1. DUTTA DC, “ Text book of obstretics “, Jaypee brothers medical publisher ,new delhi
,(2016).pgno-177-90.
2. Jacob annamma, A text book of midwifery ang gynaecological nursing, Jaypee
brothers medical publishers, new delhi, 3rd edition (2012), Page no- 262-64.