IDENTIFICATION DATA

Name :- Kiran

Age/Sex :- 23/f

Father’s name :- Swaminath Pal

Ward &unit:- Gyno/4

Bed no :- 8

Registration number :- 2020148722

Mother’s occupation :- Housewife

Father’s occupation :- Farmer

Education :- B.A.Pass

Address :- Bassi.jaipur

Date of admission :- 5-02-2020

Income :- 5000-7000 /pm

Gravid :- Primi

Diagnosis :- Unmarried with ectopic pregnancy

(Right tubal)

SUBJECTIVE DATA
1.Admission history :- Patient had typhoid and for that she was taking
medicines from the village's Doctor. 15 days before she had very colicky
pain below the umbilicus.
That was a radiating pain from lower umbilicus to epigastric region. She
took medicine for that from the village only. There dr done an
ultrasound and on the basis of reports they told her to show in other
hospital. Then patient came to jnu hospital for treatment. From opd she
admitted to the ward gyno under unit 4.

2.Personal history :- She is unmarried 23 year old. Kiran is non-

vegetarian by habits. She never smoke or drink. She lives in a nuclear
family along with her father and mother. She speaks hindi language.
She is B.A passed. They live in their house in villege of rajasthan having ,
two rooms and no separate kitchen & bathroom. She had normal sleep
pattern of 7-8 hrs a day.

3. Medical history:- There is no H/O DIVVHTN/T.B/EPILEPSY etc. but

she had typhoid before 20 days and for that she was taking medicine
from her village's Doctor only.

4. SurgIcal history :- There is no H/O any surgical illness.

5 . Family history :- No H/O any chronic illness to any of the family

member Her Father is the only earning member of the family.

6 . Menstrual history:-
LMP: 26/01/17
 She had history of clots during mensus in February.

Menarche started at the age of 12yr.

Menstrual cycle is of 3-4 days/28-30 days.

7. Obstetrical history:
G1 :- Present Pregnacy

8. Chief conplaints :- She is having pain in abdomen with tubal

pregnancy.

PHYSICAL EXAMINATION
VITALS:

Temperature :- 98.6 F

Pulse :- 82/min regular

Respiration :- 22/min

Blood Pressure :- 110/78 mm of hg

 GENERAL APPEARANCE :- Thin built,generel rendition is fair, hydration
is adequate, looking tired, dyspnea on daily activities, conscious& oriented .

 Head, Hair 8 Scalp :- Hairs brownish in color , no dandruff, pedleulosis is

abent, scalp is clean.

 Eye :- Conjunctiva – no pallor, Sclera – no yellowish discoloration, Pupils-

reacting to the light,no evidence of eye infection.

 Nose :- No septal deviation/infection/no blockage in nose.

 Ear :- Hearing is normal,no otitis media,and infection/wax.

 Mouth :- No bleeding in gums,tongue-dry,no evidence of

glossitis/caries/stomatitis/tonsillitis.

 Neck :- No evidence of thyroid swelling and lymph node enlargement.

 Breast :- Soft,nipple is normal , secreting colostrums,no evidence of

short/long/inverted nipple.

 Chest :- Heart sound S1 & S2 is heard.Lung sound is normal & no evidence

of wheezing or crackles
  Liver & Spleen :- No evidence of hepatomegaly.

 Upper Extermities :- Normal movement of abduction,aduuction and

rotation.

 Abdomen :- Abdomen relaxed with dry dressing over sutures present.

 Gi system :- Normal intake of diest,bowel movement normal , sometimes

constipated.

 Bleeding per vagina :- Present within normal limits

 Urine output :- Within in normal limit.

 Lower extremities :- No varicose vein

NURSING MANAGEMENT
NURSING DIAGNOSIS :-
 1. Acute pain related to distension or rupture of tubal pregnancy.

2. Bleeding per vagina related to the disese condition.

3. Anxiety related to future condition of mother.

4. Disturbed sleeping pattern related to psychologicalenvironment factors.

5. Risk of fluid volume deficit related to blood loss

NURSING PROCESS :-
1.NURSING DIAGNOSIS :- Acute pain related to distension or rupture of tubal
pregnancy.

SUBJECTIVE DATA OBJECTIVE DATA

Patient is complanng of acute pain at Patient looks tensed and anxious
the right side of abdomen.

DESIRED GOAL / OUTCOME

The patient will relived from pain
 PLANNING IMPLEMENTATION RATIONALE

After 8hours of nursing Monitor vital signs. To determine presence

interventions,the of hypotension caused by
relieved or controlled rupture.
Monitor for presence of To assess the present
vaginal bleeding. situation.

Monitor for abdominal Incresed pain may cause

distension and rigidity. rupture.

Administer analgesics if To relieve the pain.

prescribd.

Advise to dodiversional Help in relieving pain.

activities.

EVALUATION OF GOAL
Patients looks and verbalization by the patient.

2.NURSING DIAGNOSIS :- Bleeding per vagina related to the disese condition.

SUBJECTIVE DATA OBJECTIVE DATA

Patient is complaining of bleeding per Bleeding was present as she was using
vagina 4-5 pad/day

DESIRED GOAL / OUTCOME

To prevent bleeding per vagina and to
promote fetal well being
 PLANNING IMPLEMENTATION RATIONALE

Assess the vitals. Vitals have been assessed To obtain the baseline
i.e.T-98.8 C ,R-18/m,P- data.
Assess for bleeding per 80/m.
vagina.
Administered one bag of To maintain normal hb
Monitor fetal heart rate. packed rbc of b+ Blood level.
group after cross
Enforce strict bed rest to checking.
minimize the risk to the
fetus. Check for any sign of all To prevent any allergic
allergic reaction. reaction.
Assist patient in daily
activities. Bleeding per vagina was To know risk for anemia
assessed

EVALUATION OF GOAL
Bleeding per vagina has been reduced to some ectent and fetus is well.

3.NURSING DIAGNOSIS :- Anxiety related to future condition of mother.

SUBJECTIVE DATA OBJECTIVE DATA

Patient is frequently ask about their Patients looks very restless.
condition and fetal well being.

DESIRED GOAL / OUTCOME

To reduce anxiety
 PLANNING IMPLEMENTATION RATIONALE

Assess level of anxiety. Anxiety level is assessed To obtain baseline data

for care.
Focus on pre-operative The patient is explained To provide necessary
teaching. about her condition. information.

Prepared the family also The patients family also To prepare for any
for surgery. explained about the possible risk.
mothers condition &
Listen to her concerns informed consent is
and offer clear taken.
explanations about
situation and The paient was given To decrese anxiety.
management approach psychological support &
explained management.
Encourage family
support. Family is encouraged to To promate well beaing
be with the patient and of the patient & decrease
given moral support. anxiety.

EVALUATION OF GOAL
Anxiety is reduced to a considerable extent.

4.NURSING DIAGNOSIS :- Disturbed sleeping pattern related to psychological

environment factors

SUBJECTIVE DATA OBJECTIVE DATA

Patient verbalizes that she did not fell a Patients looks drowsy and sleepy and
sleep well frequent yawning.
 DESIRED GOAL / OUTCOME
Patient will be able to sleep well

PLANNING IMPLEMENTATION RATIONALE

Verbalize understanding Determine the degree of To collect the baseline

of sleep disturbance. sleep disturbance as data.
patient feels.
Promote sleep
Advise mother to take To provide the rest to the
Promote rest. rest inday time also. mother.

Assist the client to Tell patient to read To induce sleep.

develop individual something or listen music
program of relaxation while going to bed.
like muscle relaxation
these to patient also. Provide the quite To induce sleep.
environment as much as
needed.

Avoid coffee and tea at To decrease the

the bed time stimulant during night.

Demonstrate patient the It will promote sleep.

relaxation exercises.

Help the client properly

deal with the situation.

EVALUATION OF GOAL
Anxiety is able to take rest now to some extent.
5.NURSING DIAGNOSIS :- Risk of fluid volume deficit related to blood loss

SUBJECTIVE DATA OBJECTIVE DATA

DESIRED GOAL / OUTCOME

Attain the adequate level of fluid in the
body.

PLANNING IMPLEMENTATION RATIONALE

Vital sign can be Assess the vital signs. To check the baseline
monitored. data.
Specially the blood
Intake and output chart pressure and pulse to be To maintain the
to be maintained. monitored. adequate fluid volume.

Capillary refill time and Check the capillary refill

skin turgor to be time.
checked.
Monitor intake and Monitor the fluid volume
Teaching regarding fluid output chart. in body .
can be given.
Advise mother to take
adequate rest.

Advise mother to take

more amount of water. To combact the loss of
fluid from the body

EVALUATION OF GOAL
Risk of fluid volume reduced to some extent
EXPLANATION ABOUT DIAGNOSIS
ECTOPIC PREGNANCY
DEFINITION :- An ectopic pregnancy is one in which the fertilized ovum is
implanted and develops outside the normal endometrial cavity.

TYPES :- Based on the site of implantation ectopic pregnancy can be classified as

SITE OF IMPLANTATION

EXTRAUTERINE UTERINE

TUBAL OVARIAN ABDOMINAL CERVICAL ANGULAR CORNUAL CESAREAN

AMPULLA ISTHMUS INFUNDIBULUM INTERSTITIAL PRIMARY SECOUNDARY

INTRAPERITONEAL EXTRAPERITONEAL

BROAD LIGAMENT
TUBAL PREGNANCY :
It is type of ectopic pregnancy in which fertilized ovum get implanted in the tubal
region of fallopian tube instead of ampulla isthemic junction.

RUPTURED TUBAL PREGANACY :

Tubal rupture is predominantaly in common in isthmic and interstitial
implantation as the isthmic portion is narrow and the wall is less distensible the
wall may be easily eroded by the chorionic villi.isthmic rupture usually occurs at 6-
8 weeks the ampullary one at 8-12 weeksand the interstitial about 4 months.

RISK FACTORS :
 History of tubal ligation
 History of pid
 contraception failure
 previous ectopic pregnancy
 Tubal reconstructive suregery
 History of infertility
 Art particularly if the tubes are patent but damaged
 Iud use Previous induced abortion
 Tubal endometriosis

PATHOPHYSIOLOGY
The most common site of ectopic implantation is a fallopian tube.followed by the
uterine cornua.pregnancies in the cervix, a cesarean delivery scar, an ovary,the
abdomen,or fallopian tube interstitial are rare.heterotopic pregnancy occurs in
only 1/10,000 to 30,000 pregnancies but may be more common among women
who have had ovulation induction or used assisted reproductive techniques such
as in vitro fertilization and gamete intrafallopian tube transfer ; in these women
the overall reported ectopic pregnancy rate is <1%.the structure containing the
fetus usually rupture after about 6 to 16 wk.rupture results in blood irritates the
peritoneum .the later rupture the more rapidly blood is lost and the higher the
risk of death.

ETIOLOGY :
a) Multiparity
b) Incresed maternal age
c) History of previous cesarean section or any other scar in the uterus
d) Placental size abd abnormality
e) Smoking
f) Prior curettage

CLINICAL FEATURES :
SYMPTOMS :

Sudden onset,painless,apparently causeless and recurrent vaginal bleeding.

SIGNS:

Abdominal Examination

 The size of the uterus is proportionate to the period of gestation.

 The uterus feels relaxed,soft and elastic without any localized area of
tenderness.
 Persistence of malpresentation like breech or tranverse or unstable lie is
more frequent . there is also increased frequency of twin pregnancy.
 The head is floating in contrast to the period of gestation.persistent
displacement of the fetal head is very suggestive.the head cannot be
pushed down into the pelvis.
 Bright red dark color bleeding occurs.
 During vaginal examination placenta feels in the lower
segment.
 Placentography shows the placenta in lower segment.

DIAGNOSIS :
1.USG

2. CLINICAL

 Sonography
 MRI

MANAGEMENT :-
 Adequate anteatal care to improve the health status of women and
correction of anemia.
 Antenatal diagnosis of low lying placenta at 20 weeks with routine
ultrasound needs repeat ultrasound examination at 34 weeks to confirm
the diagnosis.
 Significance of “warning hemorrhage “ should not be ignored.
 Color flow Doppler USG in placenta previa.

AT HOME :

1. The patients is immediately put to bed.

2. To assess the blood loss
3. Quick but gentle abdominal examination to mark the height of the uterus ,
to auscultate the fetal heart sound and to note any tenderness on the
uterus .
4. Vaginal examination must not be done.
5. Facilities for cesarean section should be available throughout 24 hours.