Cebu Institute of Technology

University
N. Bacalso Ave., Cebu City Philippines

COLLEGE OF NURSING AND ALLIED HEALTH SCIENCES

A HYPOTHETICAL CASE STUDY ON

ECTOPIC PREGNANY

IN PARTIAL FULFILLMENT OF THE COURSE NCM 234

SUBMITTED BY:

JOULE QUIJANO
BSN 2

SUBMITTED TO

MRS.JEANETTE PARIS-LIM RM,RN,MAN

FACULTY

MAY 2020

Page 1 of 37
 I. INTRODUCTION

Ectopic pregnancy is the implantation of fertilized egg that is placed

outside on the uterine cavity. The implantation sites of the fertilized egg are on
the fallopian tube, ovary, cervix or peritoneal cavity and abdomen. The
assessment findings of having ectopic pregnancy are abdominal pain, bleeding,
abnormal menstrual period and nausea and vomiting. This happens especially
when the pregnant woman have implanted Intrauterine Device. Another is that
there is previous infection on the uterine, also having scars on tubal surgery.
Laboratory Findings for this is they have high WBC, Low HCG and low
hemoglobin and hematocrit.

The statistical order for this disorder is that cases of ectopic pregnancy in cebu on
region 7, one of the causes of maternal mortality rate is the Postpartum hemorrhage.
Other disorders are Eclampsia Postpartum, Uterine Atony, Hypertension in Pregnancy,
Placental Retention, Abortion, Pre-Eclampsia, Placental Abruption and Placenta Previa.
But ectopic pregnancy was ranked on the 5 th place out of 10 disorders. Out of 1000
livebirths, there are 20 pregnant woman who would have ectopic pregnancy in Cebu
area. In the philippines, 1-2% of population of pregnant woman have cases of ectopic
pregnancy. While in international, there are 4% of cases from pregnant woman in the
whole world.

The significance of this study as a nursing student is that this case of ectopic pregnancy
is very important. Considering that maternal mortality rate still exists that it affects the
lives of the mother and baby, not only just that but it affects the whole family of the
mother. As this signifies that as a student nurse, I should educate well the mothers
especially to those mothers who were just have their labor for less than 1 year, that it is
the best way to avoid sexual intercourse with her partner. This happens mostly to those
women who have IUD and if they had intercourse, it would result of having ectopic
pregnancy. And to those mother who had their surgery of removing fallopian tube, I
should give the the emotional support that they need. And also to educate mothers
about the risks of having ectopic pregnancy and how does it gives an impact to their
lives, and how to avoid this having case.

Page 2 of 37
II. GENERAL DATA

A. BIOGRAPHIC DATA

Initials of Client/Patient : Q.R.T.

Residence: Pardo Cebu City

Contact Number : 09334567890 Nationality:Filipino_____

Religion : Roman Catholic Birth of Date:
February 13, 1989 _____
Age: 31 Sex:Female Civil Status: Married
Educational Attainment: College
____
Occupation: English Teacher
__________
Source of Income:
____Work from his husband and the income from her work
_____________________________________________________

Name of Hospital: Chong Hua Hospital _____________Ward &

Room No.:__514__
Date of Admission: 05/7/2020 Attending Physician: Dr. Kim Lluch
Impression / Admitting Diagnosis: G43 AOG on 37 weeks, ectopic
pregnancy _____
_____________________
Source of Information:
( / ) Patient
( ) Others, (Initials of SO):

Relationship to patient :

B. ADMITTING COMPLAINT/S

One or two major symptoms:

__Pain on her lower abdomen, spotting on the vagina, nausea and
vomitting_______________________________________________________
___
Duration of Symptoms:
1-3 days ___________3 days___________________________________

C. HISTORY OF PRESENT ILLNESS

Symptom: Hypogastric Pain

Location: Lower Abdomen Quadrant

Character: Sharp Pain _____

Page 3 of 37
 Intensity: Pain has been on and off throughout the day
_____
Aggravating factors: Pressure on the bladder, when doing household
chores, when sitting on a chair for longer period of time

Alleviating factors: Lying on bed on a prawn position

Treatments tried: Pain reliever ointment

D. OBSTETRIC AND GYNECOLOGIC HISTORY

On her first pregnancy, she was pregnant when she was 28 years old. It was
her first baby boy. It was on full term. The second baby was born on pre term, it was
baby girl. Then on her third baby, it was a baby boy and was born on full term. But
during on her third pregnancy, the doctor suggested that if the patient likes to attach
IUD. So the patient agree to put IUD on her uterus. All of her children were born on
Normal Spontaneous Vaginal Delivery. On her 4 th pregnancy, since it was ectopic
pregnancy, it is counted as abortion and ectopic pregnancy only last for 4 weeks.

G-4 T-2 P-3 A-1 L-3 M-0

E. FAMILY HISTORY OF ILLNESS

( X ) Diabetes ( x ) Hepatitis ( x ) Thyroid

Disease
( / ) Hypertension ( x) Vision Disorder ( x ) Arthritis
( x ) Heart Disease ( x) Seizure Disorder ( x ) Mental Illness
( / ) Stroke ( x) Cancer (x) STD
( x )Asthma (x) Blood Disorder ( x ) Tuberculosis
( x) Kidney Disease ( ) Others:___________________

GENOGRAM

x
X x
X

Patient
Q.R.T.

Page 4 of 37
- -Hypertentsion

-Stroke

F. NURSING HEALTH HISTORY UTILIZING GORDON’S FUNCTIONAL

HEALTH PATTERN

1. HEALTH PERCEPTION HEALTH MANAGEMENT PATTERN

PRIOR TO ADMISSION: Patient Q.R.T. stated that she defines health as one of
the important human need that our health should be our first priority of all. That is is
free from any sufferings or complications of all. She also stated that being a healthy
shows no signs of infections and sickness at all.

DURING HOSPITALIZATION: After she was hospitalized, her perspective about

her health didn’t change and she realized that she must be cautious enough about her
health since she had mention about her regrets on her decisions.

2. NUTRITIONAL-METABOLIC PATTERN

PRIOR TO ADMISSION: Patient Q.R.T. loves to eat healthy foods such as

vegetables. Usually she cooks vegetables food for her family. She also likes to eat fish
too. But there are times that she cooks meat. She also drinks softdrink if there are only
occasions or gatherings. Pt can consume her food during meal time or snack time.

DURING HOSPITALIZATION: During her admission, pt was advised to avoid

eating foods and to empty her bladder. Since she was admitted due to hypogastric pain
on her lower abdomen, she only eat small meals only.

1. ELIMINATION PATTERN

PRIOR TO ADMISSION: Patient Q. R. T. eliminates her bowel everyday usually at

the morning. She urinates for 3-5 times a day. The color of her stool is dark brown, and
it is soft in consistency. The color of her urine is yellow.l

DURING HOSPITALIZATION: During the admission, the patient was advice to to

void since she need to go through pelvic ultrasound examination. She urinates before
she goes through the ultrasound examination.

2. ACTIVITY-EXERCISE PATTERN

PRIOR TO ADMISSION: Pt does physical exercise, like zumba was her favorite
exercise. Then she goes on walking around her neighborhood. She likes to do
jogging.She used to to household chores like cleaning their house and washing their
clothes.

DURING HOSPITALIZATION: Patient always stays on her bed, keeps on a lying

position on bed and resting. But she can walks like going to comfort room but she
complains that she has abdominal pain but she just keep enduring the pain.

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 Criteria Rate Criteria Rate Perceived ability for:
Feeding IV Grooming IV
Bathing IV General mobility IV
Toileting IV Cooking IV 3. SL
Home maintenance IV Shopping IV EE
Dressing IV Bed mobility IV P-
Gait IV Posture III
ROM IV Hand grip IV
REST PATTERN

PRIOR TO ADMISSION: The pt mentioned that she don’t have any problems
when it comes to her sleeping schedule. She sleeps early at 10 pm in the evening. Then
her sleeping hours was 8-9 hours.

DURING HOSPITALIZATION: Pt stated that she encounter problems during her

sleeping time because she experienced of hypogastric pain on her lower abdomen. She
cannot sleep in comfortable position because the pain on her abdomen keeps coming.
Her sleeping pattern is not in a continuation.

4. COGNITIVE-PERCEPTUAL PATTERN

PRIOR TO ADMISSION: She was able to finish college and had a job as a
teacher. She finished bachelor of science in education major in English. She works very
well, she can able to do all the tasks. She can do well on her job as a teacher, that she
likes her job very much that she likes to teach her students. She was very responsive.

DURING HOSPITALIZATION: The pt was well oriented during the interview. She
does give good answers during the interview. She knows what is the date and time.
She was good in making decision in life. Despite that she experienced lower abdominal
pain, she was making ways to on how to remove and ease the pain like applying pain
ointment.

5. SELF-PERCEPTION—SELF-CONCEPT PATTERN

PRIOR TO ADMISSION: The patient verbalized that she was very happy when
she find out that she was pregnant on her first baby. She felt blessed and grateful. She
want to have a happy family. She wants to achieve her goals in life. She want to live a
worry-free life. She don’t have any complains on her life. She just want to have simple
family and to live a humble life.

DURING HOSPITALIZATION: The patient didn’t change her perspective on her

life. She was very cooperative during the interview. She can move freely during her bed
rest. She was very responsive. But she felt sad when she find out that for the whole
time, it was just a false pregnancy. She was disappointed that it was a serious disorder
that she was facing in her life.

6. ROLES-RELATIONSHIPS PATTERN

PRIOR TO ADMISSION: The whole family of the pt was very supportive to her in

Page 6 of 37
all ways and would show care and love to her. Her husband was very helpful to the
patient and her mother and father was very caring to her daughter. The family of the
pt was very considerate if they encounter such real life problems.

DURING HOSPITALIZATION: The pt shows good relationship towards to her

husband and to her mother and father. They were very supportive when the pt having
difficulty moment in her life regarding on the disorder. Since pt was very frustrated and
worried, her family were always there being present to them.

7. SEXUALITY-REPRODUCTIVE PATTERN

PRIOR TO ADMISSION: Pt verbalized that both of her partner feel satisfied on

their sex life. She has regular menstruation. They have tried other contraceptions such
as condom, withdrawal and control birth pills.

DURING HOSPITALIZATION: Pt verbalized that she decided to make an

agreement to his husband to avoid intercourse because it has affected on her
reproductive system. She verbalized that she was afraid to do intercourse.

8. COPING-STRESS TOLERANCE PATTERN

PRIOR TO ADMISSION: Pt verbalized that she deals her stress is through,

sharing her thoughts or doubts to her husband and to her parents, then she manage
her stress through exercise,socializing with her friends and watching TV shows. She
beat stress though playing games on her cellphone and watch entertaining videos.

DURING HOSPITALIZATION: Pt verbalized that she felt stressed and confused.

She said that she felt anxious about everything that happened to her. She said that the
disorder that she deals on her life has affected her whole life. She tried to be positive
for her family.

9. VALUES-BELIEFS PATTERN

PRIOR TO ADMISSION: The pt verbalized that she was a roman catholic. She
said that she goes to church especially on every Sundays. She thanked the Lord when
she found out that she’s pregnant on her first baby. She also thanked the lord for
having a happy family. She used to pray the rosary with her family, sometimes only by
herself.

DURING HOSPITALIZATION: Despite that she was admitted in the hospital, she
keeps on praying before she sleeps. Her faith and belief did not change at all. But
despite of her circumstances that she faced, she keeps on praying to God that she
wished that she would have complete full fast recovery and wishing for longer life for
her family.

Page 7 of 37
III. PHYSICAL ASSESSMENT AND REVIEW OF SYSTEMS

PHYSICAL ASSESSMENT FINDINGS REVIEW OF SYSTEMS

Pt’s skin have smooth
SKIN texture and dosen’t have
any presence of lesions or
wounds. She has normal
body temperature
Pt’s hare is smooth and
HAIR shiny. No signs of any
dandruff, no itchiness on
the scalp and no lesions or
wounds on the hair.
Pt’s head is in good shape,
HEAD there were no changes or
abnormalities. Round and
symmetrical.
Pt’s face don’t have any
FACE lesions or masses. It has a
rough texture.

The size of the auricles are

EARS symmetrical, no presence
of tenderness and it is
aligned. It is very firm
The eyes of the pt is well
EYES round. Both of the pupils
constrict and dilate
properly through the
respond of the light
accommodation. Pupils
moved of the same time.
Pt don’t have any problems
on her eyes
Pt’s nose don’t have any
NOSE presence of ant lesions or
masses. No problem when
it comes to smelling
objects
The pt’s lips don’t have any
MOUTH presence of any mass
tenderness. She have
complete teeth, they are in
stable condition.

The neck of the pt have no

NECK presence of tenderness

Page 8 of 37
PHYSICAL ASSESSMENT FINDINGS REVIEW OF SYSTEMS
and it is symmetrical, equal
in size. No presence of
masses on the neck.
The breast of the pt are on
CHEST (ANTERIOR / good shape. It has dark
POSTERIOR) areola on both breast. It
was palpated to check if
there is masses from outer
to inner starting from the
breast to the armpit. No
presence of masses. The
chest of the pt are in
symmetrical. No asthma or
no breathing problems, can
breath properly. Clear
sound on breathing, RR is
at 17.
No presence of masses or Due to the pain on the
ABDOMEN wounds. It is on a smooth inflammation on her fallopian
texture. But with presence tube. Anterior uterine
of pain on a scale of 7/10. support might be pulled.
No presence of fundal
height since it did not
reach for 3 months.
There are no presence of
UPPER EXTREMITIES tremors or masses or
lumps. They are in good
texture. No other color.
Just pale and warm skin.
They have same
coordinated movements.
No presence of swelling on
the arms and upper body
portion. No tenderness at
all.
Checked on both legs and
LOWER EXTREMITIES feet, no presence of
tremors or lumps. They are
in good texture. Pale skin
and warm temperature.
Same coordinated
movements. No swelling
on both legs. No
tenderness at all.
The vagina of the pt has Due to the sign of nearing of
GENITALS presence of spotting on rupture, and uterine
her labia majora area. It bleeding.
was red spots. Has
presence of bleeding.
The pt’s anus or rectums
ANUS /RECTUM has no presnece of dark
spots or bleedings. No

Page 9 of 37
PHYSICAL ASSESSMENT FINDINGS REVIEW OF SYSTEMS
masses or lesions.

IV. ANATOMY AND PHYSIOLOGY

Uterus may be of several anatomical types. For example, some mammals like deer,
moose, cats etc. have bipartite uterus, pigs and dogs have bicorn ate uteri, and single

Page 10 of 37
uterus with a single cavity is found in humans, horses and apes. The uterus lies in the
pelvis behind the urinary bladder and in front of the rectum. The uterus is a pear
shaped muscular organ. It has four segments – the fundus (top of the uterus), corpus
(body), cervix (mouth) and the internal os (opening). The uterus has numerous nerves,
and networks of arteries and veins as well as ligaments such as the round ligaments,
cardinal ligaments, broad ligaments, and uterosacral ligaments of uterus. The uterine
tubes (or fallopian tubes, oviducts, salpinx) are muscular ‘J-shaped’ tubes, found in the
female reproductive tract. They lie in the upper border of the broad ligament, extending
laterally from the uterus, opening into the abdominal cavity, near the ovaries.

The fallopian tube has many active roles in the process of reproduction, which include
ovum pick-up, transportation of both sets of gametes to the site of fertilisation within
well-defined time limits, providing an environment in which final gamete maturation and
fertilisation take place, and maintenance of the gametes and the pre-embryo, which is
delivered to the uterine cavity at a time when conditions are optimal for nidation. The
ampulla is where the site of fertilization and the ovaries are two almond-sized gland on
either side of the uterus and behind the fallopian tube. The ovaries has its functions
where it happens the oogenesis where it develops a mature ovum which is an egg.
Then it happens of the ovulation which is a monthly release of mature ovum, then it
also secretes and produce female hormones which is the estrogen and progesterone.
Ovaries are the ones who regulates menstrual cycles of a women.

V. PATHOPHYSIOLOGY

Coitus

Entry of spermatozoon in the cervix then to the fallopian tube

Union of ovum and spermatozoon at distal 3rd of fallopian tube

Predisposing Factors: Precipitating Factors:

Beyond conceivable age Tubal damage caused by:
Congenital anomalies in the fallopian tube Chronic salphingitits
Pelvic Inflammatory Disease
Use of IUD more than 2 years
Previous pelvic/tubal surgery
Previous ectopic pregnancy
Maternal cigarette smoking

Legend: Obstruction/damage in the tube

Signs and Symptoms Page 11 of 37
Diagnostic evaluation
Management Narrowing of the fallopian tube
Complications
 Prevents egg from reaching the uterus

Blastocyst implants outside the endometrium of the uterus (6-12 wks)

Abdomen Fallopian tube: Ovary and Cervix

Ampullary portion of the tube
Isthmic segment of the tube
Laparatomy Fimbrae
Cornual and interstitial portion of the tube
Hysterectomy
Oophorectomy

Salpingectomy
Fimbraectomy
Cornuectomy
Amenorrhea Implantation within the fallopian tube Co

Page 12 of 37
 Limited decidual
Muchreaction
higher BP in tubal arteries than uterine
Decreased
arteriesmuscle
Decreased
lining of resistance
the tube to the invading

Serum pregnancy test shows HCG

Growing zygote ruptures the slender tube/trophoblast cells break through with n
Tearing and destruction of
Placental dislodgement

Progesterone secretion stops Tube rupture

Cauldocentesis
Ultrasound

Uterine decidua sloughs off

Bleeding/vaginal spotting
Sharp stabbing pain at L/R lower abdomen

Pain radiating to shoulder Conception products expelle

Blood accumulation in the peritoneum
Rigid abdomen
Cullen’s sign

Hct
Hgb Hemorrhage
Tachycardia
Tachypnea
Hypotension Shock
Lightheadedness
Narrowed pulse pressure

Modified trendelenburg
Fluid resuscitation
O2 supplementation
Blood transfusion as indicated

Page 13 of 37
-Fertilization occurs at the usual distal third of the fallopian tube.

-After the union, zygote begins to divide and grow.

-However, due to an obstruction by several factors (see Risk

Factors), the zygote cannot travel through the length of the tube.

-It lodges on that constricted part and implantation takes place at

that area instead of the uterus.

Page 14 of 37
 VI. LABORATORY/ DIAGNOSTIC RESULTS

LABORATORY DATE NORMAL VALUES RESULT SIGNIFICANCE NURSING

EXAM TAKEN RESPONSIBILITIES
1. hCG Test: 05/07/20 6 and 24 mIU/mL, Negative To measure the amount of 1. Idenitify the patient
25mIU/mL above the hormone hCG in blood 2. Introduce yoiuself to the
or urine to see if a woman patient
is pregnant. 3Check Doctor’s order
4. Explain the procedue to the
2. Hemoglobin: 120-150 127 Used to screen for, patient
diagnose, or monitor a 5.Assess General Health Status
number of conditions and 6.Instruct patient to avoid
diseases that affect red drink lots of fluids to help have
blood cells (RBCs) and/or a clear laboratory results
the amount of hemoglobin 7.Instuct pt to avoid eating
in blood. foods to help not alternate the
result
3. Hematocrit: 37-47 38 Measures how much of 8.Give an assurance to the
your blood is made up of patient
red blood cells. Red blood 9. Explain to the patient on
cells contain a protein the procedure of the
called hemoglobin that examination.
carries oxygen from your
lungs to the rest of your
body

4. Urinalysis: 4.5 - 7.2 6.0 Slightly yellow To detect and manage a

wide range of disorders,
such as urinary tract
infections, kidney disease

Page 15 of 37
 LABORATORY DATE NORMAL VALUES RESULT SIGNIFICANCE NURSING
EXAM TAKEN RESPONSIBILITIES
and diabetes. A urinalysis
involves checking the
appearance, concentration
and content of urine.

5. Rh Test Less than 14 IU/ml 10 IU/ml Rh factor screening test

during your the prenatal
visit. This will identify
whether your blood cells
carry the Rh factor
protein. If your blood has
the protein, you're Rh
positive. If your blood
lacks the protein, you're
Rh negative.

Page 16 of 37
LABORATORY DATE NORMAL VALUES RESULT SIGNIFICANCE NURSING
EXAM TAKEN RESPONSIBILITIES

Page 17 of 37
DIAGNOSTIC EXAM DATE RESULT / IMPRESSION SIGNIFICANCE NURSING RESPONSIBILITIES
TAKEN

1. Pelvic Ultrasound 05/07/20 The gestational sac is not present and The significance of this 1.Idenitify the patient
fetal pole are present on fallopian tube, diagnostic test is to see clearer 2. Introduce yoiuself to the patient
thickened edge of a yolk sac view on the fallopian tube to fin 3. Check Doctor’s order
representing an early developing the zygote that have attached 4. Explain the procedue to the
embryo. Possible to detect heart beat on the wall of the fallopian tube. patient
on the fallopian tube. 5.Assess General Health Status
6.Instruct patient to drink lots of
fluids to help have a clear image of
ultrasound
7.Instuct pt to avoid eating solid
foods
8.Give an assurance to the patient
9. Explain to the patient on the
procedure of the examination.

Page 18 of 37
DIAGNOSTIC EXAM DATE RESULT / IMPRESSION SIGNIFICANCE NURSING RESPONSIBILITIES
TAKEN

2. Magnetic 05/08/20 A GS-like structure with a "three rings" 1. It is used as a problem- 1.Idenitify the patient
Resonance Imaging appearance on T2-weighted images, solving tool in special 2.Introduce yoiuself to the patient
presence of solid components in the circumstances, include absence 3. Check Doctor’s order
sac, dilatation of the affected fallopian of ionizing Idenitify the patient 4. Explain the procedue to the
tube with hematosalpinx, and tubal wall 2. Introduce yoiuself to the patient
enhancement. patient 5.Assess General Health Status
3. Check Doctor’s order 6.Instruct patient to drink lots of
4. Explain the procedue to the fluids to help have a clear image of
patient ultrasound
5.Assess General Health Status 7.Instuct pt to avoid eating solid
6.Instruct patient to drink lots of foods
fluids to help have a clear image 8.Give an assurance to the patient
of ultrasound 9. Explain to the patient on the
7.Instuct pt to avoid eating solid procedue of the examination.
foods
8.Give an assurance to the
patient
9. Explain to the patient on the
procedue of the examination.

radiation, superb soft tissue

contrast, and sensitivity
sufficient for identifying
hemorrhage and its stages.

Page 19 of 37
DIAGNOSTIC EXAM DATE RESULT / IMPRESSION SIGNIFICANCE NURSING RESPONSIBILITIES
TAKEN

3.

Page 20 of 37
VII. MEDICAL MANAGEMENT

MEDICAL IDEAL (BOOK) ACTUAL (DONE OR NOT

DONE)
MEDICATIONS 1. Methotrexate Not Done

2. Mifepristone Not Done

LABORATORY 1. Urinalysis 1. Not Done

2. Hematology 2. Not Done

3. hCG test 3. Not Done

4. CBC Test 4. Not Done

DIAGNOSTICS 1. Pelvic Ultrasound 1. Not Done

2. Magnetic Resonance 2. Not Done

Imaging

DIET !. Avoid folic acid 1. Not Done

2 Unsatuated Foods 2. Not Done

3. Low Salt Diet

3Not Done

TREATMENTS: 1. Follow up 1. Not Done

gynecologist after 2
days if there is fever or
chest pain or trouble
breathing.

2. To report if there are 2. Not Done

any complications or
symptoms such as
bleeding or fever,
follow up checkup

Page 21 of 37
 schedule

VIII. SURGICAL MANAGEMENT

SURGICAL (INVASIVE IDEAL (BOOK) ACTUAL

OR NON-INVASIVE) (DONE OR NOT
DONE)
1. Laparoscopy This will be performed Not done
to ligate the bleeding
blood vessels and
repair or remove the
damaged fallopian
tube.

2. Salpingectomy This intervention would Not Done

be performed if the
fallopian tube is
completely damaged.
The affected tube
would be removed and
what would be left
would be sutured
appropriately

Page 22 of 37
IX. OUTLINE OF NURSING MANAGEMENT

GOAL PROBLEM NURSING INTERVENTIONS

Surgical Site
-Assess skin and mucous membranes
HEALTH PROMOTION on the
for signs of petechiae, bruising,
bleeding site
hematoma formation, or oozing of
on4 repair
blood.
the damaged
-Educate the at-risk patient about
fallopian tube
precautionary measures to prevent
tissue trauma or disruption of the
normal clotting mechanisms.
-Avoid heavy activities
-Educate the patient and family
members about signs of bleeding that
need to be reported to a health care
provider.
Risk for -Examine skin for breaks or
DISEASE Infection on irritation,signs of infection
PREVENTION the surgical -Wash hands and teach patient and SO
site to wash hands before contact with
patients and between procedures with
the patient
-Encourage intake of protein-rich and
calorie-rich foods.
-If infection occurs, teach the patient to
take antibiotics as prescribed. Instruct
patient to take the full course of
antibiotics even if symptoms improve
or disappear.
Medications -Take the prescribed meds from the
CURATIVE as prescribed doctor such as Methotrexate or
by the doctor. antibiotics on proper time
-Do not continue taking meds if side
effects occure
-Explain to the pt on the importance of
taking the specific medications and
how does it affects on the health
-Instruct pt to eat healthy foods such
as vegetables and other green foods
that are rich on Iron.

Home -Instruct the pt to do home activities

REHABILITATION Activities and like watching tv or read books to help
Exercises relieve stress
-Instruct pt to avoid heavy home
activities
-Instruct pt to do light exercises only

Page 23 of 37
such as walking or swimming
-Instruct pt to do light yoga for 30
minutes to help keep the mind calm

Page 24 of 37
 X. DRUG SUMMARY/ DRUG STUDY

NAME OF DRUG: DOSAGE/ CLASSIFICATION MECHANISM OF INDICATIONS/ SIDE EFFECTS NURSING

GENERIC NAME/ FREQUENCY/ ACTION CONTRAINDICATIONS ADVERSE EFFECTS RESPONSIBILITIES
BRAND NAME ROUTE/ (Before, During, After)
HOW SUPPLIED
Generic Name: PO: 30mg/Day Anti-Rheumatic Interferes with Indication: Side Effects: Before:
Methotrexate for 5 days Once a folic acid -Treatment of CNS: Headache, 1. Identify the patient
day per orem metabolism. mycosis fungoides. Dizziness, 2. Introduce yourself to
Brand Name: Result is -Treatment of severe Drowsiness the patient
Rheumatrex inhibition of psoriasis and EENT: Blued 3. Check Doctor’s Order
DNA synthesis rheumatoid arthritis, Vision, Dysathria 4. Assess General
and cell unresponsive to transient Health Status
reproduction. conventional blindess 5. Explain the
Death of therapy. Resp: Interstitial procedure
replicating cells, -Throphoblastic Pneumonitis,
particularly Neoplasma Pulmonary During:
malignant ones, Fibrosis 1. Monitor for
and Contraindication: GI: Anorexia, abdominal pain
immunosuppreio -Hypesensitivity Hepatotoxicity, 2. Assess nutritional
n. -Pregnancy or Nausea, status
lactation Vomiting, 3. Monitor for
-products containing GU: Infetility symptoms of gout
benzyl alcohol shoul Derm: Alopecia, 4. Monitor for
not be used in Photosensitivity, pulmonary toxicity,
neonates pruritus manifest dry, non-
Hemat: productive cough
Leukopenia,
thombocytopenia After:
MS: 1. Educate the pt the
Osteonecrosis, importance of the drug
stress fracture 2. Educate pt about the

Page 25 of 37
Misc: possible side effects
Nephopathy, 3. Instuct pt to report
chills, fever, soft any kind of
tissue necrosis complications.

Adverse Effects:
Pulmonary
Fibosis, Aplastic
Anemia

Page 26 of 37
NAME OF DRUG: DOSAGE/ CLASSIFICATION MECHANISM OF INDICATIONS/ SIDE EFFECTS NURSING
GENERIC NAME/ FREQUENCY/ ACTION CONTRAINDICATIONS ADVERSE EFFECTS RESPONSIBILITIES
BRAND NAME ROUTE/ (Before, During, After)
HOW SUPPLIED
Generic Name: PO: 600mg/Day Anti- Antagonizes Indication: Side Effects: Before:
Mifepristone single dose per progestational endometrial and -Medical termination CNS: Dizziness, 1. Identify the patient
orem agent myometrial of intrauterine Drowsiness 2. Introduce yourself to
Brand Name: effects of pregnancy through GI: Nausea, the patient
Mifeprex progesterone 49-day pregnancy Vomiting, 3. Check Doctor’s Order
Diarrhea 4. Assess General
Contraindication: GU: Ruptured Health Status
-Presence of ectopic 5. Explain the
intrauterine device. pregnancy, pelvic procedure
-Bleeding disorders pain
or concurrent During:
anticoagulant Adverse Effects: 1. Determine duration
therapy Abdominal Pain, of pregnancy
-inherited porphyrias Uterine Bleeding, 2. Assess amount of
-Confirmed or Uterine cramping bleeding and cramping
suspected ectopic during treatment
pregnancy 3. Monitor Laboratory
Results

After:
1. Educate the pt the
importance of the drug
2. Educate pt about the
possible side effects
3. Instuct pt that
vaginal bleeding still
occurs

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NAME OF DRUG: DOSAGE/ CLASSIFICATION MECHANISM OF INDICATIONS/ SIDE EFFECTS NURSING
GENERIC NAME/ FREQUENCY/ ACTION CONTRAINDICATIONS ADVERSE EFFECTS RESPONSIBILITIES
BRAND NAME ROUTE/ (Before, During, After)
HOW SUPPLIED
Generic Name: PO: 650 mg 3-4 Anti-pyretics Inhibits the Indication: Side Effects: Before:
Acetaminophen times a day per synthesis of -Mild Pain GU: Renal failure 1. Identify the patient
Brand Name: orem prostaglandins -Fever (high 2. Introduce yourself to
Pain Reliever that may serve doses/Chronic the patient
as mediators of Contraindication: use) 3. Check Doctor’s Order
pain and fever, -Previous Derm: Rash, 4. Assess General
primarily in the hypesensitivity Urticaria Health Status
CNS. Adverse Effects: 5. Explain the
Hepatic Failure, procedure
Hepatotoxicity
During:
1. Assess if there is any
presence of pain
5. Assess if there is any
presence of fever
6. Instruct patient to
take medications on
time

After:
1. Educate the pt the
importance of the drug
2. Educate pt about the
possible side effects
3. Instuct pt to report
any kind of
complications.

Page 28 of 37
Page 29 of 37
 XI. NURSING CARE PLAN

ASSESSMENT NURSING DIAGNOSIS PLANNING/ INTERVENTIONS AND RATIONALE EVALUATION

GOAL OF CARE RATIONALE
Subjective: Powerlessness related to early loss of -The patient will Independent: 1. Client has not yet The Patient was
“Mahadlok naman pregnancy secondary to ectopic express sense of identified the drug use able to
ko maburos ug pregnancy. control. 1. Assist client to recognize is problematic. While recognize tje
balik, wala nako problem exists. Discuss in a client is hurting, it is means to
kasabot sa akong caring, nonjudgemental easier to admit control over
sitwasyon karon” as manner how drug has substance use has personal
vebalized by the interfered with life created negative situation, and
patient consequencs. makes choices
2. Provide information 2.Understanding these free from
Objective: regarding understanding of concepts can help the undue stress
-Hopelessnes human behavior and client to begin to deal from others.
-Pale interactions with others. with past
-Expression of problems/losses and
having no control or prevent repeating
influence over ineffective coping
situation OUTCOME behaviors
-Nonparticipation in SCIENTIFIC BASIS IDENTIFICATION / 3. Evaluate the patient’s 3. Powerlessness is the
care or decision- EXPECTED decision-making competence. feeling that one has lost
making OUTCOME the implicit power to
Perception that one’s own action will -Vebalize control their own
Temp: 36.2 not significantly affect an outcome; a acceptance of need interests.
RR: 22 perceived lack of control over a for treatment and 4. Know 4. To recognize the
PR: 88 current situation or immediate awareness that situations/interactions that patient’s right to refuse
BP: 110/90 happening. willpower alone may add to the patient’s to certain procedures.
cannot control sense of powerlessness. Some routines are done
abstinence on patients without
their consent fostering
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ASSESSMENT NURSING DIAGNOSIS PLANNING/ INTERVENTIONS AND RATIONALE EVALUATION
GOAL OF CARE RATIONALE
Source from: 5. Encourage verbalization of a sense of
https://nurseslabs.com/powerlessness feelings, thoughts, and powerlessness.
/ concerns about making
decisions. 5.This approach creates
Reference from Book: a supportive
Doenges Moohouse Murr Nursing Care Collaborative: environment and sends
Plans Edition 7 Guidelines for 1. Refer to assist with making a message of caring.
individualization Client Care Across the contact with programs for
Life Span ongoing treatment needs 1. Continuing treatment
is essential to positive
Dependent: outcome
1. Instruct the family to have
proper good communication. 1. To have proper
understanding between
2. Educate the SO and the the client and to her
family about proper home family
care after discharge
2. In order to help the
patient to have fast
recovery from the
surgery and will know
what to do.

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 ASSESSMENT NURSING DIAGNOSIS PLANNING/ INTERVENTIONS AND RATIONALE EVALUATION
GOAL OF CARE RATIONALE
Subjective: “Naay Fluid volume deficit related to -Patient verbalizes Independent: The patient
spots na red dapit rupture of the blood vessels of awareness of causative 1 To determine extent and become
sa akong ubos unya the fallopian tube secondary to factors and behaviors 1. Assess the amount of amount of bleeding responsive and
nag bleeding pud” ectopic pregnancy As evidenced essential to correct fluid
bleeding, use the rule of thumb less anxious,
as vebalized by the by vaginal spotting deficit. (more than 1 sanitary pad in an 2. To detect for and in a calm
patient hour is considered excessive. impending hypovolemic state, and
shock reported that
Objective: 2. Monitor vital signs esp. the she feels no
-Vaginal Spotting Bp, RR and PR 3. To facilitate venous pain and no
-Bleeding return and to prevent presence of
-Restlessness excessive abdominal bleeding
-Autonomic 3. Position client in a viscera shift and
Responses Trendelenburg position restriction of the
diaphragm that occurs
Temp: 36.2 4. During treatment, monitor with the head-down
RR: 22 closely for signs of circulatory position
PR: 88 overload (headache, flushed
BP: 110/90 OUTCOME skin, tachycardia, venous 4. Close monitoring for
SCIENTIFIC BASIS IDENTIFICATION / distention, elevated central responses during therapy
EXPECTED OUTCOME venous pressure [CVP], reduces complications
Ruptures the slender fallopian -Patient explains shortness of breath, increased associated with fluid
tube or trophoblast cells break measures that can be BP, tachypnea, cough) during replacement.
through the narrow base. taken to treat or treatment.
Presence of hemorrhage. Dry prevent fluid volume 5. Signs of dehydration
mucous membranes loss. Patient describes 5. Assess skin turgor and oral are also detected through
symptoms that indicate mucous membranes for signs the skin. Skin of elderly
Source of website from: the need to consult of dehydration. patients losses elasticity,
https://nurseslabs.com/deficient with health care hence skin turgor should
-fluid-volume/ be assessed over the

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ASSESSMENT NURSING DIAGNOSIS PLANNING/ INTERVENTIONS AND RATIONALE EVALUATION
GOAL OF CARE RATIONALE
Reference from Book: provider sternum or on the inner
Doenges Moohouse Murr Collaborative: thighs. Longitudinal
Nursing Care Plans Edition 7 1. Monitor CBC, blood typing, furrows may be noted
Guidelines for individualization cross matching and hcg level along the tongue.
Client Care Across the Life Span results.

2. Prepare client for possible 1. CBC will determine the

surgery amount of hemoglobin
    Laparoscopy- and rbc levels. Blood
    Laparotomy- typing is necessary for
blood transfusion and hcg
3. Administration of level is done if pregnancy
Methotrexate has not been confirmed
yet.

2. Laparoscopy- three
small puncture wounds;
remove tubal pregnancy,
Laparotomy- surgical
incision made approx 4in
long; tubal pregnancy
removed

3. Methotraxate is a
chemotherapeutic drug, a
folic acid antagonist that
attacks and destroys fast-
growing cells.

Page 33 of 37
 ASSESSMENT NURSING PLANNING/ INTERVENTIONS AND RATIONALE EVALUATION
DIAGNOSIS GOAL OF CARE RATIONALE
Subjective: “Feel Anxiety and fear may -Appear relaxed and Independent: 1. Feelings are real, and it is The patient
naman nako kay mao be related to threat of report anxiety is reduced helpful to bring them out in become
naman ning katapusan death and possible loss to a manaeable level 1. Acknowledge fears/anxieties. the open so they can be responsive and
sa akong kinabuhi” as of ability to conceive. Validate observations with client, discussed and dealt with less anxious,
vebalized by the example “You seem to be afraid” and in a calm
patient 2. Provides clues about such state, verbalized
2. Observe speech content, factors as the level of that she had
Objective: vocabulary, and communication anxiety, ability to learn on how to
-Anxious patterns comprehend what is cope up with
-Pale currently happening, stress and
-Restlessness cognition difficulties, and anxiety.
-Appears to be tensed possible language
and nervous differences.

Temp: 36.2
RR: 22 3. Note narrowed focus of 3. Narrowed focus usually
PR: 88 attention reflects extreme fear/panic
BP: 110/90 OUTCOME
SCIENTIFIC BASIS IDENTIFICATION / 4. Encourage client to develop 4. Has been shown to raise
EXPECTED OUTCOME regular exercise/activity program endorphin levels to enhance
Unconscious conflict -Vebalized awareness sense of well-being and help
about essential goals of feelings of anxiety 5. Acknowledge reality of situation reduced level of anxiety
and values of life, and healthy ways to as the client sees it,without
unmet needs deal with them. challenging the belief 5. Client may need to deny
situational/maturational - reality until ready to deal
crises, intepersonal with it. It is not helpful to
transmission and force the clients to face facts
contagion, stress threat
of death (perceived or

Page 34 of 37
ASSESSMENT NURSING PLANNING/ INTERVENTIONS AND RATIONALE EVALUATION
DIAGNOSIS GOAL OF CARE RATIONALE
actual)
Collaborative: 1. Provides opportunities for
1. Refer to specific support group sharing experiences, provide
mutual support and practical
Doenges Moorhouse problem solving, can aid in
Murr, Nursing Care decreasing alienation and
Plans Edition 7 helplessness.
Dependent:
1. Instruct the family about the 1. To help the patient
importance on having proper become less stress and have
communication calm mind.

Page 35 of 37
XII. DISCHARGE PLAN

METHODS INSTRUCTIONS
-Adviced pt to take medication on proper time as prescibed by
MEDICATIONS the doctor.
-Adviced pt not to take other medications that are not
necessary, unless to seek physician.
-Educated pt on the importance of taking the specific
medications and how does it affects on the health
-Educated pt on the possible side effects of taking the
medications

-Instructed Pt to avoid strenuous activities for fast recovery on

EXERCISE the surgical site
-Instructed pt to avoid heavy chores
-Adviced pt to have little exercise like walking or swimming.

-Instructed SO and patient to follow up gynecologist after 2

TREATMENT days if there is fever or chest pain or trouble breathing.
- Instructed pt to follow up check up for ultrasound
-Instructed pt to report if there are any complications or
symptoms such as bleeding or fever
-Adviced pt to have proper hygiene
HEALTH -Family support is encouraged to the pt and given psychological
TEACHING support
-Educated pt to have home rest for 3-5 days.
-Educated pt to avoid unhealthy foods
-Instructed pt to discontinue medications if side effects occur
-Instructed pt to follow check up
OUT-PATIENT -Instructed pt to consult doctor if there are any problems

-Instruct pt to avoid junkfoods and soda

DIET -Instruct pt to eat green vegetables foods
-Fluid restriction is not adviced
-Adviced pt to avoid unsaturated fats foods

-Instruct pt to avoid intercourse for 1 year

SEXUALITY / -Instruct pt to seek medical advice from physician for family
SPIRITUAL planning methods
-Instruct pt to express her feelings and emotions to her parents
and to her family.

Page 36 of 37
XIII. REFERENCES

Rajkumari Amrit Kaur, College of Nursing, Lajpatnagar, India. Care Plan on Ectopic
Pregnancy. Retrieved from https://www.slideshare.net/MnSavita/ectopic-pregnancy-
76251866
Marianne Belleza, R.N. Retrieve From https://nurseslabs.com/ectopic-pregnancy/
E. A.Davis Davis’s Drug Guide For Nurses Ninth Edition, Retrieved from
www.drugguide.com
Retrieved From https://radiologykey.com/ultrasound-evaluation-of-ectopic-pregnancy/
Retrieved Fom:
https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?
hwid=uh2804
Krissi Danielsson, Retrieved from: https://www.verywellfamily.com/how-do-doctors-
diagnose-ectopic-or-tubal-pregnancy-2371355
Retrieved from: https://www.mayoclinic.org/diseases-conditions/ectopic-
pregnancy/diagnosis-treatment/drc-20372093
Retrieved from: https://www.nhs.uk/conditions/ectopic-pregnancy/treatment/

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