case study ectopic preg

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¾ Because of the high maternal mortalityassociated with undiagnosed ectopicpregnancy until after rupture or tubal

ligation, it is very important for nurses to bealert to sign and symptoms of thiscomplication of pregnancy.

¾ Therefore any woman during her child

bearing years of experience irregular vaginalspotting associated with dull, aching pelvicpain, with or without signs of pregnancy,should be evaluated for a possible ectopicpregnancy.



� If an ectopic pregnancy is suspected, adetailed history should include question

regarding the type of abdominal pain.The pain caused by an unrupturedectopic pregnancy can be unilateral,cramp like pain related to tubal

distention by the enlarge embryo or fetusat the time of tubal rupture many patientexperience a sudden, sharp, stabbingpain in lower abdomen.



� Assess for vaginal bleeding, and obtainmenstrual history. Vaginal bleeding is usually

related to the sloughing of the endometriallining related to decreasing progesteroneand estrogen levels and can presents ascontinuous or intermittent vaginal bleeding

in small or large quantities. It is usuallydifferent from the patient·s normal period.Pad counts should be kept determine theamount and type of vaginal bleeding



� Assess for the presence of any signs ofsyncope.

� When an ectopic pregnancy ruptures or aborts, blood is lost into the peritoneal cavity.

� At this time the patient can experience afeeling of faintness or weakness related tohypovolemia. If the bleeding is not continuous,

the depleted blood volume is restored to near normal 1 or 2 days by hem dilution and thefaint or weak feeling subsides. If bleeding isprofuse, the patient can go into should quickly.



� To assess the amount of intraperitoneal

blood loss, the patient·s vital signs should

be checked as frequently as thesituation indicates.



DRUGS ACTION INDICATION ADVERSE

REACTION

NURSING

RESPONSIBILITIES

Generic

Name:PropofolBrand Name:Diprofol

Propofol is a short

acting anesthetic

given IV for the

induction and

maintenance of

general

anesthesia. It is

also used for

sedation in adult

patients

undergoing

surgery in

conjunction with

local or general

anesthesia.

Propofol has no

analgesic activity

and

supplementary

Induction and

maintenance of

General

Anesthesia

Hypotension,

Bradycardia,prematureatrialcontractions,

convulsions,hallucination,

nausea,vomiting, skin

flushing, rash.

*Propofol should be

administered with caution to

patients with hypovolemia.

*record baseline vital signs.

*Monitor clients

postoperative state of

sensorium. Report if client

remains non responsive orconfused for a time.




REACTION

NURSING

RESPONSIBILITIES

Generic Name:Atracurium Besylate

Brand Name:

Tracrium

Atracuriumbesylate is a

highly selective,

competitive or

nondepolarizing

neuromuscular

blocking agent.

Adjunct to generalanesthesia to

enable tracheal

intubation to be

performed ad to

relax skeletal

muscles duringsurgery or

controlled

ventilation.

Hypotension, skinflushing,

anaphylactic

reactions,

seizures.

*Check

preoperative

and post

operative

urine output.

*Evaluateclient·s

response to

the

anesthetic.

*Continue to

monitor client

for adverse

reactions.

*Maintain a

patent airway

together with

Generic Name:

Succinylcholine

ChlorideBrand Name:

Anectine

ANECTINE

(succinylcholine

chloride) is anultra short-acting

depolarizing-type,

skeletal muscle

relaxant for

intravenous (IV)

administration.

Succinylcholine

chloride is

indicated as anadjunct to general

anesthesia, to

facilitate tracheal

intubation, and to

provide skeletal

muscle relaxationdurin sur er or

respiratory

depression to the

point of apnea;this effect may be

prolonged.

Hypersensitivity

reactions,

including

anaphylaxis, mayoccur in rare




REACTION

NURSING

RESPONSIBILITIES

GenericName:Thiopental

SodiumBrand Name:Pentothal

Pentothal(Thiopental

Sodium for Injection, USP) is an

ultrashort-acting

depressant of the

central nervous

system which

induces hypnosisand anesthesia,

but not analgesia.It produces

hypnosis within 30to 40 seconds of

intravenousinjection. Recovery

after a small doseis rapid, with some

somnolence and

retrograde

amnesia.

Repeated

intravenous doses

lead to prolonged

anesthesiabecause fatty

Pentothal (Thiopental

Sodium for Injection,

USP) is indicated (1) as

the sole anesthetic agent

for brief (15 minute)

procedures, (2) for

induction of anesthesia

prior to administration of

other anesthetic agents,

(3) to supplement

regional anesthesia, (4)

to provide hypnosis

during balanced

anesthesia with other

agents for analgesia or

muscle relaxation, (5) for

the control of convulsive

states during or following

inhalation anesthesia,

local anesthesia, or

other causes, (6) in

neurosurgical patients

with increased

intracranial pressure, if

adequate ventilation is

provided, and (7) for

narcoanal sis and

respiratorydepression,

myocardial

depression,

cardiac

arrhythmias,

prolongedsomnolence and

recovery,

sneezing,

coughing,

bronchospasm,

laryngospasm andshivering.

Anaphylactic and

anaphylactoid

reactions to

Pentothal



ASSESSMEN

T

DIAGNOSIS PLANNING INTERVENTIO

N

RATIONALE EVALUATIO

N

-Description

of pain andit·s location

-Monitor v/sand LOC

-Natureand

amount ofvaginal

bleeding

-

Anticipator y, grieving

R/T the lossof

pregnancyand effects

on futurepregnancie

s.

- After

nursinginterventio

n, will beable to

acceptthe loss of

pregnancy.

-Identify

cultural/religious beliefs

that mayimpact sense

of loss.-Ascertain

response offamily/ SO to

client·ssituation.

-Noteemotional

responsessuch as

withdrawal,angrybehaviour,

crying.-

-For the

health careprovider to

identifyhow to talk

about thesituation.

-to assessappropriate

ness offamily tothesituation.

-to identifyhow long

will it taketo acceptthe

situation by

-begins to

accept lossof

pregnancyand

expressesgrief by

verbalizingfeelings

andreactions toloss.



ASSESSMEN

T

DIAGNOSIS PLANNING INTERVENTIO

N

RATIONALE EVALUATIO

N

-Fluid loss

(e.g.,fever,diarrhea/vomiting,excessive

sweating,surgical

drains)-Limitedintake- Fluid shifts

(e.g.,ascites,

effusions,burns,

sepsis)-

Environmental factors

-

hemorrage

- Risk for

deficientfluidvolume

-

Demonstratebehavioursor lifestyle

changesto prevent

development of fluidvolumedeficit.

-Monitor I/O

-Weightcilent andcomparewith recent

weight hx.Perfrom serial

weights.- noteclient·sLOC/mentati

on.- Encourage

oral intake:-Provide

water andother fluid

needs to aminimum

amount daily

-Limit fluids

-To ensure

accuratepicture offluid status.- to

determinetrends.

- toevaluateability toexpress

needs.

-

Demonstratedbehaviorsto prevent

developmenmt of fluid

volumedeficit.



� SALPINGECTOMY

¾ Salpingectomy has traditionally been done

via a laparotomy; more recently however,laparoscopic salpingectomies havebecome more common as part of minimallyinvasive surgery. The tube is severed at the

point where it enters the uterus and along itsmesenteric edge with hemostatic control.



� This is the most common treatment of

ectopic pregnancy. The salpingectomy

is performed by cross-clamping thebroad ligament and removing the whole

tube. This form of surgical management

is most appropriate in the ruptured

ectopic pregnancy where there isconsiderable bleeding.



� This procedure involves excision of

segment of the Fallopian tube involved

in the ectopic pregnancy. The tubalsegment to be removed is coagulated

(see diagram 16) and cut off with bipolar

forceps (see diagram 17 and 19). The

mesovarium is also coagulated and cutoff in the same manner (see diagram

18).



� Unilateral salpingo-oophorectomy is the

surgical removal of a fallopian tube and

an ovary. If both sets of fallopian tubesand ovaries are removed, the procedure

is called a bilateral salpingo-

oophorectomy.



� In a salpingo-oophorectomy, a woman'sreproductive organs are accessed

through an incision in the lower abdomen, or laparoscopically (A). Oncethe area is visualized, a diseasedfallopian tube can be severed from theuterus and removed (B and C). Theovary can also be removed with thetube (D). The remaining structures arestitched (E), and the wound is closed.



� If performed through an abdominal incision,salpingo-oophorectomy is major surgerythat requires three to six weeks for full

recovery. However, if performedlaparoscopically, the recovery time can bemuch shorter. There may be somediscomfort around the incision for the firstfew days after surgery, but most women are

walking around by the third day. Within amonth or so, patients can gradually resumenormal activities such as driving, exercising,and working.



� Immediately following the operation, the

patient should avoid sharply flexing the

thighs or the knees. Persistent back painor bloody or scanty urine indicates that a

ureter may have been injured during

surgery.

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