Ectopic Pregnancy - Nursing Case Study

by - June 15, 2020

DESCRIPTION:
Ectopic or tubal pregnancy happens when implantation occurs outside the uterine cavity which is usually at the ampullar section of the fallopian tube. The zygote cannot travel the length of the tube because of an obstructions like adhesion of the fallopian tube from a previous infection, congenital malformations, scars from tubal surgery, or a uterine tumor pressing on the proximal end of the tube. This condition is known as the second most frequent cause pf bleeding in early pregnancy and the number of this incidence increases because of the increasing rate of pelvic inflammatory disease that usually leads to tubal scarring. If a women experienced an ectopic pregnancy before, the statistical risk for another ectopic pregnancy is greater than usual because inflammation in fallopian tube leaves scarring and is bilateral. Although for some unknown reasons, when a women is taking oral contraceptives before her pregnancy it can reduce the incidence of an ectopic pregnancy.
FOCUS ASSESSMENT (SIGNS AND SYMPTOMS):
In an ectopic pregnancy, there is no unusual symptoms at the time of implantation and the corpus luteum of the ovary function as if the implantation site is in the ovaries, so therefore menstruation will not occur. A women who is experiencing ectopic pregnancy might experience nausea, sharp, stabbing pain in lower abdominal quadrant, light headedness, and severe shock. The healthcare provider will be able to observe that the client is vomiting, minimal vaginal bleeding, rapid pulse and respiration, and falling blood pressure.

DIAGNOSTIC AND LABORATORY TEST:
There are several diagnostic and laboratory test that can be done in order to confirm an ectopic pregnancy and confirming this condition can now be done during their early pregnancy period because their check – ups can help to identify if they are positive for it or not. Ectopic pregnancy will be able to detect through use the quantitative hCG test and transvaginal ultrasound wherein the mother will be asked to do a blood test in order to confirm the levels of hCG and progesterone. The pregnancy is said to be an ectopic if the results of the hCG and serum progesterone levels starts in decreasing and the ultrasound showed that there is a ruptured tube and blood collecting in the peritoneum. Magnetic resonance imaging or MRI is also effective to use in diagnosing ectopic pregnancy.

RISK FACTORS:
There are situations that can that bring risk to mothers to experience ectopic pregnancy and one common of these is when the pregnant mother had a ectopic pregnancy before because she will more likely to experience it again. If the pregnant mother has an infection, like gonorrhea or chlamydia, it can cause inflammation in her tubes and other organs near so it increases the risk of an ectopic pregnancy. Due to infertility, some women tend to undergo in vitro fertilization or IVF because they have a tubal scarring thus ectopic pregnancy is possible to their situation. If a woman has a fallopian tube abnormalities they are more likely to do a tubal surgery in order to correct the damaged fallopian tube and this procedure usually leads in scarring and disrupting the normal anatomy of the tubes thus it increases the risk of having an ectopic pregnancy. Smoking before the women gets pregnant can also be one of the risk factors because it is a dose – dependent, meaning, the risk is dependent on the woman’s habit and the more she smoke the greater the risk is.

PATHOPHYSIOLOGY:
NURSING DIAGNOSES BY PRIORITY:
Acute pain related to distention or rupture of fallopian tube
Anxiety related to threat of death and possible loss of ability to conceive
Powerlessness related to early loss of pregnancy secondary to ectopic pregnancy
Disturbed body image related to surgical procedure secondary to ectopic pregnancy
Disturbed sleep pattern related to psychological environmental factors

NURSING CARE PLAN:
Acute pain related to distention or rupture of fallopian tube
Anxiety related to threat of death and possible loss of ability to conceive
Powerlessness related to early loss of pregnancy secondary to ectopic pregnancy
NURSING MANAGEMENT / INTERVENTION:
When a pregnant women arrives at the hospital she might be already in a severe shock so it is a must to take her vital signs in order to obtain a baseline data because there is a tendency that both her respiratory and pulse rate will become high while her blood pressure is low. Leukocytosis or the increase of number of white blood cells in the blood may be present but not because of the infection but due to trauma. In order to confirm ectopic pregnancy, a transvaginal examination will be done in order to see the ruptured tube and blood collecting in the peritoneum area. Monitoring the intake and output will be done in order to establish the client’s renal function and to test if the hCG and serum progesterone level decrease because if it decrease, it only suggests that the pregnancy has ended. If the pregnancy has confirmed ended, encourage her to verbalize or express her concerns about it and her possibly reduced potential for future childbearing.

MEDICAL / SURGICAL MANAGEMENT:
In some cases of ectopic pregnancy, it usually ends spontaneously before it rupture and are reabsorbed over the next few days without the need for treatment. The healthcare provider will prescribed an intramuscular or less often oral methotrexate that could keep the ectopic mass from bursting. However, there are situations wherein ectopic pregnancy is not being discovered early not until it ruptures thus the rise of an emergency situation. Intravenous fluid using a large – gauge catheter will be given to restore intravascular volume, blood will administered too due to blood loss, and laparoscopy will be done in order to ligate the bleeding vessels and to remove or repair the damaged fallopian tube. 

REFERENCES:

  • Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2016). Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales. Philadelphia, Pennsylvania: F.A. DAVIS COMPANY
  • Potter et. Al (2017). Fundamentals of Nursing (9th ed.). Singapore: Elsevier Inc.

You May Also Like

0 comments

BE UPDATED ON MY LATEST POST BY JOINING THE MAILING LIST