REPUBLIC of the PHILIPPINES

City of Makati
UNIVERSITY OF MAKATI
COLLEGE OF ALLIED HEALTH STUDIES
J. P. Rizal Extension, West Rembo, Makati City 1215
Telephone No.: (+632) – 881 – 1571
CENTER OF NURSING
_______________________________________________________________________________

A CASE OF A 37-YEAR-OLD FEMALE EXPERIENCING ABDOMINAL PAIN DUE TO

THE RUPTURED ECTOPIC PREGNANCY

A Case Study Presented to the Faculty of Nursing –

College of Allied Health and Studies –
University of Makati

In Partial Fulfillment of the Requirements for

Related Learning Experience
Care of Mother, Child at Risk or with Problems
Obstetrics-Gynecology Ward

Submitted by:
Group 1
Albania, Bernard David
Bandolin, Deruth
Beto, Maria Juden A.
De Ocampo, Johmel
Lebarios, Andrea Jessica I.
Llena, Ma. Cielo
Matriz, Karylle Ashley

MARCH 2021
 TABLE OF CONTENTS
PAGES

I. INTRODUCTION ........................................................................................................1
II. OBJECTIVES............................................................................................................... 3
III. NURSING HISTORY ................................................................................................. 5
IV. GORDON’S FUNCTIONAL HEALTH PATTERN .................................................. 7
V. REVIEW OF SYSTEM……………………………………………………..……….13
VI. PHYSICAL ASSESSMENT ..................................................................................... 20
VII. COURSE IN THE WARD……………………………………………………..…… 26
VIII. DIAGNOSTIC AND LABORATORY RESULTS.....................................................29
IX. DIFFERENTIAL DIAGNOSIS……………………………………………...………32
X. ANATOMY AND PHYSIOLOGY............................................................................ 33
XI. PATHOPHYSIOLOGY............................................................................................. 38
XII. SURGICAL MANAGEMENT…………………………………………….………...41
XIII. MEDICAL MANAGEMENT .................................................................................... 45
XIV. THEORETICAL FRAMEWORK…………………………………………..……….56
XV. NURSING CARE PLAN............................................................................................ 64
XVI. DISCHARGE PLAN………………………………………………………………... 79
XVII. EVALUATION……………………………………………. ………………………..83
XVIII. BIBLIOGRAPHY.........................................................................................................84
INTRODUCTION

Pregnancy is the period during which a woman carries a developing fetus normally
in the uterus, starting from conception (fertilization of ova) until the baby is born. After
ovulation the ovum is picked up by the fimbriae of fallopian tubes and then swept by ciliary
action towards the ampulla where fertilization occurs. As soon as the zygote develops it
begins dividing very rapidly, it remains in the fallopian tube for 3 -4 days until it reaches
the molecular stage (8-32 cell stage). The embryo proceeds through the isthmus to the
uterine cavity for up to 72 hours, by the sixth day it enters the uterus and begins to penetrate
the decidua (endometrium) this is called implantation which takes place within the uterine
cavity in normal positioned pregnancy (Abraham S.,2014).

Delay or obstruction of the passage of fertilized egg down the fallopian tube to the
uterus may result in implantation in the fallopian tube or ovary or peritoneal cavity, this
known as ectopic pregnancy which eventually most fails to develop, and the hCG fails to
raise dramatically as happens in the normal intrauterine pregnancy.

Ectopic Pregnancy is a complication of pregnancy Occurs when the site of

implantation is outside of the womb (uterine cavity) either in the tubes, ovaries or
abdominal cavity, With rare exceptions, ectopic pregnancies are not viable, Pregnancy can
even occur in both the womb and the tube at the same time (heterotopic pregnancy) Ectopic
pregnancies carry high rates of morbidity and mortality if not recognized and treated
promptly. It may present with pain, vaginal bleeding, or more vague complaints such as
nausea and vomiting (Gnugnol, D., 2020).

Danielsson, K. (2021) Stated that about 1 in every 50 pregnancies in the U.S. is an

ectopic pregnancy and between 6% to 16% of pregnant women who go to an emergency
department in the first trimester for bleeding, pain, or both have an ectopic pregnancy.

According to Qadar (2015) the risk factors are history of pelvic infection is the most
common risk factor for ectopic pregnancy folds increases the risk, due to destruction of the
fallopian tubes. Chlamydia (a common sexually transmitted disease) and Gonorrhea are
both able to grow within the fallopian tubes, history of surgery on the fallopian tubes or
within the pelvis, history of ectopic pregnancy. When an ectopic pregnancy in the fallopian
tube is treated conservatively.

In the case given, the 37 years old woman experienced abdominal pain that started
2 hours ago in her lower abdomen. She also felt dizzy and nauseated especially when she
sits up. There is also a present of bruises on her shoulder. There is no vaginal bleeding or
discharge, bowel or urinary symptoms. Her last period was about a month ago, she also
stated that they often forgot to use condoms and was diagnosed with chlamydia with pelvic
infection when she was 19 years old. Based on the findings when she experienced
abdominal pain and diagnosed with chlamydia the diagnosis was ruptured ectopic
pregnancy.

Studying this topic has not only provided the student nurses an advance knowledge
but it inspired the students on learning this disease as part of being cautious on any possible
incidences in near future in case. This study can be served as an eye opener not only to the
student nurses themselves, but also to people around them. All the knowledge they gathered
in this paper may be the key for early prevention and intervention to everyone else.
OBJECTIVES

General Objectives

This study aims to provide an understanding about a condition called Ectopic

Pregnancy. This is to help identify and define the problems experienced by the client. Also,
to gather appropriate and adequate knowledge about the disease in order to provide
effective nursing interventions and enhance the skills and attitude towards the clients.

Specific Objectives
This case study specifically aims to:

Knowledge:
● Define what is Ectopic Pregnancy
● Recognize the signs and symptoms of Ectopic Pregnancy
● Identify the health condition of the patient;
● Identify and describe the signs and symptoms of Ectopic Pregnancy. Discuss its
pathophysiology and etiology
● Present the patient’s biography and health history with its Gordon’s functional
health pattern;
● To identify and understand the predisposing and precipitating factors that
contributed to our patient’s illness
● Provide appropriate health teaching for the patient

Skills:
● Deliver proper nursing diagnosis, intervention and outcome for the patient
● Monitor the patient’s vital signs accurately for signs of systemic infection
● Deliver therapeutic nursing management and provide professional support towards
their condition with consideration of the patient’s own cultures and beliefs
● Make and develop a plan of care appropriate for the patient.
Attitudes:
● Establish rapport with the patient;
● Communicate well by the use of this it will establish trust from the patient
● Showing empathy and understanding will allow to deliver more effective patient
care
● Provide support system to reinforce negotiated behaviour
NURSING HISTORY

Name of the patient: Patient A

Address: Blk 155 lot 7 Amarillo St Brgy Rizal Makati city
Age: 37 years old
Birthdate: January 6, 1983
Gender: Female
Height: 160 cm
Weight: 55 kg
BMI: 27.5
Nationality: Filipino
Religion: Catholic
Civil Status: Married
Date of Admission: October 27, 2020
Hospital: Ospital ng Makati
Mode of Admission: Unplanned Admission
Date Interviewed: October 27, 2020
Informant: Ignacio D. Magiba

Chief Complaint: Abdominal pain

Subjective cues: “I don’t notice my vaginal bleeding”, "kamusta na po ba yung baby ko
baka kung mapano na po siya", “Masakit po ang tiyan ko a pain scale of (7 out of 10) “as
Verbalized by the patient

Diagnosis: Ruptured Ectopic Pregnancy

GORDON’S FUNCTIONAL HEALTH PATTERN

Functional Prior to Hospitalization During

Analysis and
Health Pattern Hospitalization
Interpretation

She’s taking all her

I. Health The patient stated that health is During
Prescribed
Perception a need for every individual; hospitalization,
medications. Patient
Health rated her health 7/10 with 1 as patient rated her
cannot function
Management the lowest and 10 as the highest. health as 5/10 with
normally like before
Pattern The patient stated that she is a 1 as the lowest and
but her health values
nonsmoker and non-alchoholic 10 as the highest.
increased.
beverage drinker. She The patient stated
consistently takes her prescribed that she cannot
Readiness for
multivitamins soon after her consider herself as
enhanced
child’s termination and healthy like before
therapeutic regimen
diagnosed with chlamydia, and and was idle
management
is accompanied with a healthy sometimes. But
diet and lifestyle. She has no still, the patient has
Reference:
difficulty in accessing health increased valuing
Doenges, M.E.
care facilities and she claimed in terms of her
(2006). Nurses
that she visited the nearest health.
Pocket Guide 10th
health centre for her first
Edition. F.A Davis
postpartum regular checkup this
Company. p.553-555
week. Patient claimed to have an
immunization with unrecalled
vaccines.

II. Nutritional Prior to her having an illness, Then the Patient Prior to her illness,
Metabolic the patient stated that during the started to eat small Patient was known to
Pattern 24 hour period, she usually meals a day due to have a good appetite
consumes three main meals and decrease in but during
rarely has snacks during the day appetite because of hospitalization, she
and drinks 8 glasses of water per her illness. Her had a change in
 day, she is not allowed to fluid intake were appetite and was able
consume caffeinated drinks or just 1 L per day to consume small
alcoholic beverages since she is since she was meals only. It was
breastfeeding her new born baby vomiting all of her also noted that she
thus she is consistently taking fluid. has decreased water
her multivitamin supplement in intake.
order to replenish all the
vitamins that she had lost during Deficient fluid
her pregnancy and childbirth. volume
No issues were identified in
terms of hair loss, increased Reference:
facial hair growth, skin Doenges, M.E.
disorders or nail growth. (2006). Nurses
Pocket Guide 10th
Edition. F.A Davis
Company. p. 252-
258.

III. Elimination Prior to her hospitalization, During During her hospital

Pattern patient usually urinates 150mL hospitalization, stay, the patient said
of yellowish color urine for 3-4 she was tested for that she defecates
times a day since she was urinalysis, there every day and
vomiting almost all the fluids was blood and urinates
and foods that she was protein detected approximately 5
consuming for 2 days. No but it is likely due times a day. There
painful urination, incontinence to contamination was a change in the
or retention was noted. She from persisting amount, type and
added that she observed blood in vaginal discharge frequency of the
her urine. The patient stated that (lochia). After the stool and the urine.
she experienced no problem Nurses
with bowel elimination and has administered her Readiness for
never utilized suppositories, prescribed enhanced urinary
medication, her elimination
 condition
improved in which Reference:
the patient urinates Doenges, M.E.
an average amount (2006). Nurses
of 700mL with Pocket Guide 10th
pale yellowish Edition. F.A Davis
colored urine and Company. p.583-585
no blood was
observed. No
constipation noted.

IV. Activity and During the patients

Patient’s exercise activity was During the
Exercise Pattern hospitalization the
walking up early as 8 AM and hospitalization the
patient stated that
walks because she was advised patient sated that
there was a quite
to do to help her body recover she can’t do her
changes in her
and heal as soon as possible. usually routine and
activities and has
unable to take care
restriction for her
of her self
action

Activity intolerance

V. Sleep Rest
The patient stated that she sleeps During
Pattern Patient stated that
around 8-9 PM and wake up as hospitalization.
she can't get enough
early as 3 AM. She also takes a Patient stated that
sleep because of
nap from 12nn to 4 pm. Patient she has difficulty
physical and
also stated that she didn't in sleeping pattern
environment stimuli
experience any difficulty in because she is
sleeping and does not use any awaken when the
sleeping aid. nurse comes to her
Disturbed Sleeping
room to take vital
Pattern
signs
VI. Cognitive Patient is oriented about the The patient is During the
Perceptual time, place and the patient can conscious, she is assessment the
Pattern understand English and Filipino aware of what is patient is still
but she prefers the Filipino happening around cooperating despite
language her, She prefers of her condition and
Filipino for her to as long as the nurses
understand what explain their motive
will happen during she remain calm.
the intervention.
Fear

VII. Self – The client stated that she views She stated that her Although the patient
Perception herself as functional. Although self-concept is had undergone body
Self – Concept she states she is reasonably altered. Other than changes due to her
Pattern satisfied with her current status having low self- recent pregnancy,
in life and what she has achieved esteem because of this does not appear
for herself and her family, her her body changes, to detract from her
perception of how she looks was during her stay in general feeling of
challenged since she have body the hospital she physical wellbeing
changes due to her recent started to think that although her body
pregnancy, it demonstrates she is a burden to image and
issues around physical her family because perception of herself
dissatisfaction, possible low she is hospitalized being a burden were
self-esteem and a lack of and can only do highlighted
confidence in social situations minimal tasks. negatively in more
than one pattern.

Risk for situational

low self-esteem

Reference:
Doenges, M.E.
(2006). Nurses
 Pocket Guide 10th
Edition. F.A Davis
Company. p.466-468

VIII. Role The patient is married women The patient stated The patient’s
Relationship for 3 years and currently living that she had a hospitalization
Pattern in Makati along with her really close brought the patient
parents, husband, and siblings. relationship with and her family and
The patient stated that she have her siblings, friends closer that
close friend to talk about husband and before
parents because
they are the one Readiness for
who taking care of Enhanced
her during Communication
hospitalization
stay.

IX. Sexuality – The patient stated that she and Patient stated that Due to physiological
Reproductive her husband are both sexually she is not active in factors the patients
Pattern inactive. And according to the sexual life because sexual inactive is
patient at the age of 14 years old of her condition normal
she began menstruating and she
didn’t experience any difficulty Normal Ineffective
during her pregnancy Sexuality Pattern

X. Coping- Stress The patient copes In times of According to the The patient is still
Tolerance stress or problems, She cites her patient, her recent optimistic and copes
Pattern husband as being her primary health condition to stress by sharing
support and states they have made her a little bit her problems and
always talked through as a stressed but again talking to her
family any issues which may her husband is her husband despite of
impact on her coping primary means of her health condition.
mechanisms. The patient does support during this
not drink alcohol, use time. Readiness for
 medication or take drugs to Enhanced Coping
relieve stress. According to her,
as much as possible she does not Reference:
take she has always been Doenges, M.E.
optimistic and has a positive (2006). Nurses
outlook in life. When everything Pocket Guide 10th
went wrong, she just pray and Edition. F.A Davis
she believes that everything will Company. p.186-189
soon be okay

XI. Value- Belief The patient stated that she is a Patient stated that After what
Pattern devoted Roman Catholic. She her belief to God happened, Religious
said that she believes that God remained the same effort is still a part of
will help her to solve her though the patient’s life and did
problems. She usually goes to frequency of not blame Him for
church every Sunday. Her attending mass her condition.
family and faith have always decreased and
been the most important part of believed that Readiness for
her life. She has been married to she, being sick is Enhanced Spiritual
her husband for 4 years and just a challenge Well-Being
values her relationship with brought by God to
him. She believes she has teach her to be a Reference:
enjoyed a rewarding life and has better server of Doenges, M.E.
always been thankful to the the almighty and (2006). Nurses
things that God gave her. strengthen their Pocket Guide 10th
faith as a family Edition. F.A Davis
Company. p.524-528
REVIEW OF SYSTEM

SYSTEM ASSESSMENT INTERPRETATION ANALYSIS

Reproductive Subjective cues: Ectopic Pregnancy Ruptured ectopic

system pregnancy in
“I feel so much pain An ectopic pregnancy reproductive system
in my abdomen” As is a medical
Pregnancy begins
verbalized by the emergency in which a
with a fertilized egg.
patient. fertilized egg implants
Normally, the
itself outside the
fertilized egg
uterus. Usually, an
attaches to the lining
ectopic pregnancy is
of the uterus. An
situated in one of the
ectopic pregnancy
fallopian tubes. As it
occurs when a
grows, it can cause the
fertilized egg
tube to tear or burst.
implants and grows
This results in
outside the main
dangerous internal
cavity of the uterus.
bleeding.

An ectopic
An ectopic pregnancy
pregnancy most often
occurs in roughly one
occurs in a fallopian
in 100 pregnancies. It
tube, which carries
is important to know
eggs from the ovaries
that an ectopic
to the uterus. This
pregnancy is not able
type of ectopic
to develop into a
pregnancy is called a
healthy pregnancy or
tubal pregnancy.
baby, and the mother
Sometimes, an
must be treated to
ectopic pregnancy
avoid risks and occurs in other areas
complications, such as of the body, such as
rupture, that can be the ovary, abdominal
life-threatening. cavity or the lower
part of the uterus
Reference: (cervix), which
Verywellfamily (2019) connects to the
Signs of a Ruptured vagina.
Ectopic Pregnancy.
An ectopic
Retrieved from
pregnancy can't
https://www.verywellf
proceed normally.
amily.com/ruptured-
The fertilized egg
ectopic-pregnancy-
can't survive, and the
symptoms-and-signs-
growing tissue may
2371253
cause life-threatening
bleeding, if left
untreated.

Reference:
Mayoclinic (n.d.),
Ectopic Pregnancy.
Retrieved from
https://www.mayocli
nic.org/diseases-
conditions/ectopic-
pregnancy/symptoms
-causes/syc-
20372088
Cardiovascular Subjective cues: Tachycardia Tachycardia on
system cardiovascular
“I can feel my Arrhythmias can cause system
palpations and I don’t cardiovascular
feel well” As stated complications in Pregnant women
by the patient pregnancy. have an increased
Palpitations are a risk of having the
common symptom in usual arrhythmias
pregnancy, and seen in women of
electrocardiography childbearing age.
(ECG) or ambulatory Most of these are
ECG monitoring can benign sinus
be conducted to tachycardias or
determine correlation bradycardias or atrial
of the symptoms with and ventricular
arrhythmias. The ectopic beats.
differential diagnosis Women who have
for supraventricular had sustained
tachycardia (SVT) in supraventricular or
pregnant patients is ventricular
similar to that for non- tachycardias before
pregnant patients, and pregnancy frequently
includes develop them during
atrioventricular nodal pregnancy. These
reentrant tachycardia arrhythmias often
(AVNRT), have enough
atrioventricular hemodynamic
reentrant tachycardia significance to
(AVRT), atrial decrease uterine
fibrillation (AF) or blood flow, which
flutter, and atrial adds a sense of
tachycardia (AT). urgency for
Increase in circulating treatment. The
plasma volume and management is
hyperdynamic similar to that of
circulation in nonpregnant women,
pregnancy can with nuances
predispose to SVT. important for the
SVT can occur in protection of the
pregnant patients with developing fetus.
structurally normal
hearts or with Reference:
structural heart NCBI (2012),
diseases such as Arrhythmias in
valvular heart disease, pregnancy. Retrieved
hypertrophic from
cardiomyopathy, or https://pubmed.ncbi.
congenital heart nlm.nih.gov/2281336
disease. 7/

Reference:
Practice Update(2017)
MY APPROACH to the
Pregnant Patient With
a Supraventricular
Tachycardia.
Retrieved from
https://www.practiceu
pdate.com/content/my
-approach-to-the-
 pregnant-patient-with-
a-supraventricular-
tachycardia/53866

Cardiovascular Subjective cues: Hypovolemia Hypovolemia in

system Cardiovascular
“I feel cold and my Hypovolemia is a system
hands is watery” As decrease in the volume
verbalized by the of blood in your body, Pregnancy is a
client. which can be due to dynamic process
blood loss or loss of associated with
body fluids. Blood loss significant
can result from physiological
external injuries, changes in the
internal bleeding, or cardiovascular
certain obstetric system. These
emergencies. Diarrhea changes are
and vomiting are mechanisms that the
common causes of body has adapted to
body fluid loss. Fluid meet the increased
can also be lost as a metabolic demands
result of large burns, of the mother and
excessive perspiration, fetus and to ensure
or diuretics. adequate
Inadequate fluid intake uteroplacental
can also cause circulation for fetal
hypovolemia. growth and
At the onset of development.
hypovolemia, the Insufficient
mouth, nose, and other hemodynamic
mucous membranes changes can result in
dry out, the skin loses maternal and fetal
its elasticity, and urine morbidity, as seen in
output decreases. preeclampsia and
Initially, the body intrauterine growth
compensates for the retardation. In
volume loss by addition, maternal
increasing the heart inability to adapt to
rate, increasing the these physiological
strength of heart changes can expose
contractions, and underlying,
constricting blood previously silent,
vessels in the cardiac pathology,
periphery while which is why some
preserving blood flow call pregnancy
to the brain, heart and nature’s stress test.
kidneys. With Indeed,
continuing volume cardiovascular
loss, the body loses its disease in pregnancy
ability to compensate is the leading cause
and blood pressure of maternal mortality
drops. At this point, the in North America.1
heart is unable to pump We therefore review
enough blood to vital here the normal
organs to meet their cardiovascular
needs and tissue physiology of
damage is likely to pregnancy to provide
occur. clinicians with a
Hypovolemic shock basis for
occurs when a fifth of understanding how
the blood volume is the presence of
lost. Symptoms may cardiovascular
include cold, clammy disease may
skin, paleness, rapid compromise the
breathing and heart mother and fetus and
rate, weakness, how their decisions
decreased or absent about medical care
urine output, may need
sweating, anxiety, adjustment.
confusion, and
unconsciousness. Reference:
Hypovolemic shock is Monika Sanghavi
a medical emergency and John D.
requiring immediate Rutherford.
intervention. Ahajournals(2014)
Circulation. retrieved
Reference: from
HealthGrades(2021) https://www.ahajour
Hypovolemia. nals.org/doi/full/10.1
Retrieved from 161/circulationaha.1
https://www.healthgra 14.009029
des.com/right-
care/symptoms-and-
conditions/hypovolem
ia#:~:text=Hypovolem
ia%20is%20a%20decr
ease%20in,causes%20
of%20body%20fluid
%20loss.
PHYSICAL ASSESSMENT
General Survey

Patient is 37 years old woman who had termination 3 years ago, and feeling:
 Abdominal pain 2hrs ago in lower abdomen but generalized by now.
 Nausea and dizziness
 As if bruised shoulder
 Does not feel vaginal bleeding
 No bowel and urinary symptoms
 Diagnosed with chlamydia when 19 y/old
 Peripherals: Cold and clammy hands
 Abdomen: symmetrically distended
o generalized tenderness on light palpation
o rebound tenderness and guarding
o no obviously palpable masses
 Vaginal examination not done
 Urine Pregnancy: Positive

Temperature: 35.9℃

Respiratory Rate: 15 bpm

Pulse Rate: 120 bpm

Blood Pressure: 95/50 mmHg

Height: 160 cm

Weight: 55 kg

Diet: N/A

Contraptions: N/A

Neuro Vital Signs:

 ● Eyes: 4/4
● Verbal: 5/5
● Motor: 6/6
Total: 15 / 15

Date of Interview: October 27,2020

Time of Interview: 2:00 am

Organ/ Technique Actual Findings Analysis and Interpretation

System
Skin Inspection Color: pale Abnormal
Paleness may be caused by reduced
blood flow and oxygen or by a
decreased number of red blood cells

Palpation Clammy Normal

Hair Inspection Color: Black and Normal

white
Residing hairline Normal
Not evenly Normal
distributed
Moist Normal
No infestations Normal
Head Inspection Symmetrical Normal
facial features
(-) lesions Normal
(-) deformities Normal
(-) masses Normal
Ears Inspection Symmetry Normal
(-) discharge Normal
 (+) earwax Normal
(-) lesions Normal
(-) nodules Normal
(-) redness Normal
Eyes Inspection Pink Normal
conjunctivae
Sclera – not Normal
totally white

Palpation Normal
(-) discharges

Eyelids: Normal
(-) masses

Nose Inspection Symmetrically Normal

aligned
(-) discharge Normal
(+) nasal cannula Normal
Mouth and Inspection Pale Normal
Throat Moist Normal
Pink mucosa Normal
(+) dentures in Normal
upper portion
(+) lost teeth in Normal
lower portion
(-) swelling Normal
(-) bleeding Normal
(-) infection Normal
 Gums are pink Normal
Yellowish teeth Normal
(-) lesion Normal
Palpation

(-) Lumps Normal

Neck Inspection (-) swelling Normal
(-) lesion Normal

Palpation
Palpable carotid Normal
pulse
No palpable Normal
lymph nodes
Thorax Inspection Symmetrical Normal
and Lungs chest expansion
with respiration
(-) Retractions Normal

Palpation
Smooth Normal
Warm Normal

Auscultation Dry Normal

Bronchial sound
(-) wheezing Normal
sound
(-) Crackle Normal
Sound Normal
(-) Rales
Heart Inspection (-) Visible PMI Normal

Auscultation (+) Irregular Abnormal

Rhythm
 Tachycardia refers to a fast resting
heart rate, usually over 100 beats per
minute. Depending on its underlying
cause and how hard the heart has to
work, it can be dangerous.
(-) Thrills
(-) Murmurs Normal
Normal
Upper Inspection (-) Pallor Normal
Extremities (-) Rashes Normal
(-) Bruises Normal
(+) Contraptions Normal
Heplock in Right Normal
arm
(-) Swelling Normal
(-) Edema Normal

Abdomen Inspection Symmetrical Normal

(+) Distended Abnormal
The pain usually appears in the
lower abdomen or pelvic region –
often localized on one side of the
body. It can feel dull or cramp, be
continual or scattered, and possibly
worsen with movement. As
the ectopic
pregnancy progresses, abdominal
pain may become severe and sharp
(-) Masses
(-) Lesions Normal
 Normal
(-)Normal bowel
Auscultation
sounds Normal

(-) Dull sounds

when organs are Normal
percussed

Percussion (-) Masses

(+)Light Normal
Tenderness Normal

Palpation (-) Rigidity

(-) Distention Normal
Normal
Lower Inspection (-) Pallor Normal
Extremities (-) Rashes Normal

(-) Edema Normal

Palpation
(-) Poor
Normal
peripheral
pulses
COURSE IN THE WARD

DATE DOCTOR’S NURSING PATIENT’S

ORDER RESPONSIBILITIES REACTION

 Monitored V/S q every Patient’s

October V/S shift, recorded and cooperate with the
27, 2020 reported immediately any nurse
deviations.

 Assess the patient Patients doesn’t

For urinary pregnancy  Teach the patient on how hesitate to
test as doctors ordered to fill the specimen bottle cooperate with the
properly nurse.

 Verified doctor’s order The patient

For Undergo  Informed the patient about hesitates first
Diagnostics test: the diagnostic exams because of the
 Filled out necessary injection but lately
Hemoglobin request form she cooperates
 Informed the laboratory with the
Mean cell volume department about the procedure.
exams
White cell volume
 Followed up results and
Platelets attached it to pt’s chart.

Sodium

Potassium

Urea

Creatinine

As doctors ordered

 Get the signature of the Patient seems

Emergency Medical present significant other. afraid of the
Consent Form  Explain the method for the surgery.
emergency surgery.
  Verified doctor’s order
IVF therapy: PNSS  Regulated at 20-21
1LX 12 hrs as doctors gtts/minute and put on IV
ordered tag

 Informed the pt and

Salpingectomy significant other about
surgery the surgery procedure.

Epidural anesthesia  Informed the patient about

the local anesthesia. To
reduce the pain and make
the local/target area to be
paralyzed in the meantime.

 Advise pt to take a The Patient looks

October CBC complete bed rest to regain exhausted and
27, 2020 energy. sleeps peacefully.

Post-
operative
surgery

 Monitored V/S q15 Patient's

V/S minutes for 1hr, q30mns cooperates every
for 2 hrs, 14hrs for 24 hrs. procedure
 record and report
immediately for any
deviations.

 Verified doctor’s order

Continue IVF: PNSS  Regulated at 20-21
1Lx12hrs as doctors gtts/minute and put on IV
ordered tag

 Monitored pt’s I & O q

I & O q shift and shift, recorded and
record reported any deviations

 Verified doctor’s order Willing to take her

For Medication:  Performed skin testing medication if
Tylenol  Administered prescribed she’s in pain
(Acetaminophen) 325 pain medication as the pt
mg/tab q 4 hours for reported for any pain.
 10 days as doctors  Observed 10 Rights of
ordered Drug Administration
 Monitored Vital Signs

 Verified doctor’s order

October Continue IVF: PNSS  Regulated at 20-21
28, 2020 1Lx12hrs as doctors gtts/minute and put on IV
ordered tag

 Monitored V/S q15

V/S minutes for 1hr, q30mns
for 2 hrs, 14hrs for 24 hrs.
 record and report
immediately for any
deviations.

 Monitored pt’s I & O q

I & O q shift and shift, recorded and
record reported any deviations

 Verified doctor’s order

Medication: Tylenol  Performed skin testing
(Acetaminophen) 325  Administered prescribed
mg/tab q 4 hours for pain medication as the pt
10 days as doctors reported for any pain.
ordered  Observed 10 Rights of
Drug Administration
 Monitored VItal Signs

 Verified doctor’s order Patient is thankful

October Discontinue IVF  Discontinued for everyone who
29, 2020 helps to ease her
pain and excited to
Medication  Informed p’t to take go home.
Patient participated
medication when the pain
in the health
appears and teach pt how teaching and stated
Patient discharge form to take medications. that she will follow
 Signed/ verified by the every step she
As doctors ordered
doctor learned
 Signed by the significant
other
DIAGNOSTIC AND LABORATORY RESULTS

Hematology

LABORATORY OBSERVED NORMAL VALUES INTERPRETATION

TEST RESULT AND ANALYSIS

Haemoglobin 9.6g/dL 11.7-15.7 g/dL Normal

Mean Cell Volume 87 fL 80-99 fL Normal

White Cell Volume 7.1x10^9/L 3.5-11x10^9/L Normal

Platelets 204x10^9/L 150-440x10^9/L Normal

Sodium 135 mmol/L 135-145 mmol/L Normal

Potassium 6.0 mmol/L 3.5-5 mmol/L Normal range of

potassium is between
3.6 and 5.2 millimoles
per liter (mmol/L) of
blood. A potassium
level higher than 5.5
mmol/L is critically
high, and a potassium
level over 6 mmol/L
can be life-threatening.

Reference:
Wint, C. (2020, April
23). High potassium:
Causes, symptoms, and
diagnosis. Retrieved
March 07, 2021, from
https://www.healthline.
com/health/high-
potassium-
hyperkalemia

Urea 6 mmol/L 2.5-6.7 mmol/L High blood urea

nitrogen level means
your kidneys aren't
working well. But
elevated blood urea
nitrogen can also be
due to: Urinary tract
obstruction,
 Congestive heart
failure or recent heart
attack.

Reference:
Blood urea nitrogen
(bun) test. (2019, July
02). Retrieved March
07, 2021, from
https://www.mayoclini
c.org/tests-
procedures/blood-urea-
nitrogen/about/pac-
20384821#:~:text=Gen
erally%2C%20a%20hi
gh%20blood%20urea,f
ailure%20or%20recent
%20heart%20attack

Creatinine 70 µmol/L 70-120 µmol/L Normal

Pregnancy Test
Test Zine Clinical
Laboratory
PATIENT NAME: PATIENT A
DATE: OCTOBER 27,2020
AGE: 37
SEX: FEMALE
REF BY DR: CRUZ
Test RESULT
PROTHROMBIN TIME
(PT)
CONTROL 15 sec
PATIENT VALUE 14 sec
INR 1.0
APTT
CONTROL 32 sec
 PATIENT VALUE 30 sec
URINE PREGNANCY TEST POSITIVE

Bleeding Time
Bleeding Time Total Bleeding Peak Bleeding Time to Peak
(min) (mg) Rate (mg/30s) Bleeding (min)
Mean 5.7 13.7 3.2 1.0
SD 1.8 10.3 1.8 0.4
% CV 32 75 56 40

Ultrasound

Findings:
Transvaginal ultrasound: intrauterine pseudosac associated with an ectopic
pregnancy. The yoke sac is the first visible structure within the gestational sac and is a
distinct circular structure with a bright echogenic rim and sonolucent center and is
recognized 3 weeks post-conception (5 weeks after the last menstrual period).
DIFFERENTIAL DIAGNOSIS

Sign and Ectopic Ovarian Cyst Adnexal Salpingitis

Symptoms Pregnancy Rupture Torsion
Vaginal + + + +
Bleeding
Lower + + + +
Abdominal
Pain
Pelvic Pain + + + +
Tender Cervix + - - -

A ruptured ovarian cyst is a common phenomenon, with presentation ranging from

no symptoms to symptoms mimicking an acute abdomen. Sequelae vary. Menstruating
women have rupture of a follicular cyst every cycle, which is either asymptomatic or with
mild transient pain (mittelschmerz). In less usual circumstances, the rupture can be
associated with significant pain. In very rare circumstances, intraperitoneal hemorrhage
and death may occur. The most pressing issues facing clinicians encountering patients with
potential cyst rupture in the acute setting are to rule out ectopic pregnancy, ensure adequate
pain control, and rapidly assess the patient for hemodynamic instability to allow
appropriate triage.
Ovarian torsion is a condition that occurs when an ovary twists around the
ligaments that hold it in place. This twisting can cut off blood flow to the ovary and
fallopian tube. Ovarian torsion can cause severe pain and other symptoms because the
ovary is not receiving enough blood. If the blood restriction continues for too long, it can
lead to tissue death.
Salpingitis is inflammation of the fallopian tubes, caused by bacterial infection.
Common causes of salpingitis include sexually transmitted diseases such as gonorrhoea
and chlamydia. Salpingitis is a common cause of female infertility because it can damage
the fallopian tube. Treatment options include antibiotics.
ANATOMY AND PHYSIOLOGY

Anatomy and Physiology of Reproductive System

The female reproductive system is designed to carry out several functions. It produces the
female egg cells necessary for reproduction, called the ova or oocytes. The system is designed to
transport the ova to the site of fertilization. Conception, the fertilization of an egg by a sperm,
normally occurs in the fallopian tubes. After conception, the uterus offers a safe and favorable
environment for a baby to develop before it is time for it to make its way into the outside world. If
fertilization does not take place, the system is designed to menstruate (the monthly shedding of the
uterine lining). In addition, the female reproductive system produces female sex hormones that
maintain the reproductive cycle. During menopause the female reproductive system gradually stops
making the female hormones necessary for the reproductive cycle to work. When the body no
longer produces these hormones, a woman is considered to be menopausal.
The female reproductive organs consist of the ovaries, the uterine tubes (or fallopian tubes),
the uterus, the vagina, the external genitalia, and the mammary glands. The internal reproductive
organs of the female are located within the pelvis, between the urinary bladder and the rectum. The
uterus and the vagina are in the midline, with an ovary to each side of the uterus. The internal
reproductive organs are held in place within the pelvis by a group of ligaments.

External Female Genitalia

● Vulva external female reproductive structure
● Mons Pubis is a pad of fat that is located at the anterior, over the pubic bone (after puberty,
it is covered with pubic hair)
● Labia majora are folds of hair-covered skin that begin just posterior to the mons pubis.
● Labia minora extends medial to the labia majora.
● Clitoris an organ that originates from the same cells as the glans penis and has abundant
nerves that make it important in sexual sensation and orgasm
● Hymen is a thin membrane that sometimes partially covers the entrance to the vagina. An
intact hymen cannot be used as an indication of “virginity”; even at birth, this is only a
partial membrane, as menstrual fluid and other secretions must be able to exit the body,
regardless of penile–vaginal intercourse.
● Bartholin’s glands (or greater vestibular glands) secrete mucus which keeps the vestibular
area moist.
Labia majora
● The labia majora enclose and protect the other external reproductive organs. Literally
translated as "large lips," the labia majora are relatively large and fleshy, and are
comparable to the scrotum in males. The labia majora contain sweat and oil-secreting
glands. After puberty, the labia majora are covered with hair.

Labia minora
● Literally translated as "small lips," the labia minora can be very small or up to 2 inch wide.
They lie just inside the labia majora, and surround the openings to the vagina (the canal
that joins the lower part of the uterus to the outside of the body) and urethra (the tube that
carries urine from the bladder of the body.

Bartholin’s glands
● These glands are located next to the vaginal opening and produce a fluid (mucus)secretion.

Clitoris
● The two labia minora meet at the clitoris, a small, sensitive protrusion that is comparable
to the penis in males. The clitoris is covered by a fold of skin, called the prepuce, which is
similar to the foreskin at the end of the penis. Like the penis, the clitoris is very sensitive
to stimulation and can become erect
Vagina
● Is a muscular canal (approximately 10 cm long) that serves as the entrance to the
reproductive tract. It also serves as the exit from the uterus during menses and childbirth.
The outer walls of the anterior and posterior vagina are formed into longitudinal columns,
or ridges, and the superior portion of the vagina—called the fornix—meets the protruding
uterine cervix. The walls of the vagina are lined with an outer, fibrous adventitia; a middle
layer of smooth muscle; and an inner mucous membrane with transverse folds called rugae.
Cervix
● The lower one-third of the uterus is the tubular "cervix," which extends downward into the
upper portion of the vagina. The cervix surrounds the opening called the "cervical orifice,"
through which the uterus communicates with the vagina.

Ovaries
● Are the female gonads. Paired ovals, they are each about 2 to 3 cm in length, about the size
of an almond. The ovaries are located within the pelvic cavity, and are supported by the
mesovarium, an extension of the peritoneum that connects the ovaries to the broad
ligament.
● The ovarian cycle is a set of predictable changes in a female’s oocytes and ovarian follicles.
During a woman’s reproductive years, it is a roughly 28-day cycle that can be correlated
with, but is not the same as, the menstrual cycle (discussed shortly). The cycle includes
two interrelated processes: oogenesis (the production of female gametes) and
folliculogenesis (the growth and development of ovarian follicles).

Fallopian tubes
● These are narrow tubes that are attached to the upper part of the uterus and serve as tunnels
for the ova (egg cells) to travel from the ovaries to the uterus. Conception, the fertilization
of an egg by a sperm normally occurs in the fallopian tubes. The fertilized egg then moves
to the uterus, where it implants to the uterine wall.

Uterus (womb)
● The uterus is a hollow, pear-shaped organ that is the home to a developing fetus. The Uterus
is divided into two parts: the cervix, which is the lower part that opens into the vagina, and
the main body of the uterus, called the corpus. The corpus can easily expand to hold a
 developing baby. A Channel through the cervix allows sperm to enter and menstrual blood
to exit.
● The Wall of the Uterus (3 Layers)
○ The outer serous coat called the perimetrium, consists of peritoneum supported by
a thin layer of connective tissue.
○ The middle muscular coat called the Myometrium consists of 12 to 15 mm of
smooth muscle. The myometrium increased greatly during pregnancy. The main
branches of the blood vessels and nerves of the uterus are located in this layer
○ The inner mucous coat called endometrium is firmly adherent to the underlying
myometrium.
■ The endometrium is partly sloughed off each month during menstruation.
■ It lines only the body of the uterus.
● The Ligaments of the Uterus
○ Transverse Cervical Ligaments
■ This extends from the cervix and lateral parts of the vaginal fornix to the
lateral walls of the pelvis.
○ Uterosacral Ligaments
■ These pass superiorly and slightly posteriorly from the sides of the cervix
to the middle of the sacrum.
■ They are deep to the peritoneum and superior to the levator ani muscles.
■ The uterosacral ligaments tend to hold the cervix in its normal relationship
to the sacrumà
○ Round Ligament of the Uterus
■ These ligaments are 10 to 12 cm long and extend for the lateral aspect of
the uterus,passing anteriorly between the layers of the broad ligament.
■ They leave the abdominal cavity through the inguinal canal and insert into
the labia majora.
● The Broad Ligament
○ This is a fold of peritoneum with mesothelium on its anterior and posterior
surfaces.
○ It extends from the sides of the uterus to the lateral wallandfloor of the pelvis.
○ The broad ligament holds the uterus in its normal position.
○ The 2 layers of the broad ligament are continuous with each other at a free edge.
○ This is directed anteriorly and superiorly to surround the uterine tube. Laterally,
the broad ligament is prolonged superiorly over the ovarian vessels as the
suspensory ligament of the ovary.
○ The ovarian ligament lies posterosuperiorly and the round ligament of the uterus
lies anteroinferiorly within the broad ligament.
○ The broad ligament contains extraperitoneal tissue (connective tissue and smooth
muscle) called parametrium.
○ It gives attachment to the ovary through the mesovarium.
○ The Mesosalpinx Is a mesentery supporting the uterine tube.
PATHOPHYSIOLOGY
PATIENT-BASED

Presents abdominal pain started 2 hours ago and was initially

The classic triad in the lower abdomen but is now generalized.
of ectopic 37 year old
pregnancy female with
includes abdominal
abdominal pain, She feels nauseated and dizzy, especially when she sits up. She pain. She had
amenorrhea, and also feels as if she has bruised her shoulder. She has not noticed termination 3
vaginal bleeding. any vaginal bleeding or discharge, and there are no bowel or years ago. She
Progression of urinary symptoms. was diagnosed
symptoms to
severe abdominal
with
tenderness, chlamydia
peritoneal signs, She had termination 3 years ago. She was diagnosed with when she was
and shock is chlamydia when she was admitted to hospital at the age of 19 admitted to
indicative of a with pelvic infection. On examination, she is pale, looks unwell hospital at the
ruptured ectopic and intermittently drowsy. The temperature is 35.9, pulse age of 19 with
pregnancy. 120/min and BP 95/50 mmHg. Peripherally she is cool and Pelvic
hands are clammy. Abdomen is symmetrically distended Infection.

Abdominal Pain
due to the
presence of The examination findings also suggest the clinical diagnosis and
Ruptured a positive pregnancy test confirms the presence of ruptured
Ectopic ectopic pregnancy.
Pregnancy
LEGENDS:
Often, the first warning signs of an ectopic pregnancy are light vaginal bleeding and
DISEASE PROCESS pelvic pain. If blood leaks from the fallopian tube, you may feel shoulder pain or an
urge to have a bowel movement. Your specific symptoms depend on where the blood
collects and which nerves are irritated. If the fertilized egg continues to grow in the
MODIFIABLE FACTORS
fallopian tube, it can cause the tube to rupture. Heavy bleeding inside the abdomen is
likely. Symptoms of this life-threatening event include extreme lightheadedness,
NON-MODIFIABLE FACTORS fainting and shock.

SIGNS AND SYMPTOMS

 THEORETICAL BASED

An ectopic pregnancy occurs when a fertilized egg

PREDISPOSING grows outside of the uterus. Almost all ectopic PRECIPITATING
FACTORS pregnancies—more than 90%—occur in a fallopian FACTORS
tube. As the pregnancy grows, it can cause the tube
The risk factors for ectopic to burst (rupture). A rupture can cause major Other factors that may
pregnancy include the internal bleeding. This can be a life-threatening increase a woman’s risk of
following: emergency that needs immediate surgery. ectopic pregnancy include:
 Previous ectopic  Cigarette smoking
pregnancy  Age older than 35
 Prior fallopian tube years
surgery If you do not have the symptoms of a fallopian tube  History of infertility
 Previous pelvic or rupture but your ob-gyn or other health care  Use of assisted
abdominal surgery professional suspects you may have ectopic reproductive
 Certain sexually pregnancy, he or she may: Perform a pelvic exam; technology, such as
transmitted Perform an ultrasound exam to see where the in vitro fertilization
infections (STIs) pregnancy is developing; Test your blood for a (IVF)
 Pelvic inflammatory pregnancy hormone called human chorionic
disease gonadotropin (hCG)
 Endometriosis

An ectopic pregnancy cannot move or be moved to

the uterus, so it always requires treatment. There are
two methods used to treat an ectopic pregnancy: 1)
medication and 2) surgery. Several weeks of follow-
up are required with each treatment.
LEGENDS:

DISEASE PROCESS Once you have had an ectopic pregnancy, you are at
higher risk of having another one. During future
PREDISPOSING FACTORS pregnancies, be alert for signs and symptoms of
ectopic pregnancy until your ob-gyn or other health
PRECIPITATING FACTORS care professional confirms the next pregnancy is
growing in the right place.
 An ectopic pregnancy usually happens because a fertilized egg wasn't able to quickly move
down the fallopian tube into the uterus. Ectopic pregnancy can be difficult to diagnose because
symptoms often are like those of a normal early pregnancy. These can include missed periods,
breast tenderness, nausea, vomiting, fatigue, or frequent urination (peeing).

Often, the first warning signs of an ectopic pregnancy are pain or vaginal bleeding. There
might be pain in the pelvis, abdomen, or even the shoulder or neck (if blood from a ruptured ectopic
pregnancy builds up and irritates certain nerves). The pain can range from mild and dull to severe
and sharp. It might be felt on just one side of the pelvis or all over.

At first, an ectopic pregnancy may feel like a typical pregnancy with some of the same
signs, such as a missed menstrual period, tender breasts, or an upset stomach. Other signs may
include: Abnormal vaginal bleeding, Low back pain, Mild pain in the abdomen or pelvis, and Mild
cramping on one side of the pelvis

At this stage, it may be hard to know if you are experiencing a typical pregnancy or an
ectopic pregnancy. Abnormal bleeding and pelvic pain should be reported to your obstetrician–
gynecologist (ob-gyn) or other health care professional.

As an ectopic pregnancy grows, more serious symptoms may develop, especially if a

fallopian tube ruptures. Symptoms may include the following: Sudden, severe pain in the abdomen
or pelvis, Shoulder pain, and Weakness, dizziness, or fainting

A ruptured fallopian tube can cause life-threatening internal bleeding. If you have sudden,
severe pain; shoulder pain; or weakness, you should go to an emergency room.
SURGICAL MANAGEMENT

Procedure done or to
Nursing Responsibilities Interpretation and Analysis
be done

Pre-Operation: Nurses must secure the Vital signs, i.e. respiratory rate, oxygen
Vital signs consent form of every saturation, pulse, blood pressure and
Urinary pregnancy diagnostic test to be temperature, are regarded as an essential part
Complete Blood Count performed and explain to of monitoring hospitalized patients. Changes
Ultrasound the client the procedures in vital signs prior to clinical deterioration are
Diagnostic tests and educate how to well documented and early detection of
Emergency Medical perform the procedure. preventable outcomes is key to timely
Consent form Monitor the VS every shift intervention.
and assess the patient.
Then, inform the laboratory A human chorionic gonadotropin (hCG) urine
department about the test is a pregnancy test. A pregnant woman's
exams. Document the placenta produces hCG, also called the
follow up result and attach pregnancy hormone. If you're pregnant, the
to pt’s chart. test can usually detect this hormone in your
urine about a day after your first missed
period.

The complete blood count (CBC) is a group

of tests that evaluate the cells that circulate in
blood, including red blood cells (RBCs),
white blood cells (WBCs), and platelets
(PLTs). The CBC can evaluate your overall
health and detect a variety of diseases and
conditions, such as infections, anemia and
leukemia.

An ultrasound can provide very important

diagnostic information about a developing
baby, including confirming the pregnancy and
gestational age; checking for multiple
 pregnancies, congenital anomalies, and/or
problems with the placenta; monitoring fetal
position, fetal growth, and the level of
amniotic fluid; and aiding in other tests.

Diagnosis is the process of finding out if a

patient has a specific disease. A medical
professional prescribes a test to make a
diagnosis or to exclude possible illness.

The main purpose of the informed consent

process is to protect the patient. A consent
form is a legal document that ensures an
ongoing communication process between you
and your health care provider.

Operation:
IVF Therapy: PNSS ILX Nurse must secure the pt’s Intravenous therapy (abbreviated as IV
12hrs significant others signature therapy) is a medical technique that delivers
Salpingectomy surgery and explain the emergency fluids, medications and nutrition directly into
Epidural anesthesia procedure/surgery to be a person's vein. The intravenous route of
performed. Verify the administration is commonly used for
physician’s order and rehydration or to provide nutrition for those
administer PNSS and who cannot consume food or water by mouth.
Epidural.
Salpingectomy is the surgical removal of one
or both fallopian tubes. These tubes provide a
pathway for an egg to travel from an ovary to
the uterus, where it may be fertilized. A doctor
may recommend a salpingectomy for various
reasons, including an ectopic pregnancy.

An epidural provides anesthesia that creates a

 band of numbness from your bellybutton to
your upper legs. It allows you to be awake and
alert throughout labor, as well as to feel
pressure. The ability to feel second-stage
labor pressure enables you to push when it's
time to give birth to your baby.

Post-operative:
Take rest Verify the physician’s The importance of rest after surgery is
V.S order in administering the stressed by doctors because your body is
Continue PNSS regulation of PNSS and going to do a lot of healing while sleeping.
I & O documentation medication while After all, your body does the majority of its
Medication observing 10 rights drug healing while you're asleep. It's important that
administration administration. Perform you're able to take a nap whenever you need
(Antibiotic and Pain skin test, monitor VS and I to.
Reliever) & O record and document
findings. Advise patient to Monitoring of Intake helps caregivers ensure
take bed rest. Continue till that the patient has proper intake of fluid and
doctor’s order or recovery. other nutrients. Monitoring of output helps
determine whether there is adequate output of
urine as well as normal defecation.

Medication management services contribute

to: Improved patient use and administration of
all medications. Improved percentage of
patients meeting their health care goals.
Reduced side effects and duplication, as well
as drug interactions, of all medications.

Discharge
Discontinue IVF Verify physician’s order in Essentially, the discharge planning nurse
Medication discontinuation of IVF and serves as a connection between in-patient care
Patient discharge form inform patient medication and follow-up or out-patient care. They help
intake and verify with the to make sure that the patient and their family
doctor and significant understand exactly what to do after discharge
others. to prevent injury and encourage healing. They
are a crucial part of proper patient care.
 MEDICAL MANAGEMENT
Side Effects/
Drug Name Mechanism of Action Indication Contraindication Nursing Consideration
Adverse Reactions
Generic Name: Pharmacodynamics: Azithromycin Tablets Adverse Reactions:  Hypersensitivity Before:
Azithromycin The antibacterial are a macrolide  Diarrhea  Hepatic Dysfunction  Assessment
activity of antibacterial drug  Nausea  History:
Brand Name: azithromycin appears indicated for the  Abdominal pain Hypersensitivity to
Zithromax, to correlate with the treatment of patients azithromycin,
Xmax ratio of area under the with mild to moderate erythromycin, or
concentration-time infections caused by; any macrolide
Dosage, Route curve to minimum  Acute bacterial antibiotic;
and inhibitory exacerbations of gonorrhea or
Frequency: concentration chronic bronchitis syphilis,
(AUC/MIC) for  Acute bacterial pseudomembranous
PO Resp tract certain pathogens (S. sinusitis colitis, hepatic or
infections; Skin pneumoniae and S.  Pharyngitis/tonsillitis renal impairment,
and soft tissue aureus).  Uncomplicated skin lactation
infections and skin structure  Physical: Site of
 500 mg Pharmacokinetics: infections infection; skin
once daily  Absorption:  Urethritis and color, lesions;
for 3 days. The absolute cervicitis orientation, GI
bioavailability of  Community-acquired output, bowel
Uncomplicated azithromycin 250 mg pneumonia sounds, liver
genital capsules is 38%.  Genital ulcer disease evaluation; culture
chlamydial and sensitivity tests
in men
infections of infection,
 1 g as a urinalysis, LFTs,
single dose.  Distribution: renal function tests
Azithromycin has
been shown to During:
Pregnancy penetrate into human  Culture site of infection
Category: tissues, including before therapy.
 Category B skin, lung, tonsil, and  Administer on an
cervix. Extensive empty stomach 1 hr
Classification: tissue distribution before or 2–3 hr after
 Macrolide was confirmed by meals. Food affects the
examination of absorption of this drug.
additional tissues and  Prepare Zmax by
fluids (bone, adding 60 mL water to
ejaculum, prostate, bottle, shake well.
ovary, uterus,  Counsel patients being
salpinx, stomach, treated for STDs about
liver, and appropriate
gallbladder). precautions and
additional therapy

 Metabolism: After:
In vitro and in
vivo studies to assess  Monitor patient
the metabolism of response to therapy
azithromycin have  Monitor for adverse
not been performed. effects: Stomach
cramping,
discomfort,
 Elimination: diarrhea; fatigue,
Biliary excretion headache
(medication may
help); additional
infections in the
mouth or vagina
(consult with
 health care
provider for
treatment).
 Evaluate patient
understanding on
drug therapy by
asking patient to
name the drug, its
indication, and
adverse effects to
watch for.
 Monitor patient
compliance to drug
therapy.
 Take the full course
prescribed. Do not
take with antacids.
Tablets and oral
suspension can be
taken with or
without food.
 Report severe or
watery diarrhea,
severe nausea or
vomiting, rash or
itching, mouth
sores, vaginal
sores.
 Drug Name Mechanism of Action Indication Side Effects/ Contraindication Nursing Consideration
Adverse Reactions
Generic Name: Pharmacodynamics:  Local or regional Adverse Reactions: Bupivacaine is Before:
Bupivacaine Local anesthetics anesthesia for surgery contraindicated in
such as bupivacaine or labor  CNS: headache (especially obstetrical paracervical  Assess for the
Brand Name: block the generation with epidural and spinal block anesthesia. Its use mentioned cautions
Marcaine and the conduction of anesthesia), restlessness, by this technique has and
nerve impulses, anxiety, dizziness, tremors, resulted in fetal contraindications
Dosage, Route presumably by blurred vision, backache bradycardia and death. (e.g. drug allergies,
and increasing the hepatic and renal
Frequency: threshold for  CV: peripheral Contraindicated in pt with impairment, etc.) to
electrical excitation vasodilation, myocardial a known with prevent any
Epidural Block in the nerve, by depression, arrhythmias, hypersensitivity to it or to untoward
slowing the blood pressure changes any local anesthetic agent complications.
Injection: propagation of the  Respiratory: respiratory of the amide type or other
 Perform a thorough
ADULTS: nerve impulse, and arrest components of
physical assessment
maximum of by reducing the rate bupivacaine solutions.
 GI: nausea, vomiting (e.g. weight,
10-20 ml of rise of the action
neurological status,
potential.
 Loss of skin integrity, vital signs, heart
Pregnancy
especially in patients who sounds, skin color
Category: Pharmacokinetics:
are unable to move. and lesions, bowel
Category C  Absorption:
sounds, etc.) to
Marcaine Spinal: Very establish baseline
Classification:
rapid (within 1 data before drug
Local
minute); achieves therapy begins, to
anesthesia
maximum motor determine
blockade and effectiveness of
dermatome level therapy, and to
evaluate for
occurrence of any
within 15 minutes in adverse effects
most cases associated with
drug therapy.
 Inspect site for local
anesthetic
 Distribution: application to
ensure integrity of
Depending upon the skin and to
route of prevent inadvertent
administration, systemic absorption
distribution to of the drug.
some extent to all
body tissues, with  Monitor laboratory
high test results (e.g.
concentrations liver and renal
found in highly function tests,
perfused organs plasma esterases) to
such as the liver, determine possible
lungs, heart, and need for a reduction
brain in dose and evaluate
for toxicity.

During:
 Metabolism:
 Prepare emergency
Primarily
metabolized in the equipment to
maintain airway
liver
and provide
mechanical

 Elimination:
 ventilation if
Excretion- Urine needed.
 Ensure that patients
receiving spinal
anesthesia or
epidural anesthesia
are well hydrated
and remain lying
down for up to 12
hours after the
anesthesia to
minimize headache.
 Provide skin care to
site of
administration to
reduce risk of skin
breakdown.
 Provide comfort
measures to help
patient tolerate drug
effects.
 Provide safety
measures (e.g.
adequate lighting,
raised side rails,
etc.) to prevent
injuries.
  Educate client on
drug therapy to
promote
understanding and
compliance.

After:

 Monitor patient
response to therapy
(loss of feeling in
designated area).
 Monitor for adverse
effects (e.g.
respiratory
depression, blood
pressure changes,
arrhythmias, GI
upset, skin
breakdown, injury,
CNS alterations,
etc).
 Evaluate patient
understanding on
drug therapy by
asking patient to
name the drug, its
indication, and
 adverse effects to
watch for.
 Monitor patient
compliance to drug
therapy.
 Drug Name Mechanism of Action Indication Side Effects/ Contraindication Nursing Consideration
Adverse Reactions
Generic Name: Acetaminophen  Like other OTC pain Adverse Reactions:  Hypersensitivity Before:
belongs to a class relievers,
Tylenol of drugs called acetaminophen  Skin swelling Assessment
analgesics temporarily relieves (angioedema)
 History: Allergy to
Brand Name: (pain relievers) and minor aches and  Disorientation acetaminophen,
antipyretics pains due to  Dizziness impaired hepatic
Acetaminophen (fever reducers). The headache, backache,  Rash (may itch) function, chronic
exact mechanism of the common cold,  Hives alcoholism, pregnancy,
action of minor pain of  Low levels of red blood
Dosage, Route acetaminophen is not lactation
arthritis, toothache, cells, white blood cells,
and  Physical: Skin color,
known. It may reduce premenstrual and and/or platelets
Frequency: lesions; T; liver
the production of menstrual cramps,  Shortness of breath/cough evaluation; CBC,
prostaglandins in the and muscular aches,
PO 325–650  Serious side effects of LFTs, renal function
brain. Prostaglandins and temporarily
mg q4–6h acetaminophen include: tests
are chemicals that reduces fever.
(max: 4 g/d) cause inflammation  Toxic epidermal necrolysis
tab. and swelling.  Severe allergic During:
reaction (anaphylaxis)  Do not exceed the
Acetaminophen
Pregnancy relieves pain by  Liver failure recommended dosage.
Category:  Stevens-Johnson syndrome  Avoid using multiple
elevating the pain
Category C  Gastrointestinal hemorrhag preparations containing
threshold, that is, by
e acetaminophen.
requiring a greater
Classification: amount of pain to  Laryngeal edema Carefully check all
Analgesics, OTC products.
develop before a  Kidney toxicity
Other  Give drug with food if
person feels it. It  Liver toxicity/liver failure
GI upset occurs.
reduces fever through  Hyperammonemia  Discontinue drug if
its action on the heat-  Agranulocytosis hypersensitivity
regulating center of
reactions occur.
the brain.
Specifically, it tells  Low white blood cell  Treatment of overdose:
the center to lower count (leukopenia, neutrop Monitor serum levels
the body's enia) regularly, N-
temperature when the  Low platelet acetylcysteine should
temperature is count (thrombocytopenia) be available as a
elevated.  Low red and white blood specific antidote; basic
cell count and life support measures
low platelet count may be necessary.
(pancytopenia)
After:
 Do not exceed
recommended dose; do
not take for longer than
10 days.
 Take the drug only for
complaints indicated; it
is not an anti-
inflammatory agent.
 Avoid the use of other
over-the-counter
preparations. They may
contain
acetaminophen, and
serious overdosage can
occur. If you need an
over-the-counter
preparation, consult
your health care
provider.
 Report rash, unusual
bleeding or bruising,
yellowing of skin or
eyes, changes in
voiding patterns.
THEORETICAL FRAMEWORK
Environmental Theory by Florence Nightingale

PERSONS
 Patient who is acted on by nurse
 Affected by environment.
 Has a negative power.

ENVIRONMENT
 Foundation of theory. Included everything
physical, psychological and social.

HEALTH
 Maintaining well-being by using person’s
power.
 Maintained by control of environment.

NURSING
 Provide fresh air, warmth, cleanliness, and good
diet, quiet to facilitate person’s reparative
process.
 In line with Florence Nightingale’s, Environmental theory, ventilation is essential
in ensuring the swift recovery of the patients and reducing cross infection. Nightingale
believed that the person who repeatedly breathed his or her own air would become sick or
remain sick. She was very concerned about “noxious air” or “effluvia” and foul odours
from excrement. She also criticized “fumigations,” for she believed that the offensive
source, not the smell, must be removed. Second to fresh air, the sick also needed light,
direct sunlight was what patients wanted. During patients recovery she should never be
waked intentionally or accidentally including unnecessary noises during the first part of her
sleep. Effective drainage and cleanliness are also important because this might prevent and
avoid infection in able to ensure the patients safety. In accordance to the case problem, it
can be associated to Nightingale’s theory, wherein, clean environment plays an important
role in revitalizing the patient’s optimum level of health. In order for the patient to reach
full recovery in healing from her present surgery, a good environment is to be ensured.
Having a clean, quiet and well-ventilated environment, also an effective drainage and pure
water will help the body to restore more quickly.
Comfort Theory by Katharine Kolcaba

PERSONS
 Individual and family is the recipient of the
nursing care.

ENVIRONMENT
 External surroundings of the patient either
family, or institutional surroundings that can be
manipulated to enhance comfort.

HEALTH
 Health is considered to be optimal functioning
as defined by the patient, and family through
enhanced comfort.

NURSING
 The process of assessing the patients comfort
needs, developing and implementing appropriate
nursing interventions, and evaluating patients
comfort following nursing interventions.
 Kolcaba described comfort existing in three forms: relief, ease, and transcendence.
If specific comfort needs of a patient are met, the patient experiences comfort in the sense
of relief. Within these concepts in mind, nurses formulate a comfort care plan, with the
goal of enhancing comfort over a measurement of baseline comfort. When comfort of
patients and/or families is enhanced, they can engage more fully, either consciously or
subconsciously, in health seeking behaviours. Health seeking behaviours are mutually
agreed upon goals. It can be internal and external. When patients and families do better,
the institution does better too, as in measures of patient satisfaction. Corresponding to the
comfort theory the patients is in need of sympathy in which she is grieving for her lost
child. In this Kolcaba’s theory enters to which it provide patients a holistic care including;
Physical to which it pertains to bodily sensations, homeostatic mechanisms, and immune
function. Psychospiritual pertaining to internal awareness of self, including esteem,
identity, sexuality, meaning in one’s life, and one’s understood relationship to a higher
order or being. Also variables include prognosis, financial situation, social support, and
others in an effort to find health.
Human to Human Relationship Theory by Joyce Travelbee

PERSONS
 The process is that of interaction.
 The nurse and the patient are human beings.

ENVIRONMENT
 Believed nursing is accomplished through
human to human.

HEALTH
 An individual defined state of well-being in
accord with self-appraisal of physical emotional
spiritual status.

NURSING
 Developing feelings of empathy, and later
feelings of sympathy. This relationship can only
be established by an interaction process.
 It is believed that nursing is accomplished through everything the nurse said or did
with an ill person helped to fulfill the purpose of nursing. This theory deals with the
interpersonal aspects of nursing, focusing especially on mental health. The nurse and the
patient are human beings, relating to each other. The process is presented through
interaction and will progress through stages emerging identities, developing feelings of
empathy and later feelings of sympathy. The main concepts are suffering, meaning,
nursing, hope, communications, self-therapy, and a targeted intellectual approach. Each of
these concepts is defined by Travelbee to help nurses understand. Suffering ranges from a
feeling of unease to extreme torture, and varies in intensity, duration, and depth. The nurses
job is to help the patient find meaning in the experience of suffering, as well as help the
patient maintain hope. Hope is defined as a faith that can and will bring change that will
bring something better with it. In terms with the patient in our case study after losing a
child from the complication of her pregnancy, and grieving for what she had lost and so
the job of the nurse is to give the client a possession of courage to be able to acknowledge
its shortcomings and fears and go forward toward its goal. This is to prove the assumption
that fulfillment in life is the best protection against emotional instability
 Self-care Theory by Dorothea Orem

PERSONS
 Reflect upon themselves and their environment
 Symbolize what they experience
 Use symbolic creations in thinking,
communicating, and guiding efforts to make
things that are beneficial for themselves and for
others

ENVIRONMENT
 Environmental conditions can be external
and/or psychosocial surrounding.
 The quality of an environment can positively or
negatively impact a person’s ability to provide
self-care

HEALTH
 Health includes promotion and maintenance of
health, treatment of illness and prevention of
complication.

NURSING
 A service geared towards helping the self and
others
 Is required when self-care demands exceed a
patient’s self-care ability (agency)
 According to Dorothea Orem’s Self Care Deficit people are distinct individual and
in which it focuses on the performance or practice of the individuals perform on their own
behalf. This might be actions to maintain one’s life and life functioning, develop oneself
or correct a health deviation or condition. People should be self-reliant and responsible for
their own care and others in their family needing care. In order to promote self-care
behaviors. A person’s knowledge and awareness is necessary in knowing the potential
health problems. Moreover, to maintain and enhance the health of the patient it is the nurse
job to create such plan to successfully implement it. In line with our case study the nursing
is needed because the patient is limited or incapable of providing self-care for the reason
that she undergoes a operation and or surgery and in need of help in order to improve her
health status. This can also improve the relationship between the nurse and the patient and
the wholly or the partial compensatory nursing system and supportive educative system
that takes place between nurse and the client. It also provide nurses with the resources and
support to empower themselves for it raise the idea that nurses should provide holistic care
and not just treat injuries but to also think critically in adjusting care based on the situation,
the patient, their own knowledge and their own desired outcome.
 NURSING CARE PLAN

Assessment Nursing Inference Planning Intervention Rationale Evaluation

Diagnosis

Subjective Fluid What is Independent

Short Term Short Term
Cues deficit hypovolemia?
Objective Objective
evidence by ● Assess client history ● Estimation of the
“I don’t
hypovolemi Hypovolemia is of blood loss volume of blood loss
notice my After 10 minutes After 10 minutes of
a(blood a decrease in the (amount, duration, aids in the
vaginal of nursing nursing
loss) volume of blood characteristics, and differential diagnosis
bleeding” as intervention the intervention the
in your body, presence of clot). . A one gram of pad
verbalized by client will be able client:
which can be Instruct pad count; weight is equal to
the patient to:
due to blood loss weigh approximately 1 ml ● Demonstrat
or loss of body ● Demonstra pads/underpad.] of blood loss. es
Objective
fluids. Blood te cooperation
Cues
loss can result cooperatio and
from external ● Monitor uterine ● Tenderness is
n and understandi
BP: 95/50 activity, fetal status,
injuries, internal understand usually present in ng with the
mmHg and any abdominal
bleeding or ing with ruptured ectopic procedure
PR: 120 bpm tenderness.
certain obstetric the
TEMP: 35.9 C Long Term
Hemoglobin: emergencies. procedure pregnancy or Objective
9.6 g/dl Diarrhea and abruptio placentae
Long Term
vomiting are After 4 hour of
Objective
common causes ● Monitor vital signs, ● Reflects the extent of nursing
of body fluid capillary refill, color blood loss, although intervention the
After 4 hour of
loss. Fluid can of mucous cyanosis and client:
nursing
also be lost as a membranes/skin changes in BP and
intervention the
result of large pulse are late signs
client will be able  Demonstrat
burns, excessive of circulatory loss
to: es
perspiration, or and developing
improveme
diuretics.Inadeq shock.
nt in
uate fluid intake ● Demonstra
fluid balanc
can also cause te Dependent
e
hypovolemia.At improvem
the onset of ent in ● Prepare for laparotomy

hypovolemia, fluid balan according to physician’s

the mouth, nose, ce order in the case of

and other ruptured ectopic

mucous pregnancy.

membranes dry
out, the skin ● Administer IV solutions,
losesits plasma expanders, whole
elasticity, and blood, or packed cells, as
urine output physician’s order.
decreases.
Initially,the
body
compensates for
the volume loss
by increasing the
heart rate,
increasing the
strength of heart
contractions, and
constricting
blood vessels in
the periphery
while preserving
blood flow to
the brain, heart
and kidneys.
With continuing
volume loss, the
body loses its
ability to
compensate and
blood pressure
drops. At this
point, the heart
is unable to
pump enough
blood to vital
organs to meet
their needs and
tissue damage is
likely to occur

Reference:
Healthgrades(20
21)
Hypovolemia.
Retrived from
https://www.hea
lthgrades.com/ri
ght-
care/symptoms-
and-
conditions/hypo
volemia#:~:text
=Hypovolemia%
20is%20a%20de
crease%20in,cau
ses%20of%20bo
dy%20fluid%20l
oss.
Assessment Nursing Inference Planning Intervention Rationale Evaluation
Diagnosis

Subjective Dysfunctional Independent Short Term:

Short Term
Cues Grieving grief is a type
Objective
related to of intense grief ● Support free flow ● Expression of grief After 30 minutes to
"kamusta na death of that may not of emotional is influenced by 1 hour of nursing
po ba yung the fetus progress in the expression. Only cultural/religious intervention the client
After 30
baby ko baka same manner restrict behavior beliefs and will be able to:
minutes to 1
kung mapano as normal that is dangerous expectations
hour, the
na po siya" as grief. A person to well-being of running the gamut ● Identified and
patient will be
verbalized by who patient/couple from stoic silence expresses her
able to:
the mother. experiences a to screaming and feelings
significant loss pounding one’s
● Ackno
Objective will process chest/throwing
wledge ● Patient
Cues their grief in objects.
Presenc recognized
ways that
e and impact/effect of
Crying depend on their ● Recognize the ● If the process of
impact the grieving
perception of stage of grief grieving is not
of process and
Verbal that loss. being displayed, completed, grief
dysfunc
expression of Several factors e.g., denial, may become
 distress, can determine tional anger, dysfunctional, inquires proper
anger, loss, whether a situatio bargaining, resulting in help
guilt person will n depression, behaviors that are
struggle with acceptance. Use disturbing to
Alteration in coping with ● Express therapeutic personal safety and
eating habits or their loss. The feelings communication to the future of the
Long Term:
sleep pattern individual's of loss, skills family and
After 2-3 days of
emotional state guilt, marriage/relationsh
nursing intervention
and how fear, ip.
the client will be able
capable they anger
to:
are of dealing or ● Assess severity ● Patient/couple may
with that loss sadness of depression. detach themselves
● Patient has plan
are two of and have problem
Long Term for future, one
those. making decisions
Objective day at a time
Dependent

After 2-3 ● Patient started to

● Review past life ● Useful in dealing
days of participates in
Reference: experiences/ with current
nursing self-care activities
Vasquez A. previous loss, situation and
intervention of daily living
(2019) role changes and
Dysfunctional the client will coping skills, problem solving Patient
grief Retrieved be able to: noting strengths/ existing needs participates in
from: success self-care activities
https://www.go of daily living
ogle.com/searc ● Maintai
Collaborative
h?q=Grieving+ n
related+to+dea healthy ● Severe grief
● Plan follow-up
th+of+the+fetu patterns response may be
meetings or phone
s+ncp&source of noted in older
calls, as appropriate.
=lnms&tbm=is sleep, women and those
Refer to community
ch&sa=X&ved activity with longer-term
resources/support
=2ahUKEwjZx and pregnancies. In
groups and refer for
4OO- eating addition, carrying
counseling or
p3vAhXh_2E the fetus for 1 or
psychiatric therapy,
KHcYIC- more days after
if necessary.
MQ_AUoAXo ● Mechan death increases
ECAcQAw&bi isms risk. In cases of
w=1366&bih= and pathological grief,
667#imgrc=jG social ongoing counseling
may be necessary
B9fG1xxxhad support to help
M system individual(s)
identify possible
causes of the
● Seek abnormal reaction
fulfillm and to achieve
ent resolution of the
through grieving process.
preferre
d
spiritua
l
practice
s
 Assessment Nursing Inference Planning Intervention Rationale Evaluation
Diagnosis

Subjective Fallopian tube Independent Short Term:

Acute pain Short Term
Cues rupture is most After 30 to 45 minutes
related to Objective ● Monitor maternal
often a ● To determine of nursing intervention
distention vital signs.
“Masakit po complication presence of the client will be able
or rupture After 30 to 45
ang tiyan ko a of a tubal hypotension and to:
of minutes of
pain scale of ectopic tachycardia
fallopian nursing
(7 out of 10) pregnancy caused by rupture ● Relieved pain
tube. intervention
“as where the or hemorrhage.
the client will
verbalized by pregnancy
be able to: ● To further assess
the breaks open ● Monitor for presence
patienT due to and amount of the present Long Term:
progressive ● The vaginal bleeding. situation After 7 hours of
growth. It can pain indicating nursing intervention
potentially lead scale of hemorrhage. the client will be able
Objective
to shock. 7 will ● Monitor for increase ● Increased pain
to:
Cues
and pain and and abdominal
● Facial be 4 out abdominal distention distention ● Replenish her
mask of 10 and rigidity. indicates rupture energy and be
pain Reference: and possible intra- able to interact
.
Goel, A. abdominal with her family
● Warry (2019) ● Facial hemorrhage. and nurses.
Dependent
behavio Fallopian Tube mask

ur rupture pain ● Provide comfort

Retrieved from and measures like back

● Promotes
https://radiopae warry rubs, deep breathing.
relaxation and
dia.org/articles/ behavio Instruct in relaxation
may enhance
fallopian-tubal- ur will or visualization
patients coping
rupture- be exercises
abilities by
1#:~:text=Fallo reduce
refocusing
pian%20tube% attention.
20rupture%20i ● Provide diversional
s%20most,can Long Term activities ● Diversional

%20potentially Objective activities aids in

%20lead%20to refocusing

%20shock. After 7 attention and

hours of enhancing coping

nursing with limitations.
intervention
the client will
be able to:

● Relieve
and
control

● Feel
refresh
 Assessment Nursing Inference Planning Intervention Rationale Evaluation
Diagnosis

Subjective Fear Preoperational Independent Short Term:

Short Term ● Patients who find
Cues related to anxiety is a ● Determine the type
Objective it unacceptable to
upcoming common of the patient’s fear After 5 to 10 minutes
expose fear may
“Natatakot po surgery reaction by thorough, rational of nursing intervention
After 5 to 10 find it convenient
ako sa experienced by questioning and the client will be able
minutes of to know that
gagawing patients who active listening to:
nursing someone is
surgery sakin are admitted to
intervention willing to listen if
“as a hospital for ● The fear was
the client will they choose to
verbalized by can be lessened
be able to: share their
the described as an
feelings at some
patient unpleasant
time ● Understand her
state of tension ● Lessen
feelings and
or uneasiness her fear ● To have an idea
identify healthy
that results ● Explain to the client about the disease
● Know ways to deal
Objective and family about the
from a patient's how serious it is
what with them.
Cues disease process
doubts or fears
are the
procedu
● Excessi
 ve before an res that
.
Sweati operation will be
● To lessen the fear
ng perform Long Term:
and to be prepare
to keep After 30 minutes of
● Shakin her ● Explain to the client nursing intervention
g of calm and family the the client will be able
hand treatment to:

● Feel ● The client is r

● The client will
Relax relaxed, able to
feel wanted and
● Convey an attitude rest/sleep
valid about her
of empathy appropriately.
feelings
Long Term
(allowing crying of
Objective
the patient) ● Active
participation
After 30
after the
minutes of
treatment
nursing
intervention
Dependent ● This help the
the client will ● Physician order of client to feel relax
be able to: anxiety medication if
needed
● Cooper
ative
with the
interve
ntion

● Duratio
n of
fear
will
decreas
e
DISCHARGE PLANNING

Medication  Take home the medication prescribed by the doctor. Then orient the
patient and other significant others about the drug (generic and
brand name), exact dosage, frequency, route of administration,
when to take, and the side effects.
 Tylenol (acetaminophen) 325 mg/tab q 4 hours for 10 days (can be
taken with or without, but take with food if GI upset occurs. It used
to treat mild or moderate pain.

Exercise /  Advised patient to take a morning walk gently as an exercise to

Environment promote faster healing and blood circulation and avoid heavy
workout.
 Don’t take any heavy housework to prevent the incision from
opening.
 Give the patient a peaceful surrounding away from stress.
 Advised others to assist the patient every time she needs help.

Treatment  Advised to take follow-up check-ups for faster recovery.

 Advised patient it requires 3-6 weeks to heal completely

Health Teaching  Instruct the patient to take her medicine (pain reliever and
/ Hygiene antibiotic).
 Take a complete bed rest and sleep for faster recovery
 Avoid stress
 Take a proper bath
 If possible, use a condom to prevent the bacteria to spread to her
partner that is caused by chlamydia trachomatis.
 Advised patient regarding their risk of future ectopic pregnancy.
 After a patient's treatment, she may have vaginal bleeding that's
similar to a period. It may last for up to a week. Use pads instead of
tampons. You may use tampons during your next period. It should
start in 3 to 6 weeks.
  Advise the patient that talking to family members, friends, or a
counsellor may help you cope with your loss.
 If you feel sad for longer than 2 weeks, tell your doctor or a
counsellor.

Observable Signs  Educate the patient and significant others. It takes 2 weeks for the
& Symptoms bleeding to stop.
 Instruct the patient and significant other if there’s a present of fever
go to the nearer hospital immediately.

Diet / nutrition  Inform the patient that food has a big impact to help the body to
recover from the surgery.
 Encourage patient to eat foods that are rich in Protein and Vitamin
C. It helps for tissue repair and regeneration of the wound.
 Remove red meat in the Diet Meal Plan because it may trigger
inflammation.

MEAL PLAN

DAY 1

BREAKFAST
 2 pcs. Of boiled egg,2 banana and low-fat milk

LUNCH
 Sinigang na bangus and 1 cup of rice
SNACK
 2 oranges and 1 apple, grapes(49g)

DINNER
  Stir fry chopsuey and 1 cup of rice

TOTAL CALORIC INTAKE: 1,095 kcal

DAY 2

BREAKFAST
 2 sweet potatoes, 1 chicken sandwich

LUNCH
 Adobong manok and 1 cup of rice
SNACK
 Strawberries (33.2g), grapes (30.2g), kiwi (36g), bananas (30g) and
pineapple (33g)

DINNER
 Adobong manok and 1 cup of rice

TOTAL CALORIC INTAKE: 1,559 kcal

DAY 3

BREAKFAST
 Mixed fruits, low fat milk, sweet potatoes

LUNCH
 Pinakbet and 1 cup of rice
SNACK
 Carrot juice
DINNER
  Kare- kare and 1 cup of rice

TOTAL CALORIC INTAKE: 1,035 kcal

DAY 4

BREAKFAST
 2 pcs. Of boiled egg,2 banana and low-fat milk

LUNCH
 Sinigang na bangus and 1 cup of rice
SNACK
 2 oranges and 1 apple, grapes(49g), strawberry juice

DINNER
 Fried tilapia and 1 cup of rice

TOTAL CALORIC INTAKE: 1, 276 kcal

Spirituality  Encourage the patient to have faith and pray to God ask for his
guidance and give you strength in life.
 Encourage others to give physical, emotional and mentally support
to the patient.
EVALUATION

In this case, as nursing students, we may easily distinguish the major issues about the topic
or subject of study and we will also get the potential and coherent solution of such issues of a
relevant subject and the reason why those have emerged. We came up with a topic called Ectopic
Pregnancy to associate it with our assigned rotation which is obstetrician-gynecologist focuses on
the complication. The group gained insights into the topic. It helps the students to widen their ideas
on how to give the best holistic care for the patient.

We students, experienced difficulties and concern about the interruption in our nursing
education would mean for future careers as registered nurses. We don't have exact knowledge about
this case and how we should execute the nursing intervention to make this possible. An elongated
situation and the need for clarity surrounding course completion resulted in a need for urgency,
increasing pressure and uneasiness for many. With increasing workloads and extra tasks, many
battled to adjust to academics and the encounter with our family with the expanding requests set
upon us in school. But with the help of the internet, articles, and books we are able to finish it and
adapt the new normal to overcome it.

The group gave their best to finish it and teamwork helped us strengthen our knowledge by
brainstorming giving each other ideas each member contribute all their to accomplish their goal by
using every technique they need to do to surpass their limits even that they don’t see it in an actual
way to make us know our weakness to gain our strength to complete our task.
BIBLIOGRAPHY

Abraham, S. (2014) Stages Of Development of the Fetus. Retrieved from

https://www.merckmanuals.com/home/women-s-health-issues/normal-pregnancy/stages-
of-development-of-the-fetus
Acetaminophen (tylenol): Side effects, dosages, treatment, interactions, warnings. (2017, April 14).
Retrieved March 07, 2021, from
https://www.rxlist.com/consumer_acetaminophen_tylenol/drugs-
condition.htm#what_are_side_effects_associated_with_using_acetaminophen
Azithromycin tablets - FDA prescribing INFORMATION, side effects and uses. (n.d.). Retrieved
March 07, 2021, from https://www.drugs.com/pro/azithromycin-tablets.html
Blood urea nitrogen (bun) test. (2019, July 02). Retrieved March 07, 2021, from
https://www.mayoclinic.org/tests-procedures/blood-urea-nitrogen/about/pac-
20384821#:~:text=Generally%2C%20a%20high%20blood%20urea,failure%20or%20rec
ent%20heart%20attack
Bupivacaine: Side effects, dosages, treatment, interactions, warnings. (2017, July 24). Retrieved
March 07, 2021, from
https://www.rxlist.com/consumer_bupivacaine_marcaine_sensorcaine/drugs-
condition.htm
Doenges, M.E. (2006). Nurses Pocket Guide 10th Edition. F.A Davis Company.
Gnugnol, D. (2020) All about Ectopic Pregnancy. Retrieved From
https://www.ncbi.nlm.nih.gov/books/NBK539860/#:~:text=Differential%20Diagnosis&te
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