Adventist Medical Center College

San Miguel, Iligan City

OB Case Study Presentation

with Ectopic Pregnancy

Presented to the Faculty of the

School of Nursing

In Partial Fulfillment of the Requirements for the degree

Bachelor of Science in Nursing

Abdullah, Asniah

Barodi, Hanifah

Bucayong, Karla Jane

Cornell, Nur Muhammad

Eusibio, Paul Jacob

Disomangcop, Fatma Anais

Ibarrat, Celesty Joy

Mimbalawag, Omerah

Nacabog, Nichole Julienne

Pandapatan, Jawaher

Villamor, Ruffa Mae

February 13, 2017

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TABLE OF CONTENTS

PAGES

OBJECTIVES 3-4

DEFINITION OF TERMS 5

INTRODUCTION 6-7

VITAL INFORMATION 8

MENSTRUAL HISTORY 9

PAST & PRESENT HISTORY 9-11

GORDON’S ASSESSMENT 12-16

PHYSICAL ASSESSMENT 17-19

NORMAL ANATOMY AND PHYSIOLOGY 20-21

PATHOPHYSIOLOGY 22

LABORATORY AND DIAGNOSTIC RESULTS 23-24

INSTRUMENTS 25-26

NURSING CARE PLAN 27-30

SURGICAL MANAGEMENT 31-33

DRUG STUDY 34-45

HEALTH EDUCATION PLAN 46-47

REFERENCES 48

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OBJECTIVES

General Objectives

The main goal of the group is to be able to present the case study of our chosen client that would
provide a comprehensive discussion of the pathological mechanism of the condition to yield
significant information for the case study.

Specific Objectives

After an hour and a half of our case presentation the

For the Presenters will be able to:

1. Deliver to the students and clinical instructors a very organized, systematic and logical
presentation of health condition and problems of our chosen client
2. Discuss the contributing risk factors and signs and symptoms associated in the health
condition and problems
3. Interpret the pertinent data gathered from the patient and her significant others
4. State past and present health history of the patient
5. Discuss the anatomy and physiology of the organ involved in the patient’s condition
6. Trace the pathophysiology of the patient’s disease
7. Interpret the laboratory test results
8. Discuss the problem identified and time-bounded nursing interventions
9. Discuss the nature of the drugs given
10. Discuss the surgical procedure performed
11. Discuss the health education plan

For the students:

After an hour and half of our case presentation the students will be able to:

1. Understand the health condition and problems of our client

2. Recognized the contributing risk factors associated in the health condition and problems
3. Learn the basic and appropriate nursing intervention, treatment plan of health condition
and problems of our based patient
4. Learn about management factors that optimize health
5. Participate and be encouraged in question and answer portion

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For the Clinical instructors:

After an hour and half of our case presentation will be able to:

1. Provide ongoing and timely feedback to the presenters regarding their learning needs and
performance
2. Give emphasis regarding the data that needs to be improved and enhanced
3. Provide an effective instructional skills
4. Suggest for further nursing management, community –based and family centered nursing
interventions
5. Clarify and add any information to the topic being discussed

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DEFINITION OF TERMS

An abscess –Is a collection of pus that has built up within the tissue of the body. Dysuria – Pain
urination or difficulty of urinating

Concepcion - The action of conceiving a child or of a child being conceived.

Ectopic pregnancy- Abnormal implantation occurred outside the uterine cavity

Electocautery -cautery using a needle or other instrument that is electrically heated.

Gravida- Number of pregnancy

Hemostasis- the stopping of a flow of blood

Human Chorionic Gonadotropin - Hormone produced in the human placenta that maintains the
corpus luteum during pregnancy

Implantation - The attachment of the fertilized egg when the fertilized egg (now called a
blastocyst) has completed its travel through the fallopian tube and adheres to the lining of the
uterus.

Laparotomy- An operation to open the abdomen

Oophorectomy- The removal of one or both ovaries by surgery

Salpingectomy-Removal of one or both intestine tubes though an abdominal incision

Salpingitis is an infection and inflammation in the fallopian tubes.

Trophoblast - A layer of tissue on the outside of a mammalian blastula, supplying the embryo
with nourishment and later forming the major part of the placenta.

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INTRODUCTION

In humans, implantation is the very early stage of pregnancy at which the conceptus adheres to
the wall of theuterus. At this stage of prenatal development, the conceptus is a blastocyst. It is by
this adhesion that the fetus receives oxygen and nutrients from the mother to be able to grow.

In humans, implantation of a fertilized ovum is most likely to occur about 9 days after ovulation,
ranging between 6 and 12 days. The reception-ready phase of the endometrium of the uterus is
usually termed the "implantation window" and lasts about 4 days. The implantation window
follows around 6 days after the peak in luteinizing hormone levels. With some disparity between
sources, it has been stated to occur from 7 days after ovulation until 9 days after ovulation, or
days 6-10 postovulation.On average, it occurs during the 20th to the 23rd day after the last
menstrual period.

The implantation window is characterized by changes to the endometrium cells, which aid in the
absorption of the uterine fluid. These changes are collectively known as the plasma membrane
transformation and bring the blastocyst nearer to the endometrium and immobilize it. During this
stage the blastocyst can still be eliminated by being flushed out of the uterus. Scientists have
hypothesized that the hormones cause a swelling that fills the flattened out uterine cavity just
prior to this stage, which may also help press the blastocyst against the endometrium.[5] The
implantation window may also be initiated by other preparations in the endometrium of the
uterus, both structurally and in the composition of its secretions.

Ectopic pregnancy is the one in which the implantation occurred outside the uterine cavity. The
most common site ( in the approximately 95% of such pregnancies)is in the fallopian tube. Of
these fallopian tube sites, approximately 80% in the ampullar portion, 12% occur in the isthmus,
and 8% are in the interstitial or fimbrial. With ectopic pregnancy, fertilization occurs as usual in
the distal third of the fallopian tube. Unfortunately, because an obstruction is present, such as an
adhesion of the fallopian tube from a previous infection ( chronic salpingitis or pelvic
inflammatory disease), and congenital malformations, scars from tubal surgery or a uterine
tumors pressing on the proximal end of the tube, the zygote cannot travel the length of the tube.
It lodges at a strictured site along the tube and implants there instead of in the uterus. (Pilliteri,
2014)

Ectopic pregnancy, also known as eccyesis or tubal pregnancy, is a complication of

pregnancy in which the embryo attaches outside the uterus.Signs and symptoms classically
include abdominal pain and vaginal bleeding. Less than 50 percent of women have both of these
symptoms. The pain may be described as sharp, dull, or crampy. Pain may also spread to the
shoulder if bleeding into the abdomen has occurred.Severe bleeding may result in a fast heart
rate, fainting, or shock.[1][2] With very rare exceptions the fetus is unable to survive.

6
Risk factors for ectopic pregnancy include: pelvic inflammatory disease, often due to Chlamydia
infection,tobacco smoking, prior tubal surgery, a history of infertility, and the use of assisted
reproductive technology. Those who have previously had an ectopic pregnancy are at much
higher risk of having another one. Most ectopic pregnancies (90%) occur in the Fallopian
tube which are known as tubal pregnancies.Implantation can also occur on the cervix, ovaries, or
within the abdomen. Detection of ectopic pregnancy is typically by blood tests for human
chorionic gonadotropin (hCG) and ultrasound. This may require testing on more than one
occasion. Ultrasound works best when performed from within the vagina. Other causes of similar
symptoms include: miscarriage, ovarian torsion, and acute appendicitis.

Prevention is by decreasing risk factors such as chlamydia infections through screening and
treatment. While some ectopic pregnancies will resolve without treatment, this approach has not
been well studied as of 2014. The use of the medication methotrexate works as well as surgery in
some cases. Specifically it works well when thebeta-HCG is low and the size of the ectopic is
small. Surgery is still typically recommended if the tube has ruptured, there is a fetal heartbeat,
or the person's vital signs are unstable. The surgery may be laparoscopicor through a larger
incision, known as a laparotomy.[1] Outcomes are generally good with treatment.

The rate of ectopic pregnancy is about 1 and 2% that of live births in developed countries,
though it may be as high as 4% among those using assisted reproductive technology. It is the
most common cause of death during the first trimester at approximately 10% of the total. In
the developed world outcomes have improved while in the developing world they often remain
poor. The risk of death among those in the developed world is between 0.1 and 0.3 percent while
in the developing world it is between one and three percent.[6] The first known description of an
ectopic pregnancy is by Albucasis in the 11th century. The word "ectopic" means "out of place".

Up to 10% of women with ectopic pregnancy have no symptoms, and one-third have nomedical
signs. In many cases the symptoms have low specificity, and can be similar to those of
other genitourinary and gastrointestinal disorders, such as appendicitis,salpingitis, rupture of
a corpus luteum cyst, miscarriage, ovarian torsion or urinary tract infection.[1] Clinical
presentation of ectopic pregnancy occurs at a mean of 7.2 weeks after the last normal menstrual
period, with a range of 4 to 8 weeks. Later presentations are more common in communities
deprived of modern diagnostic ability.

Signs and symptoms of ectopic pregnancy include increased hCG, vaginal bleeding (in varying
amounts), sudden lower abdominal pain, pelvic pain, a tender cervix, an adnexal mass, or
adnexal tenderness.[2] In the absence of ultrasound or hCG assessment, heavy vaginal bleeding
may lead to a misdiagnosis of miscarriage.[1] Nausea, vomiting anddiarrhea are more rare
symptoms of ectopic pregnancy.[

Rupture of an ectopic pregnancy can lead to symptoms such as abdominal

distension,tenderness, peritonism and hypovolemic shock. A woman with ectopic pregnancy

7
may be excessively mobile with upright posturing, in order to decrease intrapelvic blood flow,
which can lead to swelling of the abdominal cavity and cause additional pain.[8]

There are a number of risk factors for ectopic pregnancies. However, in as many as one third[9] to
one half[ no risk factors can be identified. Risk factors include:pelvic inflammatory
disease, infertility, use of an intrauterine device (IUD), previous exposure to DES, tubal surgery,
intrauterine surgery (e.g. D&C), smoking, previous ectopic pregnancy, endometriosis, and tubal
ligation. A previous induced abortion does not appear to increase the risk.

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 VITAL INFORMATION

Name: Miss France

Age: 33 years old

Place of birth: Negros occidental

Religion: Roman Catholic

Race: Cebuano

Civil status: Single

Date of admission: February 05, 2017

Time of admission: 07:38 pm

OB Index: G3P1A0L1Mo

Age of gestation: 4 weeks

Diagnosis: Consistent Ectopic Pregnancy

Chief complaint: Severe hypogastric pain and vaginal spotting

Physician: Mr. Jacobe

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 MENSTRUAL HISTORY

Miss France started her menarche when she was 15 years old. She would usually have 28
days of cycle with a period duration of four to five days. She can consume 2 pads of sanitary
napkins. She does not experience dysmenorrhea. Her last menstrual period was Jan 09, 2016
with the expected date of delivery of September 26, 2017

PAST HISTORY

Miss France had a mumps when she was 9 years old. She does not usually get cough or
colds but experiences fever at times due to weather conditions. She got pregnant at the age of
24. She delivered her daughter via normal spontaneous vaginal delivery (NSVD), at home in the
year 2008. According to her obstetrical record, she has G3P1A0L1Mo . She stated that she had
all the necessary prenatal check-ups with her first pregnancy at the health center and no
complications were noted. There is no history of ectopic pregnancy in the family.

Miss France was admitted in Lanao del norte on her 2nd pregnancy in the year 2010. The
fetus has gestational week of 16 . Ultrasound result was done with the result of ectopic
pregnancy. She was advised to transfer in Mhars General Hospital- Ozamis City because there is
no available operating doctor at that time. She had undergone left salpingectomy.

PRESENT HISTORY

February 8-9, 2017, we, the Adventist Medical Center College (AMCC) nursing
students was given the opportunity to have clinical exposure – Delivery Room at Lanao Del
Norte Provincial Hospital. Miss France was one of the patients admitted to the Gyne Ward. She
was admitted due to diagnosed ruptured ectopic pregnancy. She undergone pelvic laparotomy
and right salpingectomy- oophorectomy.The group chose Miss France as their subject primarily
because her case posed as a very intricate case requiring due understanding and knowledge. The
group recognizes their partial knowledge about ectopic pregnancy and the surgical procedures
involved in such condition, thus making this case a good avenue to broaden the proponents
knowledge about the disease and the surgical procedures involved.

The purpose of our duty is for us to conduct high-depth assessment of a childbearing woman and
her family and plan nursing care specific to that client, basing on nursing research and standards
of care. The assessment will include physiologic, psychologic, social, cultural, and

10
environmental influences pertaining to the client as it relates to preconception, antepartum,
intrapartum and postpartum care as well as the newborn.

This duty has been considered an importance experience for us nursing students to apply
theoretical knowledge to real situations. We must acquire knowledge from clinical exposure for
us to adapt ourselves in dealing with the patient which can affects and improve our learning and
attitude towards professional nursing.

One week prior to admission, Miss France was lying on the bed when she first felt the
symptoms. She experienced knife like stabbing pain in her hypogastric region followed by
consistent nausea and vomiting.

Hours prior to admission, her condition became worsen. She observed blood spotting
which prompted her to go to the Hospital. Her vital signs are as follows: T- 36 C, BP- 90/60,
HR-87, RR-22.Ultrasound of the lower abdomen was done with the result of consistent with
ectopic pregnancy. She was advised to undergo emergency pelvic laparotomy.

The surgical procedure started at 12:27pm and ended at 1:49 P M.,with the following
vital signs of T-36.1 C; BP- 120/60, PR- 115 and RR- 20. IVF hooked of D5LR 1 L@ 30
ggts/min @ right metacarpal vein, and PNSS 1L @ 30 gtts/min @ left metacarpal vein.; Pre Op
medications given like: Nalbuphine 5mg IV, Midazolam 20mg IV, Ephedrin 5 mg and
Tranexamic acid 1 gram IV: Post op medications: (Ceptriaxone, 1 gram IV q 12 hr, Tranexamic
acid 1 gram IV TID, Ketolorac 30mg IV x 6 doses q 6hr, Paracetamol 500 mg q 4hr, Ranitidine,
50 mg IV q 6hr, Metocloramide , 10mg IV q 6hr, Diphenhydramine 50 mg IV PRN q 6hr,
Celecoxib 200 mg 1 tab BID, Folic acid 500 mg, 1 tab OD, Cophixine, 500 mg, TIDX 5 day).
Blood transfusion was given with 450 cc piggyback @ Left metacarpal vein. Blood type was A
positive , 1pack of RBC.

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 GORDON’S ASSESSMENT

PATTERN BEFORE DURING ADMISSION

ADMISSION
1. Health Perception  Miss France was admitted  Conscious and coherent.
due to hypogastric pain Concerns for her surgical
and scanting of blood. site after incision and
 She understands that the repair. Willing to accept
treatment and the and listen to health
operation is for the teachings. Shows interest
improvement of his health to recover easily and fast.
status.
 She had undergone pelvic
laparotomy and left
salpingectomy in the year
2010
 She is expected that the
hospital will give the right
treatment for her fast
recovery and the good
treatment of the nurses and
other staff in the hospital.
2. Nutritional  Miss France eats  NPO status for emergency
vegetables and dried fish pelvic laparotomy
most of the time.  She continues her
 She does not have any nutrional meal after she
food allergies. pass out flatus, day after
 She Takes Enervon C surgery, 9 am.
twice a day before in her  She was advised to eat
first pregnancy food softener, “Lugaw”
 They do not go to fast food and drink water
restaurants because of
financial constraints.
 She has discomfort in
eating or swallowing prior
to admission due to
swollen gums.
 Miss France drinks 6-8

12
 glasses of water per day.
3. Elimination  Miss France usually  No pain and burning
defecate 3x a week. sensation during urination
 She would usually  No bowel movement since
haveseldom constipation admission
 She urinates 3x a day  Catheter bag was
 No skin problems. She introduced prior to surgery
does not experienced and removed on Feb 09,
excessive perspiration and 2017 at 10 am with the
odor problems. output of 300 cc
4. Exercise and Activity  Her daily routine is doing Confine to bed
household chores.
 She played volleyball
every afternoon as her
daily exercise.
 No problem experienced
with usual activity and
exercise.
 She started to smoke at
the age of 15 and stopped
last January, 2016
 She consumed 10-16
sticks of cigarettes per
day.
 Miss France does not
experience any chest or
back pain, and does not
have any difficulty of
breathing.
5. Sleep/Rest  Miss France usually wakes  Able to rest and sleep
up at 7am in the morning. after post operation
Takes nap after doing
household chores 2hrs per
day. Feel rested and ready
for daily activities after
sleep.
 She does not need any aids
to help her sleep and she

13
 does not suffer from
insomnia or nightmares.
6. Personal Habits
a. Tobacco  Started smoking at the Confine to bed
age of 15. Estimated
packs is 10-15 sticks per
day. She stops it last
January 2016

b. Alcohol  She stated that she cannot

avoid drinking . She
only drinks occasionally and
does not have plan to quit

c. Street Drugs  Tried taking shabu twice

and stop using it when
she got pregnant on her
1st pregnancy
9. Environmental Hazards  Lives with her husband  Feels discomfort and
and only child in irritated because of poor
Poblacion Tubod, Lanao environment, lack of
del norte. ventillation ( No ceiling
 She stated that she lives or electric fan a)
in a safe area; they have  Risk for infection (Ward
quick access to area)
transportation as they live
close to the highway.
 She describes her home as
safe and feels comfortable
staying there.
10. Intimate Partner Violence Well supported and loved by Well supported by the family
her family with close Still plays the role of being
relationship mother despite condition by
means of reminding important
matter to her child
Occupational Health Miss France works as Laundry Post pelvic laparotomy.
woman Confine to bed in semi

14
 fowler’s position
Cognitive and Perceptual  No visual examination. Post op: Äkong tahi nagasakit
 Does not wear eye glasses pa”
or contact lenses. as verbalized pain felt around
 Does not experience the surgical site.
blurring vision.
 No hearing problems
 Pain felt radiating on the
abdomen

Self-Perception  Recently, Miss France  Though weak, she still

believed that admission managed to be calm and
will be helpful to assist relaxed.
her in her needs, to  Agreed to be operated and
alleviate the pain she felt. undergo surgery and gives
Hopeful to be relieved and her trust to the surgical
treated. team.
 Felt depressed when  She accepted her
diagnosed with ectopic condition afterward.
pregnancy.

Role-Relationship  Living with spouse and  Turns for help of friends

child.  The family does not
 Family structure type is depend on her
cohabitation. turns for  The family continue
help to her friends praying about her
 They were not depending condition and accepted the
on her. In times of illness, condition afterwards.
her family manage it by
praying and trusting with
God
 Her health status affects
their relationship to
others by the stress.
 When the family
members and friends

15
 knew about the conditon
they felt anxiety.

Sexuality and Reproduction  Satisfied with her sexual Confine to bed

relationship
 Taking contraceptives,
does not had any
problems using
contraceptives
 Her last menstrual period
was on January 9, 2016
 She has one child
 She started her menarche
when she was 15 years old

 Diagnosed with UTI

Coping Stress Management  In tears when diagnosed .

with ectopic pregnancy  She already accepted the
and that the baby will not condition
be able to survive.
 Ectopic is the cause of her
stress in the past.
 She usually solve her
problems by accepting the
condition she has.
 Miss France deals with
her tension and stress by
sharing her problems with
her friends
 During personal crisis she
turns for help to her
friends
 She handles her problems
successfully most of the
time

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Values and Beliefs  Family is the most  Still Family is the most
important things to important things
 Stated that she does not  Her plan for the future was
generally gets what she to take care of her only
wants in life child
 Her plan for the future was  She finds meditations and
to take care of her children prayer helpful.
 For her, being sick does  For her, being sick doesn’t
not affect her beliefs and affect her beliefs and
religion to God religion to God

Spiritual Resources Have a strong faith with God The admission and surgery
don’t interfere with spiritual
practices as stated by Miss
France.

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 PHYSICAL EXAMINATION

VITAL SIGNS

BP:120/90mmHg
PR:25bpm
Temperature: 3636.5C -

SYSTEM FINDINGS
General Apperance o With facial grimace
o Weak and pale looking
o With foul breath
o Conscious and coherent
o IVF hooked of D5LR 1 L @ 30
ggts/min @ right metacarpal vein,
and PNSS 1L @ 30 gtts/min @ left
metacarpal vein
o Indwelling Foley Catheter
o Transverse abdominal incision site

EENT
EARS o Symmetrical
o No pain
o No discharges
o With dry cerumen
o No ringing or cracking in ears
o Normal voice sound is audible

EYES o No presence of redness

o No watery or discharges
o No swelling
o Round and dark brown iris
o Pale conjunctiva
o Pupils Equally Round React to Light
Accommodation (PERRLA)

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NOSE o The external nose is symmetrical
o Color is the same with entire face
o Lesions and tenderness were both
absent
o Nasal mucosa was pink
o No discharges
o Nasal flaring was not noted
o No tenderness noted on palpation,
THROAT o No pain when palpitated
o No lesions
LUNGS o No tenderness upon palpitation
o Normal breathing pattern
o Respiratory rate of 15-18
o No abnormal sounds upon auscultation
BREAST o Round in shape
o No swelling
o No dimpling
o No redness and pain, No any nipple
discharges, Dark brown areola
o No inverted nipples.
HEART o Heart rate of 85- 114
o Blood pressure of 110/60- 120/70
o No murmurs presence
o No tenderness
o Heart sounds clear
ABDOMEN o Same color of the body
o Presence of stretch marks and surgical
scar
o Surgical site (transverse abdomen) with
dry dressing
o Bowel sounds not present after surgery
o Throbbing on surgical site
VAGINAL/PERINEUM o Scanty vaginal bleeding
o Discomfort
o With FBC and removed last February
09,2017 at 10 am
EXTREMITIES

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Upper o Good range of motion was noted
o No lesions
o No presence of abnormalities
o No tenderness
o Can extend arms without difficulty
o IVF hooked of D5LR 1 L @ 30
ggts/min @ right metacarpal vein, and
PNSS 1L @ 30 gtts/min @ left
metacarpal vein
Lower o Skin uniform in color
o No varicose
o Presence of edema
o Calf numbness

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NORMAL ANATOMY AND PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM

The female reproductive organs consist of the ovaries, uterine tubes ( or fallopian tubes), uterus,
vagina, external genitalia and mammary glands

Ovaries - the two ovaries are small organs suspended in the pelvic in the pelvic cavity by
ligaments. Ovaries are the female reproductive glands where the 400,000 ova or egg cells are
stored. The outer part of the ovary is made up of dense connective tissue and contains ovarian
follicles

Fallopian tubes – the uterine tubes extend from the area of the ovaries to the uterus. They open
directly into the peritoneal cavity near each ovary and receive the oocyte. The opening of each
uterine tube is surrounded by long, thin processes called fimbriae. It is a 4 inches long from each
side of the uterus (fundus). It transports the mature ova form the ovaries to the uterus and provide
a place for fertilization of the ova by the sperm in it’s outer 3rd or outer half.

Parts:

Isthmus – portion that is cut or sealed in a tubal ligation

Ampulla – widest, longest portion that spreads into fingerlike projections/fimbriae and it is
where fertilization usually occurs.

21
Infundibulum – rim of the funnel covered by fimbriated cells (hair covered fingerlike
projections) that help to guide the ova into the fallopian tube.

Uterus – is as big as a medium-sized pear. The part of the uterus superior to the entrance of the
uterine tubes is called fundus. The uterine wall is composed of three layers:

The outer layer called the serous layer or perimetrium of the uterus

The middle layer called the muscular layer or myometrium

The innermost layer of the uterus is the endometrium

The uterus is supported by the broad ligament and the round ligament

Vagina - is a female organ of copulation and functions to receive the penis during intercourse. It
also allows menstrual flow and childbirth. The superior portion of the vagina is attached to the
sides of the cervix so that a part of the cervix extends into the vagina.

External Genitalia – also called vulva or pudendum of the vestibule and its surrounding
structures. The vestibule is the space into which the vagina and urethra open. The vestibule is
bordered by a pair of thin, longitudinal skin folds called the labia minora. A small erectile
structure called clitoris. The two labia minora unite over the clitoris to form a fold skin called the
prepuce. Lateral to the labia minora are two prominent, rounded folds skin called labia majora.
The space between the labia majora is called the pudendal.

Fertilization is the meeting of sperm cell and the fertilized ovum. It can only occur if intercourse
takes place before the time of ovulation that usually occurs mid-cycle or about 14 days before the
women’s next menstrual period. At the time of ovulation, the ovum is released from the ovary
and transported in the fallopian tube where it remains for about 24-48 hours. Sperm cells remain
viable within the female reproductive tract for about 72 hours. Only a single sperm cell is needed
to fertilize the ovum, even though the average ejaculation contains approximately 300 million
sperm.

22
23
24
 Laboratory Results

02/05/2017

BLOOD RESULT NORMAL INTERPRESE SIGNIFICANCE

COMPONEN VALUE NTATION
TS
White Blood 7.2 4.1- 10k/Ul Normal ---------
cells
Red blood 4.03 M 4.7-6.1 Decrease Decrease RBC will
cells F 42-5.4 cause low oxygen
supply
Hemoglobin 110 M 130-170 F Decrease Decrease
120-160 hemoglobin will
result to bleeding.
Hematocrit 0.35 M 0.40-0.54 F Decrease Decrease
0.37-0.47 hematocrit
indicates that the
mass of RBC is
decrease.
Differential
Count
Neutrophils 0.67 0.50-0.70 Normal
Lymphocytes 0.30 0.25-0.40 Normal
Monocytes 0.03 0.01-0.03 Normal
Platelet 220 150-450 Normal

25
 Ultrasonography

02/08/17

Diagnostic exam Normal result Result Dignosis

Obstetric No anatomical or The uterus is Consistent with
ultrasonography functional anteflexed measuring ectopic pregnancy
abnormalities exist. 6.7 cm in length x
The organs are normal 4.70 cm in width x
in shape and size, 5.61 cm in thickness
shape, contour and with homogenous
position. The internal echotexture
structures of the endometrial stripe
organs and nearby measuring .86cm
tissues are with
normal limits No masss, no
gestational sac seen

Free fluid posteror cul

de sac about 650 cc
Urinay bladder
unmarkable

26
INSTRUMENTS

INTRUMENTS USES

1 Bladder retractor - a surgical instrument with which

a surgeon can either actively separate the edges
of a surgical incision or wound,

2 Richardson - used for holding back multiple layers of deep

tissue. This retractor is often used in
appendectomy procedures, as well as
Caesarean Sections and Laparotomy.

2 Thump forcep used to hold tissue in place when applying

sutures, to gently move tissues out of the way
during exploratory surgery and to move
dressings or draping without using the hands or
fingers.

1 Tissue forceps used to stabilize the Soft Tissue but holding or

Grasping it to help prevent any interference by
Soft tissues in Surgeries. They are used to
hold tissue which is being excised
or tissue ends while suturing, and also used to
hold/grasp dressings and surgical materials.

2 Blade holder 3 & 4 used for surgery, can have permanently

attached blades that can be sharpened

1 Mayo scissors used to cut thick tissues such as those found in

the uterus, muscles, breast, and foot.

5 Kelly clamp curved used to clamp small blood vessels. Its jaws
may be straight or curved.

5 Kelly straight forceps used for clamping large blood vessels or

manipulating heavy tissue. They may also be
used for soft tissue dissection.

27
5 Towel clips to hold sterile towels as close to the incision as
possible. used during an operation in an obese
patient who had a ruptured appendix.

5 Straight clamps used for grasping and holding objects.

2 Needle holder used in many surgical procedures to control

bleeding.

2 Babcock used to grasp delicate tissue in laser

procedures. They are frequently used with
intestinal and laparotomy procedures.

28
Nursing Diagnosis: Ineffective tissue perfusion meaning related to surgical incision

Cues Planning Intervention Rationale Evaluation

Within one hour Independent:
and half of 1. .Position Upright
nursing patient positioning

intervention properly in a promotes

semi-Fowler’s improved alveolar
to high- gas exchange.
Fowler’s as
tolerated.

2. Encourage Enhances
and assist circulation and
with early return of normal
ambulation. organ function.

3. Monitor Vital - To have baseline

signs data

Dependent:
1. Check for
optimal fluid
balance.
Administer IV

29
Nursing Dianosis: Fluid volume deficient related to blood loss

Cues Planning Intervention Rationale Evaluation

Subjective After 8 hours of Independent Goal was met
:“Kalipongo nursing intervention 1. Monitor Decrease in  Demonstrates
and circulating
n ko  Demonstrates lifestyle changes
document blood to avoid
Objective: lifestyle changes
vital signs volume can progression of
Blood loss to avoid
especially cause dehydration
progression of
900cc BP and hypotension
dehydration  Verbalizes
HR and
 Verbalizes awareness of
2. Assess tachycardia
awareness of causative
skin turgor Signs of
causative factors and
and oral dehydration
factors and behaviors
mucous are also
behaviors essential to
membrane detected
essential to correct fluid
s for signs through the
correct fluid deficit.
of skin
deficit.  Explains
dehydratio
 Explains measures that
n.
measures that can be taken to
3. Assess A normal
can be taken to treat or prevent
color and urine output
treat or prevent fluid volume
amount of is
fluid volume loss.
urine considered
loss. Patient
normal not
Patient describes
less than
describes symptoms that
30ml/hour.
symptoms that indicate the
Concentrate
indicate the need to consult
d urine
need to consult with health care
denotes fluid
with health care provider
Dependen deficit.
provider
t:
1. Urge the
patient to
drink
prescribed
amount of
fluid
 D5LR 1
L @ 30
ggts/min
PNSS 1L
@ 30

30
gtts/min

31
 NURSING CARE PLAN

Nursing Diagnosis: ACUTE PAIN RELATED TO DISTENTION FALLOPIAN TUBE

CUES PLANNING INTERVENTION RATIONALE EVALUATIO

Subectives: Short term: Independent: After 8 hours

“Sakit Within an of nursing
kaayo hour of -Monitor maternal vital - To have baseline intervention
akong pus- nursing signs date the patient
on” as intervention able to
verbalized the client’s verbalized and
by the pain will be -Used pain rating scale -To assess the rate of the showed relief
patient lessen and appropriate for age/ intensity,quality,frequency of discomfort
controlled condition. of pain ,pain lessened
from 8/10 to
Objective: Long term: - Obtained client’s 6/10 pain
- Facial After 8 assessment of pain to scale
grimace hours of include - To rule out worsening of
- Irritable nursing location,characteristics underlyiing condition
- Weak and intervention onset/duration. development of
pale the patient complication
looking will
-Limited verbalize -Provide comfort
movement and show measures such as
P- When relief of pain touch, repositioning
lying down lessened use of colds - To promote non
Q: from 8/10 in pack,nurse’s presence pharmacological pain
Throbbing pain scale and quiet environment management
R Incision and calm activities.
site
S: Mild -Instructed and
T: encourage use of -To distract attention and
Consistent relaxation reduce tension

The vital Dependent:

32
signs taken: - Administered -To decrease pain at
T: 36.4 analgesics ordered tolerable level.
PR: 80  Ketorolac
RR: 25  CelecoxiB
BP: 11O/90

33
NURSING DIAGNOSIS: Powerlessness related to early loss of pregnancy secondary to ectopic
pregnancy

CUES PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: After 8 hours Independent: To provide the After 8 hours of
intervention the patient with nursing
1. Be available to
Client states she patient will be psychological interventions the
listen.
feels sad at able to : support patient was able
pregnancy loss A) Express to:
but is able to feelings of A) express
2. Accept the
deal with physical safety. To decrease the feelings of
patient’s feelings
situation; has patient’s fear of physical safety.
B) Use effective and behaviors.
returned to work being left alone
coping B) Use effective
has forward and to encourage
mechanisms to coping
thinking plans. a trusting
reduce mechanism to
relationship.
depression. reduce
Objective 3. Instruct the
depression.
C) Mobilize patient in at least
: Receive pt. On support systems one fear reducing -To express C) Mobilize
bed with grimace and professional behavior or, such empathy with the support systems
face, weak resource as as seeking patient’s and professional
conscious and necessary. support from feelings. resource as
has the ff. Vital others when necessary
D, Re establish
signs: frightened.
and maintain D.Reestablish
- To reassure the
adaptive 4..Help her and maintain
patient that
interpersonal understand the adaptive
they’re
relationships phase of crisis interpersonal
appropriate and
and the patient’s relationships
valid
reactions to the
family members.

34
NURSING DIAGNOSIS: Risk for infection related to tissue destruction and increase in
environmental exposure/vertical incision.

CUES PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: After 8 hours of Independent: A) Verbalize
nursing understanding of
-Note risk factors - serve as basis
“Gapula pula interventions the individuals
occurrence of in providing
akong tahi” patient will be causative risk
infection.Clean preventing
able to: factors.
incision with betadine actions
A) Verbalize
or appropriate solution. B) Identify
Objective: understanding of
interventions to
individual -Change dressing as
-To reduce prevent or
Received pt. causative risk needed or indicated.
spread of reduce risk of
On bed with factors.
infection and to infection.
vertical
B) Identify promote
incision at C.Demonstrate
intervention to optimal
lower technique,
prevent/ reduce -Monitor for signs and healing.
abdomen lifetime changes
risk of infection. symptoms of sepsis.
with binder to promote safe
C)Demonstrate environment
Dependent:
technique,lifetime
Administer analgesic
changes to To assess
as ordered
promote safe patient or in
 Paracetamol
environment order to
 Ranitidine
prevent further
 Celecoxib
infections
-Prevent
infection and
fast healing of
wounds

35
NURSING DIAGNOSIS: Anxiety related to anticipatory loss/death of fetus

Subjective: Short term: - Promotes a free Goal was met

“na guol gyud ko Dependent: discussion of because the
ug nasayangan After 8 hours of 1. Provide open feeling and mother had
kay namatayan nursing environment and concerns accepted that the
napud ko og intervention the trusting baby or fetus was
anak” as patient will be relationship - Enhances sense lost
verbalized by the able to identify of trust and
patient and express 2. Be honest nurse client
feelings when answering relationship
Objective: effectively questions
Facial expression providing - Indicators of
of feeling sad information severity of
Long term: Afte feelings client is
8 hours of 3. Identify experiencing a
nursing problems with need for specific
intervention the eating, activity interventions
patien will be level, sexual
able to long desire role - To meet on
toward a plan for performance going needs and
future one day at facilitate grief
a time 4. Refer to work
additional
sources such as
fannily, friends
and community

36
 SURGICAL MANAGEMENT

Salpingo-oophorectomy is the removal of the fallopian tube (salpingectomy) and ovary

(oophorectomy). A unilateral salpingo-oophorectomy is appropriate for patients in whom an
ovary is unable to be preserved, including cases of ruptured ectopic pregnancy with an inability
to achieve hemostasis without removal of the tube and ovary, adnexal torsion in which the ovary
and tube are necrotic, a tuboovarian abscess not responsive to antibiotics, or a benign ovarian
mass in which there is no remaining normal ovarian tissue able to be conserved. A bilateral
salpingo-oophorectomy is generally one of three types: elective at time of hysterectomy for
benign conditions, prophylactic in women with increased risk of ovarian cancer, or because of
malignancy.

An abdominal approach may be preferred if the patient has known or suspected severe adhesive
disease, a large adnexal mass, or if there is a high suspicion of malignancy. [13] A laparoscopic
approach may be appropriate in cases with low risk of malignancy and smaller sized adnexal
mass. [13] A laparoscopic approach is beneficial in that it decreases blood loss, length of hospital
stay, and recovery time. A vaginal approach is the least common approach [14] and is only used
when a salpingo-oophorectomy is done concurrently with a vaginal hysterectomy.

The patient is transferred to the operating room table and placed under general anesthesia.
A pelvic examination is performed to determine uterine position, size, shape, and mobility, and
to palpate the adnexa. A Foley catheter is normally placed to gravity to drain the urinary bladder
throughout the procedure. The patient is positioned in a dorsal supine position and the patient's
abdomen is prepped and draped in a sterile fashion.
A transverse or vertical incision may be chosen depending on the indication for surgery, the
patient's body habitus, and the preference of the surgeon. The advantages of a transverse incision
include improved cosmetic results, a stronger incision with decreased wound dehiscence, and
decreased postoperative pain. Disadvantages of a transverse incision include increased blood loss
and hematoma formation, increased risk of nerve injury, decreased exposure of the upper
abdomen, and longer procedure time.
Advantages of vertical incisions include faster entry into the abdominal cavity, decreased blood
loss, decreased risk of nerve injury, and the ability to significantly extend the incision if
improved exposure is required, as for surgical staging in cancer cases. Disadvantages of a
vertical incision include poor cosmetic results, weaker incision with increased risk of wound
dehiscence, and increased postoperative pain.
After the abdomen is entered, the abdomen and pelvis are explored. Care should taken to
carefully inspect the uterus, the bilateral ovaries and tubes, the small bowel, colon, omentum,
and peritoneal surfaces for any abnormal findings.

37
A self-retaining retractor is often used to aid with exposure. The bowels are then packed to allow
for adequate exposure of the pelvis.

The infundibulopelvic ligament should be identified. The infundibulopelvic ligament contains

the ovarian vessels encased in peritoneum. Both the right and left ovarian arteries originate off of
the aorta. The right ovarian vein drains into the inferior vena cava while the left ovarian vein
drains into the left renal vein. The ureter lies in close proximity to the infundibulopelvic ligament
and must be identified prior to clamping and transection of the infundibulopelvic ligament to
avoid injury.

To aid in identification of the ureter and to drop the ureter deeper into the pelvis, the posterior
peritoneum is opened. This is done by lifting the peritoneum anteriorly with Debakey forceps
and making a small superficial incision in the posterior peritoneum. This incision is extended
superiorly parallel to the infundibulopelvic ligament. Care must be taken to remain superficial
and to avoid the ovarian vessels. Once the peritoneum is opened and reflected, the ureter is more
readily identified.

When locating ureters, it is helpful to look for their peristalsis, which can be elicited by gently
"strumming" the ureter. The ureters may be most evident where they cross over the iliac vessels,
at the level of their bifurcation from the common iliac to the external and internal iliac vessels.
The left ureter may be more difficult to visualize secondary to being covered by the sigmoid
colon. Once detected at the pelvic brim, they can be followed down the lateral pelvic side wall
until they enter the cardinal ligament underneath the uterine artery.
After identification of the ureter, an avascular window in the posterior broad ligament is
identified and opened using sharp, blunt, or electrocautery dissection. The infundibulopelvic
ligament is clamped through this window using two curved hysterectomy clamps (Zeppelin,
Heaney, or Masterson). The first clamp is positioned laterally while ensuring the ureter is at a
safe distance. The second clamp is placed approximately 1 cm medial to the first clamp.
The infundibulopelvic ligament is then sharply transected between the two clamps with curved
Mayo scissors and then suture ligated using 0 delayed absorbable suture. The proximal end of the
infundibulopelvic ligament is often doubly ligated, first using a free tie and then suture ligated
ensuring hemostasis of the uterine vessels. The specimen end may also be suture ligated to
prevent back bleeding and avoid excess clamps, improving visualization. Alternatively, the
infundibulopelvic ligament may be clamped, ligated, and transected with a vessel sealing device.
Once the infundibulopelvic ligament has been transected and secured, the portion of the broad
ligament attached to the fallopian tube is taken down. This may be accomplished with either
electrocautery of the broad ligament paralleling close to the fallopian tube, by clamping then
transecting with suture ligation, or with the use of a vessel sealing device.

38
With the ovary and tube now detached from both the infundibulopelvic ligament and the broad
ligament, the remaining attachment is now to the uterus. The ovarian ligament attaches the ovary
to the uterus and the fallopian tube attaches to the uterine cornua. This entire pedicle (ovarian
ligament and fallopian tube) is clamped, sharply transected, and suture ligated; alternatively, the
pedicle may be clamped, ligated, and transected with a vessel sealing device.
Once the tube and ovary have been removed, they should be sent to pathology for tissue
diagnosis. Often the pelvis is irrigated with warm saline to aid in the removal of any blood clots
and debris.
The pedicles should be reinspected for hemostasis. After excellent hemostasis is assured, the
self-retaining retractor is removed along with the laparotomy sponges used for packing the
bowel. Care must be taken to ensure all sponges have been removed. The abdomen and pelvis
should be inspected and a sponge count should be completed prior to closure of the incision.

The patient is transferred to the operating room table and placed under general anesthesia. The
patient is then placed in the dorsal lithotomy position.
A pelvic examination is performed under anesthesia to determine uterine position, size, shape,
mobility, and to assess the adnexa. A Foley catheter is placed to gravity to drain the urinary
bladder throughout the procedure. The patient's abdomen, perineum, and vagina are prepped in a
sterile fashion and the patient is draped.
A speculum is positioned to visualize the cervix and a uterine manipulator is then placed to aid
with visualization and manipulation of the uterus during the case. Attention is then turned back
to the abdomen for the placement of intra-abdominal trocars. Usually, the first incision is made
with the scalpel in the infraumbilical fold. For a closed technique, the abdominal wall is tented
while a Veress needle is carefully placed.
Once intraperitoneal placement is confirmed, the abdomen is insufflated with CO2gas. After
insufflation, the Veress needle is removed and a trocar placed. The laparoscope is then
introduced to confirm intraperitoneal placement.
The remaining trocars may now be placed under direct visualization. Care must be taken to
prevent injury to blood vessels, especially the inferior epigastrics. Often transillumination of the
abdominal wall can aid in avoiding injury to vessels. Additional trocars are placed depending on
surgeon preference in the right lower quadrant, left lower quadrant, and/or midline suprapubic
according to surgeon preference

39
 DRUG STUDY

Drug General Indication Mechanism of Side Nursing implication

action action effects
and
adverse
reactions

*Determine history of
Generic Ceftriaxone is Susceptible Interferes Side
hypersensitivity reactions
name: a bacterial with bacterial effects :
to cephalosporins and
cephalosporin septicemia, cell wall
Ceftriaxone Less penicillins and history of
antibiotic. It acute bacterial synthesis by
serious other allergies,
works by otitis media, inhibiting
side particularly to drugs,
interfering lower cross-linking
effects before therapy is
with the respiratory of
may initiated.
formation of tract, UTIs, peptidoglycan
include: a
the bacteria's skin and skin strands. * Lab tests: Perform
Brand name: hard lump
cell wall so structure, bone Peptidoglycan culture and sensitivity
where the
Rocephin that the wall and joint, makes the cell tests before initiation of
injection
ruptures, pelvic membrane therapy and periodically
was given;
resulting in inflammatory rigid and during therapy. Dosage
nausea,
the death of disease (PID), protective. may be started pending
vomiting,
the bacteria. intraabdominal Without it, test results. Periodic
upset
infections, bacterial cells coagulation studies (PT
stomach;
meningitis, rupture and and INR) should be done.
headache,
uncomplicated die
dizziness, *Inspect injection sites
gonorrhea.
overactive for induration and
Surgical
reflexes; inflammation. Rotate
prophylaxis.
pain or sites.
swelling
*Note IV injection sites
in your
for signs of phlebitis
tongue;
(redness, swelling, pain).
sweating;
*Monitor for
or. vaginal
manifestations of
itching or
hypersensitivity (see

40
discharge. Appendix

Adeverse *. Report their

reactions: appearance promptly and
discontinue drug. Watch
Allergic
for and report signs:
skin
petechiae, ecchymotic
reactions
areas, epistaxis, or any
occur in
unexplained bleeding.
about 3%.
Ceftriaxone appears to
Other
alter vitamin K–
adverse
producing gut bacteria;
effects are
therefore,
rare
hypoprothrombinemic
(headache
bleeding may occur.
s,
*Check for fever if
dizziness,
diarrhea occurs: *Report
nausea,
both promptly. The
vomiting,
incidence of antibiotic-
abdominal
produced
pains,
pseudomembranous
reduction
colitis (see Appendix F)
of the
is higher than with most
renal
cephalosporins. Most
functions,
vulnerable patients:
vaginitis,
chronically ill or
etc.). Pain
debilitated older adult
can occur
patients undergoing
at the site
abdominal surgery.
of
*Patient & Family
injection.
Education Report any
signs of bleeding.
*Report loose stools or
diarrhea promptly. *Do
not breast feed while
taking this drug without
consulting physician.

41
Ranitidine Ranitidine is Treating Ranitidine is decreased *Potential toxicity results
in a group of certain an oral drug sex drive, from decreased clearance
drugs called conditions that that blocks the impotence (elimination) and
histamine-2 cause your production of , or therefore prolonged
blockers. body to make acid by acid- difficulty action; greatest in the
Ranitidine too much producing having an older adult patients or
Brand name: works by stomach acid cells in the orgasm; those with hepatic or
reducing the (eg, Zollinger- stomach. It or. renal dysfunction.
Taladine,
amount of Ellison belongs to a swollen or
Zantac *Lab tests: Periodic liver
acid your syndrome). It class of drugs tender
functions. *Monitor
stomach is also used to called H2 breasts (in
creatinine clearance if
produces. treat ulcers of (histamine-2) men);
renal dysfunction is
Ranitidine is the small blockers that nausea,
present or suspected.
used to treat intestine that also includes vomiting,
When clearance is <50
and prevent have not cimetidine stomach
mL/min, manufacturer
ulcers in the responded to (Tagamet), pain; or.
*recommends reduction
stomach and other nizatidine diarrhea
of the dose to 150 mg
intestines. It treatment. (Axid), and or
once q24h with cautious
also treats famotidine constipati
and gradual reduction of
conditions in (Pepcid). on
the interval to q12h or
which the
less, if necessary.
stomach
produces too *Be alert for early signs
much acid, of hepatotoxicity (though
such as low and thought to be a
Zollinger- hypersensitivity
Ellison reaction): jaundice (dark
syndrome. urine, pruritus, yellow
sclera and skin), elevated
transaminases (especially
ALT) and LDH.

*Long-term therapy may

lead to vitamin B12
deficiency.

42
*Patient & Family
Education

*Note: Long duration of

action provides ulcer
pain relief that is
maintained through the
night as well as the day.

*Be aware that even if

symptomatic relief is
provided by ranitidine,
this should not be
interpreted as absence of
gastric malignancy.
*Follow-up examinations
will be scheduled after
therapy is discontinued.

*Adhere to scheduled
periodic laboratory
checkups during
ranitidine treatment.

*Do not supplement

therapy with OTC
remedies for gastric
distress or pain without
physician's advice (e.g.,
Mylanta II reduces
ranitidine absorption).

*Do not smoke; research

shows smoking decreases
ranitidine efficacy and
adversely affects ulcer
healing.

*Do not breast feed

while taking this drug
without consulting

43
 physician.

Metoclopram This For the Dopamine Change in *Inject IV slowly over 1-

ide medication is treatment of antagonis that mood(depr 2 minutes to prevent

used to treat gastroesophage acts by ession, transient feelings of
certain al reflux increasing constipatio anxiety
Brand name: conditions of disease sensitivity to n,
*Note reasons for
the stomach (GERD) acetylcholine; diarrhea,dr
Metozolv therapy
and intestines. resultsincrease owsiness,fa
ODT, Reglan
... Treating motility of the tigue, *Assess abdomen bowel
gastroparesis upper GI tract involuntary sounds, distention, N&V
can decrease and relaxation of movement
*Family teaching
symptoms of pyloric sphincter of the

nausea, and duodenal limbs or *Instruct to directed may

vomiting, and bulb eyes, salute syrup in water,

stomach/abdo restlessness juice or carbonated drink.

minal .
*Advise that drug
fullness.
movements or
Metocloprami
contractions
de works by
blocking a *Instruct to avoid alcohol
natural and CNS depressants.
substance
(dopamine). It
speeds up
stomach
emptying and
movement of
the upper
intestines.

44
DIPHENHY It is also used Relief of sympt Diphenhydra Constipati Monitor cardiovascular
DRAMINE to prevent and oms associated mine is an on; status especially with
treat nausea, with perennial antihistamine diarrhea; pre-existing
Brand name:
vomiting and and seasonal a used for dizziness; cardiovascular disease.
Allermax, dizziness llergicrhinitis; treating drowsines
Monitor for adverse
Banophen, caused by vasomotor allergic s; dry
effects especially in
Benadryl, motion rhinitis; reactions. mouth,
children and the older
Compoz sickness. allergic Histamine is nose, or
adult.
Nighttime Diphenhydra conjunctivitis; released by throat;
Sleep Aid, mine can also mild,uncompli the body excitabilit Supervise ambulation
Diphedryl, be used to cated urticaria during several y, and use side-rails as
Diphenhist, help you relax andangioedem types of headache; necessary. Drowsiness is
Dytuss, Nytol and fall a; allergic lossof most prominent during
QuickCaps, asleep. This amelioration of reactions and- appetite; the first few days of
Silphen medication allergic -to a lesser nausea; therapy and often
Cough, works by reactions extent--during nervousne disappears with
Simply Sleep, blocking a some viral ss; continued therapy. Older
Sleepinal, certain natural infections, restlessnes adults are especially
Sominex, substance such as the s;trouble likely to manifest
Theraflu (histamine) common cold. sleeping; dizziness, sedation, and
Thin Strips that your body When vomiting. hypotension.
Multi makes during histamine
Patient & Family
Symptom, an allergic binds to
Education
Tranquil, reaction. receptors on
Triaminic cells, it
- temporarily
Thin Strips stimulates
relieves these Do not use alcohol and
Allergy, changes
symptoms due other CNS depressants
Twilite, within the
to hay fever because of the possible
Unisom cells that lead
or other upper additive CNS depressant
Sleepgels to the release
respiratory effects with concurrent
Maximum of chemicals
allergies: use.
Strength, that cause
runny nose.
Valu-Dryl, Z- sneezing, Do not drive or engage in
sneezing.
Sleep plus itching, and other potentially
itchy, watery
many others increased hazardous activities until
eyes. itching
mucus the response to drug is
of the nose or

45
throat. production. known.
Antihistamine
temporarily Increase fluid intake, if
s compete
relieves these not contraindicated; drug
with
symptoms due has an atropine-like
histamine for
to the drying effect (thickens
cell receptors
common cold: bronchial secretions) that
and bind to
runny nose. may make expectoration
the receptors
sneezing. difficult.
without
stimulating Do not breast feed while
the cells. In taking this drug.
addition, they
prevent
histamine
from binding
and
stimulating
the cells.
Diphenhydra
mine also
blocks the
action of
acetylcholine
(anticholinerg
ic effect) and
is used as a
sedative
because it
causes
drowsiness.
The FDA
originally
approved
diphenhydram
ine in 1946.

-dizziness,
drowsiness,

46
 loss of
coordination;

dry mouth,
nose, or
throat;

constipation,
upset
stomach;

dry eyes,
blurred
vision; or.

day-time
drowsiness or
"hangover"
feeling after
night-time
use.

CELOCOXI It eases pain has analgesic, Exhibits anti- CNS: Assessment & Drug
B and reduces anti- inflammatory, dizziness, Effects
inflammation. inflammatory, analgesic, and headache,i
Therapeutic effectiveness
Celecoxib is and antipyretic antipyretic nsomnia,f
is indicated by relief of
Brand name: also known as properties. The action due to atigue.
joint pain.
Celebrex a cyclo- mechanism of inhibition of
CV:
oxygenase-2 action of the enzyme Lab tests: Periodically
peripheral
inhibitor. This CELEBREX is COX-2 monitor Hct and Hgb,
edema.
is because it believed to be liver functions, BUN and
works to due to EENT: creatinine, and serum
relieve pain inhibition of opthalmic electrolytes.
and prostaglandin effects,
Monitor closely lithium
inflammation synthesis, tinnitus,
levels when the two
by blocking primarily via pharyngiti
drugs are given
an enzyme in inhibition of s,rhinitis,s
concurrently.
the body cyclooxygenas inusitis.
called cyclo- e-2 (COX-2). Monitor closely PT/INR

47
oxygenase-2 Celecoxib is a GI: when used concurrently
(COX-2). potent inhibitor nausea, with warfarin.
COX-2 is of diarrhea,
Monitor for fluid
involved in prostaglandin constipati
retention and edema
the production synthesis in on,abdomi
especially in those with a
of irritant vitro. nal pain,
history of hypertension
substances in dyspepsia,
or CHF.
the body in flatulence,
response to dry Patient & Family
disease. mouth, Education

GI
BLEEDIN
Avoid using celecoxib
G:
during the third trimester
menorrhag
of pregnancy.
ic.
Promptly report any of
HEMATO
the following:
LOGIC:
unexplained weight gain,
decreased
edema, skin rash.
hemoglobi
n or Stop taking celecoxib
hematocrit and promptly report to
.. physician if any of the
following occurs: S&S of
liver dysfunction
including nausea, fatigue,
lethargy, itching,
jaundice, abdominal
pain, and flulike
symptoms; S&S of GI
ulceration including
black, tarry stools and
upper GI distress.

Do not breast feed while

taking this drug.

48
FOLIC It aids in the Folate Vitamin B Reportedl Obtain a careful history
ACID production of deficiency, complex y of dietary intake and
DNA and macrocytic essential for nontoxic. drug and alcohol usage
RNA, the anemia, and nucleoprotein prior to start of therapy.
Slight
Brand name: body's genetic megaloblastic synthesis and Drugs reported to cause
flushing
material, and anemias maintenance folate deficiency include
FA-8, and
is especially associated with of normal oral contraceptives,
Folacin-800 feeling of
important malabsorption erythropoiesis alcohol, barbiturates,
warmth
when cells syndromes, . Acts against methotrexate, phenytoin,
following
and tissues are alcoholism,pri folic acid primidone, and
IV
growing mary liver deficiency trimethoprim. Folate
administra
rapidly, such disease,inadeq that impairs deficiency may also
tion.
as in infancy, uate dietary thymidylate result from renal dialysis.
adolescence, intake,pregnan synthesis and
Keep physician informed
and cy,infancy,and results in
of patient's response to
pregnancy. childhood. production of
therapy.
Folic acid also defective
works closely DNA that Monitor patients on
with vitamin leads to phenytoin for
B12 to help megaloblast subtherapeutic plasma
make red formation and levels.
blood cells arrest of bone
Patient & Family
and help iron narrow
Education
work properly maturation.
in the body.

Remain under close

medical supervision
while taking folic acid
therapy. Adjustment of
maintenance dose should
be made if there is threat
of relapse.

Do not breast feed while

taking this drug without
consulting physician.

CEFIXIME Cefixime is To reduce the Mechanism of Seizures,c Determine previous

49
Brand name: used to treat a development action of holelithias hypersensitivity reactions
Suprax wide variety of drug cefixime is is,ulicaria, to cephalosporins,
of bacterial resistant similar to agranuloc penicillins, and history of
infections. bacteria and penicillin. ytosis,eosi other allergies,
This maintain the Cefixime acts nophilia,h particularly to drugs prior
medication is effectiveness by inhibiting emolytic to initiation of therapy.
known as a of Suprax bacterial cell anemia
Lab tests: Perform
cephalosporin (cefixime) and wall
* allergic culture and sensitivity
antibiotic. It other synthesis.
reaction: tests prior to initiation of
works by antibacterial Lack of
therapy and periodically
stopping the drugs, Suprax bacterial cell Hives,diffi
during therapy. Therapy
growth of should be used wall results in culty,swel
may be implemented
bacteria. This only to treat death due to ling of
pending test results.
antibiotic infections that lysis of your
treats only are proven or bacteria face,lips,t Discontinue if seizures
bacterial strongly ongue,or associated with the drug
infections. suspected to be throat. therapy occur.
caused by
Monitor for
susceptible
superinfections (see
bacteria.
Appendix F) caused by
overgrowth of
nonsusceptible
organisms, particularly
during prolonged use.

Monitor I&O rates and

pattern: Nephrotoxicity
occurs more frequently in
patients >50 y, with
impaired renal function,
in the debilitated, and in
patients receiving high
doses or other
nephrotoxic drugs.

Carefully monitor
anyone with a history of
allergies, especially to

50
 drugs. Report
manifestations of
hypersensitivity (see
Appendix F).

Promptly report loose

stools or diarrhea, which
may indicate
pseudomembranous
colitis (see Appendix F).
Discontinuation of drug
may be necessary.

Patient &*Family
Education

*Report loose stools or

diarrhea during drug
therapy and for several
weeks after. Older adult
patients are especially
susceptible to
pseudomembranous
colitis.

*Take this antibiotic for

the full course of
treatment.

*Do not miss any doses

and take the doses at
evenly spaced times, day
and night.

*Do not breast feed

while taking this drug
without consulting
physician.

51
 HEALTH EDUCATION PLAN

OBJECTIVES:

After 1hr of rendering health teaching the client will be able to

1. Gain knowledge in preventing and managing ectopic during pregnancy

2. Understand the importance of proper nutrition.

3. Verbalize understanding in the importance of health teaching.

1. Charts
2. Books
3. Visual aids

Health Teaching  Inform the patient about the importance

of complying with the prescribed
medication.

 Emphasize the mother the importance of

proper hand washing and proper hygiene.

 Encourage the client to recognize some

signs and symptoms of pregnancy if
occurs, aside from the absence of
menstrual period and morning sickness
she should visit her OB or nearest health
center for proper assessment and check-
ups.

Diet  Instruct patient to have a healthy diet and

not to become constipated.

 Instruct patient to have a high-fever diet

such as fruits and vegetables this will
help the soften the stool

 Encourage patient to adhere to diet

prescribed by the physician or the
dietitian.

 Maintain fluid intake.

Exercise  Encourage early ambulation.

52
  Explain to client to take a warm shower
before the exercise to help loosen stiff
muscles.

Treatment  Instruct the client and her family to

comply to the physician’s orders.

 Inform the client as well as the family the

dangers of non compliance to treatment
regimen.

 Encourage the patient to have followed

up visitations to the physician after
discharge.

Sexual  Advice the mother to engage in safe

sexual intercourse like proper hygiene
before intercourse to prevent from STD’s
and pelvic infections that could cause
further damage to the fallopian tubes .

Spirituality  Encourage the mother to seek God’s

guidance and to continue to have a
positive outlook in life.

 Emphasized the importance of prayers in

healing.

53
References:

Pilliteri, A. Maternal and Child Nursing Care, 7th edition

Nursingcrib.com

Americanpregnancy.com

Webmbd.com

http://emedicine.medscape.com/article/1894587-overview#a3

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