Ectopic Pregnancy

POST EX LAP, SALPHINGECTOMY RIGHT

Presented by:
Agunod, Wengel
Banasihan, Samantha Nicole A.
Maitim, Princess
Parayno, Melchizedek Ezekiel
 Introduction

 Normal pregnancies develop inside the uterus after a

fertilized egg travels through the fallopian tube and
attaches to the uterine lining. An ectopic pregnancy
occurs when a fertilized egg grows outside of
the uterus. Almost all ectopic pregnancies—more than
90%—occur in a fallopian tube that’s why it is
sometimes called “tubal pregnancy.
 Introduction

 Thefallopian tubes are not designed to hold a

growing embryo; thus, the fertilized egg in a tubal
pregnancy cannot develop properly and must be
treated. Ectopic pregnancy can also happen in the
ovary, cervix or abdominal cavity.
 Introduction

 Asthe pregnancy grows, it can cause the tube to

burst (rupture). A rupture can cause major internal
bleeding. This can be a life-threatening emergency
that needs immediate surgery. Ectopic pregnancy is
rare but it is serious and needs to be treated
immediately.
 Demographic Data

 Admission Date: September 18, 2019

 Name: Juvelyn M. Bautista
 Admission Time: 7:30 p.m.
 Age:24 years old
 Room: OB ward Bed 24
 Sex:Female
 Admitting Doctor: Dra. Ressie Caunsag
 Civil Status: Single
 Admitting Clerk: Darwin Fabroquez
 Complete Address: B31 L29 Ph6 Mabuhay,
 Chief Complaint/s: Vaginal Bleeding
Mamatid, Cabuyao City, Laguna
 Admitting Diagnosis: G3P0 (0020) T/C Ectopic
 Birthdate: 01/26/1995 Pregnancy
 Birthplace: Leyte  Final Diagnosis: G3P0 (0030) Tubal Pregnancy, Right
 Religion: Roman Catholic  Procedures/Operations:Ex lap, Salphingectomy
Right
 Educational: High school graduate
 Date of operation: September 19,2019
 Occupation: Machine operator
 Time started: 12:26 am
 Nationality: Filipino
 Time ended: 12:55 am
 Source and Reliability of Information

 Diagnostic data and other information regarding

patient’s health and condition were collected from
the patients chart. Other data such as medical history
and other personal data were gathered through an
interview with the patient. All the data that were
gathered were taken with the permission of the staff
nurses assigned in the OB ward and with consent of
the patient as well.
 Reason for Seeking Care or Chief
Complaint

 Thepatient was admitted last September 18, 2019

after being referred by her obstetrician-gynecologist
because her ultrasound revealed ectopic pregnancy.
 History of Present Illness

 The patient confirmed that she is pregnant via

pregnancy test last September 15 and decided to
consult to a private clinic last September 18, 2019. Prior
to her visit in the clinic the patient experienced series
of spotting for 2 days. Upon her consultation she was
referred to diagnostic laboratory to have an
ultrasound and the result showed an ectopic
pregnancy.
 Past Medical History

 Ob-gyn Hx: G3PO (0020)

 The patient had an abortion twice. First pregnancy was
last 2016, upon her consultation the doctor said that
the fetal heart rate was not normal and there was only
a small chance for the fetus to survive. Second
pregnancy of the patient was last 2018 and the patient
wasn’t aware that she was pregnant that time and
due to her schedule at work she had a miscarriage.
 Family History

•Legend:
Alive Deceased
Female Female

Male
Male

Patient
Family History

Grandmother Grandfather Grandfather

Grandmother
Hypertension

Mother Father
Hypertension Hypertension

48y.o 46 y.o 40 y.o 38 y.o 32 y.o

6 children 5 children 4 children 4 children

24y.o
G3P0 (0030)
 Personal-Social History

 The patient is living with her husband together with her

husband’s cousin who is both working in the production
company. She doesn’t have any problem expressing
with the health problem she’s experiencing. She
interacts with her neighbours and having a quality time
sharing her health problem with her husband and
friends also.
 Functional Assessment

 Health Perception-Health Pattern

Before hospitalization the patient perceived herself as a
healthy individual because she doesn’t feel anything
unusual and still able to do the things that she needs to
do. Whenever the patient feels discomfort due to
abdominal pain she tends to don’t mind it and continue
performing what she is doing.
 Functional Assessment

Health perception of a person greatly affects his/her

health management. His/her perception can have
positive and negative effects on his/her health
 Functional Assessment

 Nutritional-Metabolic Pattern
Prior to the hospitalization, patient eats 3-4 meals a day.
She doesn’t have any discomfort in eating. She enjoys
eating green leafy vegetables. She’s fond of eating her
favorite chicken adobo. Patient’s fluid intake includes 1-2
glass of softdrink and 6-8 glasses of water a day.
 Functional Assessment

A person’s diet must meet his/her nutritional needs. The

amount of food that he/she must take varies on his/her
lifestyle, activities and health condition.
 Functional Assessment

 Elimination Pattern
Before hospitalization, she doesn’t have any problem on
her urinary elimination pattern. The frequency of
patient’s urinary elimination depends on her fluid intake.
She doesn’t perspire excessively and any changes in her
bowel elimination pattern. The patient bowel elimination
is regular.
 Functional Assessment

The normal urine output is 30cc/hr and the frequency of

urination depends on the amount of fluid intake. Bowel
movement varies on the fluid intake, age, diet, and
medical condition of the person. There are times that
hormones also affect the frequency of bowel elimination
in women, because estrogen and progesterone in the
days leading up to and at the start of their period.
 Functional Assessment

 Activity- Exercise Pattern

The patient states that she doesn’t have any routine for
exercise because of her schedule at work, her schedule
most of the time is on the night shift. The only thing that
keeps her active is by doing her household chores..
 Exerciseand other activities improve health of an
individual and it reduces the risk of developing certain
conditions or diseases.
 Functional Assessment

 Cognitive Perceptual
According to the patient, she doesn’t have any problem
with her hearing neither her vision, but slight change with
her memory. There are times that she can’t decide
immediately.
 Functional Assessment

As an individual aged some cognitive perceptual skills

degrade. It is important to practice cognitive perceptual
skills such as paying attention, remembering, organizing,
reasoning and understanding, problem solving and
decision-making.
 Functional Assessment

 Sleep-Rest Pattern
According to the patient, she just rests and sleeps for
about 5 hours because of her night shift schedule at
work.
 Number of recommended sleeping hours varies
depending on the age of the person, at the age of the
patient it is advised for her to have at least 7-8 hours of
sleep. Sleeping 7-8 hours has a lot of good benefits for
the patient.
 Functional Assessment

 Self-perception Pattern
The patient sees herself well and healthy individual,
positive and never lost hope in everything. But there are
times whenever she remember her previous abortions
she feel sad and question herself.
 Functional Assessment

 Interpersonal Pattern
The patient has a strong relationship with her husband’s
family member as well as with her family, as verbalized
by the patient. She also have lots of friends and still able
to catch up with them. Her friends and family is her
support system whenever she’s down or having struggles
in life.
 Functional Assessment

 Sexuality- Reproductive
The patient states that her sexual life was satisfying and
they don’t use any contraceptives during their
intercourse. The patient had spontaneous abortion, but it
didn’t affect her sexual pattern with her husband
because they are still hoping to have a child.
G3P0(0030).
 Functional Assessment

 Coping Stress Management Pattern

The patient states that it is helpful in talking things over in
dealing stress and problem. She doesn’t like shouldering
all of it. She needs her family to be with her side because
after experiencing several numbers of abortions she’s a
bit losing hope and will to live
 Functional Assessment

 Personal Habits
Patient’s daily routine is going to work the going home
but whenever she has free time she do some household
chores and catch up with her family and friends.
Review of System
 System Findings Findings
September 19, 2019 September 20, 2019
 General  Pale looking  Pale looking
 Afebrile  Looking worried and tired
 Afebrile

 Integumentary  Skin  Skin

- No discoloration - No discoloration
- (-)edema - (-)edema
- No redness around the - No redness around the
surgical wound surgical wound
 Hair  Hair
- Natural hair color - Natural hair color
- Scalp is clean and dry - Scalp is clean and dry
 Nails  Nails
- Normal capillary refill - Normal capillary refill

 Head, Eyes, Ears, Nose,  Head  Head

Throat - No mass felt upon palpation - No mass felt upon
 Eyes palpation
- PERRLA  Eyes
 Ears - PERRLA
- Hearing impairment on AS  Ears
 Hearing impairment on AS
 System Findings Findings
September 19, 2019 September 20, 2019
 Respiratory  RR:18 bpm  RR:14 bpm
 (-) Cough  (-) Cough
 (-) Colds  (-) Colds

 Cardiovascular  PR: 72 bpm  PR: 80 bpm

 BP: 120/60 mmHg  BP: 110/700 mmHg
 (-) chest pain  (-) chest pain
 (-) orthopnea  (-) orthopnea

 Gastrointestinal  (-) abdominal pain  (-) abdominal pain

 (-) vomiting  (-) vomiting

 Neurologic  (-) headache  (+) headache

 (-) loss of consciousness  (-) loss of
 (-) seizure consciousness
 (-) seizure
 Hematologic  (-) bleeding  (-) bleeding
 (-) bruising  (-) bruising
Anatomy and Physiology
Anatomy and Physiology
Pathophysiology

Risk Factors:
•Two spontaneous abortions
Fertilized egg is
implanted on the
fallopian tube
Signs and Symptoms:
•Positive pregnancy test
•Amenorrhea
•Vaginal Bleeding
•Ultrasound revealing ectopic
pregnancy
Bleeding: Caused by growing
embryo in the fallopian tube
and it irritates certain nerves
Other factors:
•Maternal age of 35-44 years
•Previous ectopic pregnancy
•Previous pelvic or abdominal surgery
•Pelvic Inflammatory Disease (PID)
•Conceiving after having a tubal ligation or
while an IUD is in place
•Smoking
•Endometriosis
•Undergoing fertility treatments or are using
fertility medications
Other site:
•Ovary
•Abdominal cavity
•Cervix
Other signs and symptoms:
•low back pain
•mild to severe pain in the abdomen or
pelvis
•mild cramping on one side of the pelvis
•Shoulder pain
•Weakness, dizziness, or fainting
Ectopic Pregnancy
Laboratory
 Immunology and Serology
Urinary
Test Result Reference
HBsAG Non-Reactive
VDRL Non-Reactive

Physical Exam Normal Values Significance Nursing Implications

Color Dark Yellow Pale Yellow – Deep Amber Normal Normal kidney functions

Appearance Turbid Transparent – Cloudy - Turbid Normal Normal kidney functions

Specific Gravity 1.030 1.003 – 1.030 Normal Normal kidney functions

Chemical Exam
pH 5 4.5- 8 Normal Normal kidney functions

Glucose Negative ≤130 mg/d Normal Normal kidney functions

Protein 1+ 0 – 20 mg/dL Normal Normal kidney functions

less than 0.6 millimoles per liter Above Normal Above Normal and may be
Ketones 3+ (mmol/L) positive for ketonuria

Bilirubin Negative Negative Normal Normal kidney functions

Urobilirubin Negative Small amounts (0.5-1 mg/dL) Normal Normal kidney functions
13.5-17.5 (men) Normal Normal kidney functions
Blood/HGB 1+ 12.0-15.5 (women)

Nitrite Negative Negative Normal Normal kidney functions

Leukocyte 1+ Negative Normal Normal kidney functions

 Urine Sediment Analysis by flow cytometry
Significance Nursing Implications
Cells Results Female Results Female

Above Normal and maybe at risk for urinary tract,

bladder or kidney inflammations.

RBC 14.9H 0-11/UL 2.7H 0-2/HPF Above Normal

Normal and have no risk for bladder or kidney

infections.
WBC 21.H 0-17/UL 3.8H 0-2/HPF Above Normal

Above Normal and maybe at risk for infections or

inflammations.
Epithelial Cells 52.5H 0-17/UL 9.5H 0-3/HPF Above Normal

Above normal
Cast 1.73H 0-1/UL 5.02H 0-3/LPF Above Normal

Normal and no risk for bladder, urethra and kidney

infections.
Bacteria 249.6 0-278 44.9 0-50/LPF Normal
 Hematology

Test Name Result Unit Reference Range Significance Nursing Implications

Hematology

CBC + DIFF

CBC
Above normal and may be at risk for infection.
Other causes are not related to the patient.
WBC H 13.07 10^9/L 5 – 10 Above Normal

Normal and have no risk for anemia, hemorrhage,

hemolysis, and nutritional deficiency.
RBC 4.54 10^6/L 4.20 – 5.40 Normal

Below normal and may be at risk for anemia,

hemorrhage, hemolysis, and nutritional deficiency.
The reason for having Ferrous Sulfate.
Hemoglobin L 10.3 g/dL 12 – 16 Below Normal

Below normal and may be at risk for anemia,

hemorrhage, and bone marrow failure. May be
due to her pregnancy.
Hematocrit L 32.7 % 36 – 46 Below Normal
 Below normal and may be at risk for mycrocytic
mean corpuscular volume anemia
L 72 fl 80 – 100 Below Normal
(MCV)

mean corpuscular
L 22.7 pg 27 – 32 Below Normal
hemoglobin (MCH)

Below normal and may be at risk for anemia,

chronic diseases and lead poisoning
Mean Corpuscular
Hemoglobin Concentration L 31.5 g/dL 32 – 36 Below Normal
(MCHC)

Above Normal and may be at risk for nutrient

deficiency
RDW-CV H 17 % 10 – 16.5 Above Normal

Normal and have no risk for inflammation and

acute bacterial infections.
Platelet Count 398 10^3/uL 150 – 450 Normal

Normal and have no risk for bacterial infections

Procalcitonin 0.40 % 0.10 – 1 Normal

Above Normal and may be at risk for cancer

Mean Platelet Volume (MPV) H 10.2 fl 5 – 10 Above Normal

Normal and have no risk for bleeding or

Platelet Distribution Width infections
11.3 fl 8.3 – 25 Normal
(PDW)
 Differential Count
Significance Nursing Implications
Test Name Result Unit Reference Range

Above normal and may be at risk for infection,

noninfectious inflammation, and heart attack. May be due
Neutrophils H 70.6 % 50 – 20 Above Normal to her preeclampsia.

Normal and have no risk for infection, lymphatic system and

immunodeficiency virus infection. Other symptoms or
causes are not related to the patient
Lymphocytes 21.7 % 20 – 50 Normal

Normal and have no risk for chronic infections, parasitic

infections, and tuberculosis and viral infections
Monocytes 5.8 % 2–9 Normal

Normal and have no risk for allergic diseases and infectious

Eosinophils 1.5 % 0–6 Normal diseases

Normal and have no risk for infections and inflammations

Basophils 0.4 % 0–2 Normal

Totals 100 %
 Obstetric Ultrasound Report
Gynecology

I. Uterus 7.4 X 4.89 X 4.32 cm Position: Anteverted

Comments: The uterus is normal in size with homogeneous myometrial echopattern. A 1.3cm x 1.2cm posterofundal intramural myoma is noted.

II. Endometrium 2.89 cm

Comments: Thickened endometrium

III. Adnexae

Right Ovary 2.39 X 2.65 X 2.69 cm 8.94 ml

Comments: The right ovary is normal in size with several follicles measuring 0.27cm to 0.42cm

Left Ovary

Comments: Not visualized

IV. Cervix 2.19 X 2.16 X 2.06 cm Nabothiancyst: None

V. Others  A thick walled cystic mass is seen

Drug Study
List of Drugs
Antacid
Ranitidine: 500mg q8 x 3 doses, IV
Analgesic
Keterolac: 30mg; 15mg q6 x 4 dose, IV
Tramadol: 50 mg q6 x 4 dose, IV
Antibiotic
Cefuroxime: LD 1.5g; 750mg q8 x 3 dose, IV
Antibacteral
Metronidazole: 500mg q8 x 3 dose
Name: Juvelyn M. Bautista CC: Vaginal Bleeding
Age: 24 y.o Sex: F ADx: G3P0 (0020) Ectopic Pregnancy FDx: G3P0 (0030) Tubal Pregnancy, Right

Indication and Contraindication Dosage and Adverse Mechanism of Drug Nursing Responsibilities
Usage Administration Reaction Action Interaction
Generic name: Management of Hypersensitivity 50 mg q8 x 3 Vomiting Blocks histamine Diazepam Before:
Ranitidine benign gastric or dose, IV at H2 receptors of  Check doctor’s order
duodenal ulceration Nausea the gastric Propranolol  Check the drug’s name and
parietal cells w/c expiration
GERD Headache inhibits gastric Theophylline  Check the dose and
acid secretion. administration
Brand name: Zollinger- Ellison Diarrhea Warfarin  Check pt’s identification
Ramadin Syndrome Absorption:  Educate pt about the desired
Malaise Readily absorbed Midazolam and adverse effect of the drug
Stress ulceration in GI tract
Myalgia Fentanyl During:
Chronic dyspepsia Bioavailability:  Do not increase or decrease the
Drug Abdominal 50% Nifedipine dose, follow exactly as prescribed
Classification: Risk of developing pain Distribution: or indicated
Antacid acid aspiration Widely distributed,  Administer drug carefully
syndrome Transient local crosses placenta After:
burning or and entersbreast  Monitor for adverse effect
itching w/ IV milk  Monitor VS
administration PPB: 15%  Be alert for early signs of toxicity
Metabolism:  Take note that long term use may
Transient pain Hepatically lead to vitamin b12 deficiency
at IM site metabolised
Excretion:
Urine
Half life: 2-3 hr
Name: Juvelyn M. Bautista CC: Vaginal Bleeding
Age: 24 y.o Sex: F ADx: G3P0 (0020) Ectopic Pregnancy FDx: G3P0 (0030) Tubal Pregnancy, Right
Indication Contraindicatio Dosage and Special Adverse Mechanism Drug Nursing Responsibilities
and Usage n Administration Precaution Reaction of Action Interaction

Generic Headache Hypersensitivity LD: 30mg, IV GI bleeding Exhibits Anticoagulant Before:

name: to aspirin and CD: 15mg q6 x minimal anti- s including  Check doctor’s order
Ketorolac Muscular pain other NSAID’s 4 doses, IV Perforation, inflammatory low-dose  Check history of allergy to
peptic ulcer effect of its heparin NSAID’s
Traumatic Asthma analgesic NSAID’s  Assess for pain
pain Anaphylaxis dose  Check the drug’s name and
Nasal polyps Aspirin expiration
Brand name: Post op pain Rash Onset:  Check the dose and
Ketero Bronchospasm approx. 30 Pentoxifylline administration
Short term Bronchospas mins  Check pt’s identification
management Angloedema m Duration: 4-6 Probenesid  Educate pt about the desired
of moderate hr and adverse effect of the drug
post op pain Peptic Laryngeal
Drug ulceration/ GI edema Absorption: During:
Classification: bleeding Rapidly  Do not increase or decrease the
Analgesic Hypotension absorbed dose, follow exactly as
Moderate- following IM prescribed or indicated
severe renal administratio  Administer drug carefully
impairement n  If oral: Can be taken w/ or w/o
food
Bioavailability
: 80-100%
(oral) After:
 Monitor for adverse effect
 Monitor input and output
 Monitor for fluid retention
Indication Contraindicatio Dosage and Special Adverse Mechanism of Action Drug Nursing Responsibilities
and Usage n Administration Precaution Reaction Interaction

Hypobolemia/ Peak of Plasma

Dehydration Concentration: 30-60
min
Coagulation

Hemorrhagia Distribution:
disorder Crosses placenta and
enters breast milk
Confirmed/
suspected Poorly enters blood
cardiovascular brain barriers
bleeding
Volume: 13L
Pregnancy and
lactation Plasma Protein binding:
approx. <99%
Child <2 y.o
Metabolism:
Conjugation with
glucononic acid

Hydrolaxation to liver to
form p-hydroketerolac

Excretion:
Urine

Half life: 4-6 hr

Name: Juvelyn M. Bautista CC: Vaginal Bleeding
Age: 24 y.o Sex: F ADx: G3P0 (0020) Ectopic Pregnancy FDx: G3P0 (0030) Tubal Pregnancy, Right

Indication Contraindica Dosage Special Adverse Mechanism Drug Nursing Responsibilities

and Usage tion and Precautio Reaction of Action Interaction
Administrati n
on
Generic Managem Hypersensitivi 50 mg q6 x Epilepsy/ Dizziness Inhibits Carbamazepin Before:
name: ent of ty to codeine 4 dose, IV History of reuptake ofe
 Check doctor’s order
Tramadol moderate and opioids seizures Nausea norepineph
 Check history of alcohol
to severe erine,
Acute Pt w/ Somnolenc serotonin, consumption
pain Tricyclic
intoxication head e  Assess for pain
and antidepressant
w/ alcohol trauma  Check the drug’s name
enhances s
Brand name: Asthenia and expiration
serotonin
Algesia Hypnotics Avoid  Check the dose and
release
abrupt Fatigue Cyclobenzapri administration
Narcotics discontin  Check pt’s identification
ne
uation Hot flushes  Educate pt about the
Centrally Alters
desired and adverse
Drug acting Pregnanc Headache perception effect of the drug
Classification: analgesic y and and
Analgesic lactation Tremor response to During:
Opioids or pain
 Do not increase or
psychotropic <16 y.o Abdominal
decrease the dose,
drugs pain
follow exactly as
Absorption:
Chronic prescribed or indicated
Readily  Administer drug carefully
alcoholism
absorbed in  If oral: Can be taken w/
Lactation GI tract or w/o food
Indication Contraindicatio Dosage and Special Adverse Mechanism of Drug Nursing Responsibilities
and n Administrati Precautio Reaction Action Interacti
Usage on n on
Hypobolemia/ Constipation Bioavailability: 70- After:
Dehydration 75% (oral)
 Monitor for adverse
Diarrhea
100% (IM) effect
Coagulation
Dyspepsia  Assess level of pain relief
 Monitor VS
Hemorrhagia Distribution:
Flatulence  Assess for signs of CNS
disorder
Widely distributed, depression
Dry mouth crosses placenta  Assess bowel and
Confirmed/
and breast milk bladder fxn
suspected Vomitting  Monitor ambulation and
cardiovascular Anorexia take appropriate
bleeding
Metabolism: precautions
Anxiety
Pregnancy and Extensive HFP
lactation Confusion metabolism

Child <2 y.o Euphoria

Excretion:
Insomnia
Urine
Nervousness

Rash Half life: 6 hr

Increase
sweating
Name: Juvelyn M. Bautista CC: Vaginal Bleeding
Age: 24 y.o Sex: F ADx: G3P0 (0020) Ectopic Pregnancy FDx: G3P0 (0030) Tubal Pregnancy, Right

Indication Contraindicati Dosage and Special Adverse Mechanism Drug Interaction Nursing Responsibilities
and Usage on Administratio Precautio Reaction of Action
n n
Generic Lower Hypersensitivit LD: 1.5g, IV Hypersens Thrombophl Inhibits Probenecid Before:
name: respiratory y itivity to B- ebitis bacterial
CD: 750 mg  Check doctor’s order
tract lactan wall synthesis
Cefuroxime q8 x 3 dose,  Determine Hx of
infection IV antibiotics
hypersensitivity reactions
GI absorption GI
and allergies
difficulties disturbances Absorption:
Brand name:  Check the drug’s name
Uncomplic Renal
Absorbed and expiration
Aeruginox ated UTI insufficien
from GI  Check the dose and
Children <5 cy Skin rash
tract administration
y.o
 Advice pt to take meals
Drug Uncomplic
 Check pt’s identification
Classification: ated Pseudome Itching
Enhanced
Gonorrhea mbranous  Educate pt about the
Antibiotic by presence
colitis desired and adverse effect
of food
Urticaria of the drug
Acute
pharyngitis Pregnanc During:
Peak of
/ tonsillitis y and  Do not increase or
Plasma
lactation decrease the dose, follow
Concentrati
on: 2-3 hr exactly as prescribed or
(oral) indicated
Neonates  Administer drug carefully
< 3months 45 min (IM)
Indication Contraindicatio Dosage and Special Adverse Mechanism of Drug Nursing Responsibilities
and n Administrati Precautio Reaction Action Interacti
Usage on n on
Acute otitis Distribution: After:
media and
widely distributed on  Monitor for adverse
empitigo
the body, CSF even effect
on inflamed  Monitor manifestation of
meninges hypersensitivity
Life threatening
infection  Monitor onset of loose
stool or diarrhea
Crosses placenta
and breast milk
Bacterial
meningitis
Plasma protein
binding: 50%
Pre OP
prophylaxis
Metabolism:
Long operation
Severe Excretion:
infection
Urine/bile

Osseous/
articular Half life: 70 min
infection
 Indication Contraindicati Dosage Special Adverse Mechanism of Drug Nursing Responsibilities
and Usage on and Precaution Reaction Action Interaction
Administr
ation
Generic Treatment Hypersensitivity 500mg q8 Seizures Thrombop Inhibits Disulfiram Before:
name: of x 3 doses, hlebitis bacterial wall
 Check doctor’s order
anaerobi IV synthesis
Metronidazole  Determine Hx of
c Paraesthesi Warfarin
hypersensitivity
bacterial a GI
reactions and allergies
disturbanc Absorption:
Brand name: infections  Check the drug’s
and es Phenytoin
Absorbed name and expiration
Altozol protozoal Diarrhea
from GI tract  Check the dose and
infections Chest pain
Skin rash Ciclosporin administration
Drug  Advice pt to take
Enhanced by meals
Classification:
Tachycardi presence of  Check pt’s
Itching Busulfan
Antibacterial a food identification
 Educate pt about the
Urticaria desired and adverse
Nausea Peak of effect of the drug
Plasma
Concentration
Vomiting : 2-3 hr (oral)
45 min (IM)
Indication Contraindicatio Dosage and Special Adverse Mechanism of Drug Nursing Responsibilities
and n Administrati Precautio Reaction Action Interacti
Usage on n on
Abdominal Distribution: During:
Pain
widely distributed on  Do not increase or
the body, CSF even decrease the dose,
on inflamed follow exactly as
Headache
meninges prescribed or indicated
 Administer drug carefully
Dizziness
Crosses placenta
and breast milk After:
Sinusitis  Monitor for adverse
effect
Plasma protein
 Monitor manifestation of
Syncope binding: 50%
hypersensitivity

Metabolism: Monitor onset of loose stool

or diarrhea

Excretion:
Urine/bile

Half life: 70 min

Nursing Care Plan
NCP by: Matelyn S. Oarga

Assessment Diagnosis Planning Implementation Evaluation

Objective Data: Alteration in comfort: STG: NI: Rationale: STG:

Pain related to post-  Assess the clients pain  To identify the
 P surgical wound on surgical wound as  After 2 hours of nursing and perception intensity, onset,  Goal is met.
ubilical to hypogastric evidenced by pain intervention the pain duration After 2 hours of
quality, and
region scale of 4/10 moderate will subside nursing
quality of the
 Facial grimace pain intervention the
 Monitor vital signs pain.
 Demonstrates guarding LTG:  It serves as a pain subside
behavior  After 2-3 weeks the baseline data from 4/10
 Vital signs patient will be able to to check if moderate to
T: 37.1°C manage and provide there are any 1/10 mild pain.
P: 80 bpm pain relief deviations from
R: 14 bpm her vital signs LTG:
BP: 110/70 mmHgv  After 2 days the
 Position the client in  To provide pt was able to
 Pain scale 4/10, comfortable position comfort manage pain
moderate pain with positioning
and taking
DI:
analgesics
 Administer prescribed  To reduce or
analgesics relieve pain

CI:
 Ask the relative to call  To be relied on
the nurse if the pt pain the physician
is not relieve by the and to
analgesic administer
appropriate
intervention
NCP by: Wengel Agunod
Assessment Diagnosis Planning Implementation Evaluation

Subjective Data:  Anxiety related to STG: NI: Rationale: STG:

“natatakot ako baka hindi several abortions  Identify the coping  To determine
mechanism used in what coping  Goal partially
na ako magkaanak”, as as evidenced by  After 8 hours of
previous stressful mechanism met. After 8
verbalized by the patient restlessness, nursing intervention situation used before hours of nursing
confusion, and the patient will can be helpful intervention the
Objective Data: poor eye appear relaxed. in present pt was able to
 Pale looking contact. situation verbalized
 Restless LTG: DI: feeling of
 Allow patient to  Verbalization relaxed but still
 Poor eye contact  After 4-6 weeks the
verbalize concerns provides manifest poor
 Confusion patient will able to and feelings. opportunity for eye contact and
 G3P0(0030) cope up with the the patient to confusion.
 Post ex lap, situation and reflect, and the
salphingectomy R develop positive nurse to make LTG:
 Vital signs coping strategies. clarifications on  After 48 hours of
misconcep- nursing
T: 37.1°C
tions. intervention the
P: 80 bpm patient is slowly
R: 14 bpm  Provide a quiet, non-  It will diminish recognizing her
BP: 110/70 mmHgv stimulating feelings of current situation.
environment by anxiety and
managing nursing agitation. It will
procedures and also help
care, use of soft promote rest
lights, and limiting and sleep.
visits of families who
are also anxious
Assessment Diagnosis Planning Implementation Evaluation
CI: Rationale:

 If applicable and  Assertiveness

available, refer the Therapy
patient to a Training
personnel who facilitates
conducts development
“Assertiveness of positive-
Therapy Training”. thinking,
realistic goal-
setting and
 If the patient is learning
diagnosed with limitations.
chronic anxiety,
refer him for a
regular mental  Chronic
health counseling anxiety and
and treatment. maladaptive
coping
behaviors
need on-going
medical
monitoring
and treatment.
Care Plan by: Melchizedek Ezekiel T. Parayno
Date Initiated: September 19, 2019
Assessment Diagnosis Outcomes Interventions Rationale Evaluation

Objective: Risk for bleeding related Short term:  Determine client’s  To assess the client’s Responded well to
to surgical incision as After 2 hours, verbalized perception/ understanding interventions/teachings
The patient looked like evidenced by patient’s understanding of Understanding of and actions performed
she was in pain and was facial grimace when individual causative/risk the situation.
showing facial grimace moving and subjectively factor(s). Before our shift ended,
whenever she was expressing that the the client stated that she
moving or changing surgical wound is painful. Before discharge, understood the possible
positions verbalized Independent: dangers of bleeding and
understanding of that she’ll continue
Sept. 19, 2019 bleeding risk from  Educate client  To avoid sudden monitoring her wound
PR: @8PM – 72bpm surgery. about the possible movements that and to assess her self if
BP: @8PM – 120/60 dangers of bleeding might cause patient there are any signs of
Observe for diffuse if not prevented. to bleed bleeding and to consult
Sept. 20, 2019 oozing from tubes, or go to the nearest
PR: @4PM – 80bpm wounds, or orifices with Collaborative: hospital as soon as
BP: @4PM – 110/70 no observable clotting bleeding is confirmed.
to identify excessive  Collaborate with  To promote self
Subjective: bleeding and/or possible patient and other monitoring and
coagulopathy. health care providers assessment
“masakit pa yung sugat to monitor the surgical
ko pag gumagagalaw Long term: wound and to assess
ako.” After 1 week, achieve for bleeding.
timely wound healing;
be free of purulent
drainage or erythema;
be afebrile.
Care Plan by: Princess Anne M. Maitim
Date Initiated: September 19, 2019
Assessment Diagnosis Outcomes/Planning Interventions Rationale Evaluation

Objective: Risk for infection related Short term:  Note risk factors for  To evaluate Responded well to
to tissue destruction; After 30 minutes of occurrence of presence/character interventions/teachings
Wound from an invasive invasive procedures nursing intervention, the infection of infections. and actions performed
surgical incision. client will verbalize
understanding of and  Observe localized After 2 days of nursing
Temperature: willingness to follow up sign of infection at intervention, all the
Sept. 19, 2019 prescribed regimen insertion sites of interventions were met
8PM – 37.1° Celsius invasive lines, which was made
Before discharge, surgical incisions or evident by the absence
Sept. 20, 2019 verbalized wounds. of sign and symptoms
4PM – 36.3° Celsius understanding of related to infection.
compliance related to  Emphasize necessity
 To inform the client
self-care. of taking antibiotics,
the risk of
as directed
discontinuation of
Identify interventions to treatment
Subjective: prevent/reduce risk of
infections. Independent:
N/A  Educate client
 To avoid infection
Long term: about the
by having the
After 3 days, the patient importance of
patient clean
will be free of sign and hygiene especially
herself
symptoms related to in a hot and humid
infection. environment where
bacteria thrives.
Assessment Diagnosis Planning Implementation Evaluation
Collaborative: Rationale:

 Collaborate with  To promote self

other nurses and hygiene to
hospital employees patients and
other health
to encourage the
providers alike
patient to shower,
clean incision or
change clothing to
prevent the spread
of bacteria onto
wounds.
Progress Notes
References
Online References

 https://www.acog.org/Patients/FAQs/Ectopic-Pregnancy?IsMobileSet=false
 https://www.plannedparenthood.org/learn/pregnancy/ectopic-pregnancy
 https://americanpregnancy.org/pregnancy-complications/ectopic-pregnancy/
 https://kidshealth.org/en/parents/ectopic.html
 https://www.google.com/search?q=anatomy+and+physiology+of+reproductive+system+of+female&sxsrf=ACYBG
NRkxvEfWwXr1_dTFgG0VseHvybKjg:1569287677973&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjF9uGUpOjkAhX
GAYgKHfQxB_QQ_AUIEigB#imgrc=r7x3cutS66LZPM:
 http://www.columbia.edu/itc/hs/pubhealth/modules/reproductiveHealth/anatomy.html
 https://www.google.com/search?biw=1366&bih=608&tbm=isch&sxsrf=ACYBGNQJFVxMiFl9K7_1V7wSbSco2P9DdQ
%3A1569287493184&sa=1&ei=RW2JXcXxCsiGr7wP8qObsAM&q=fallopian+tube+anatomy&oq=+fallopian+tube&gs
_l=img.1.1.0i67l3j0l2j0i67l4j0.2591312.2591312..2593497...0.0..0.156.156.0j1......0....1..gws-wiz-
img.82GLZIgYIsA#imgrc=iZ9PzWf4Q4TjLM:
 https://www.britannica.com/science/fallopian-tube