System Disorder: Ectopic Pregnancy

STUDENT NAME: Ashley Akuebionwu

DISORDER/DISEASE PROCESS: Ectopic Pregnancy

REVIEW MODULE CHAPTER: Chapter 7

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ACTIVE LEARNING TEMPLATE: ASSESSMENT

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SAFETY CONSIDERATIONS:

• Monitor for signs of rupture: Immediate surgical intervention may be required if rupture occurs.
• Assess for hypovolemic shock: Monitor vital signs, fluid balance, and signs of internal bleeding.
• Administer Rh immunoglobulin: If the client is Rh-negative, administer Rh immunoglobulin to prevent isoimmunization.

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PATIENT-CENTERED CARE

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Alterations in Health (Diagnosis):

• Ectopic pregnancy is an abnormal implantation of the fertilized ovum outside the uterine cavity, most commonly in the fallopian tubes.

Pathophysiology Related to Client Problem:

• Pathophysiology: The fertilized egg implants outside the uterus, often in a fallopian tube. The growing embryo can cause the tube to rupture, leading to severe bleeding and potentially life-threatening complications.

Health Promotion and Disease Prevention:

• Education: Encourage early prenatal care to detect ectopic pregnancies early.
• Prevention: Promote awareness of risk factors such as a history of pelvic inflammatory disease (PID), previous ectopic pregnancy, or tubal surgery.

Risk Factors:

• Prior ectopic pregnancy
• Tubal surgery or sterilization
• History of pelvic inflammatory disease (PID)
• Use of assisted reproductive technology (ART)
• Smoking

Expected Findings:

• Unilateral pelvic pain
• Vaginal spotting or bleeding
• Amenorrhea
• Shoulder pain (if there is internal bleeding)
• Signs of shock (if rupture occurs)

Laboratory Tests:

• Serum hCG Levels: Lower than expected for gestational age.
• Progesterone Levels: May be lower than normal, suggesting an abnormal pregnancy.

Diagnostic Procedures:

• Transvaginal Ultrasound: Will show an empty uterus, and may visualize the ectopic pregnancy in the fallopian tube or other locations.

Complications:

• Tubal Rupture: Can lead to severe hemorrhage and shock.
• Infertility: May occur due to damage to the fallopian tubes.

Therapeutic Procedures:

• Methotrexate: Medical management to dissolve the ectopic tissue if the pregnancy is detected early and unruptured.
• Laparoscopy: Surgical removal of the ectopic pregnancy, often necessary if rupture has occurred or if medical management fails.

Interprofessional Care:

• Obstetrician/Gynecologist (OB/GYN): For surgical management or follow-up.
• Radiologist: For performing and interpreting ultrasound imaging.
• Pharmacist: For administering methotrexate and other medications.

Nursing Care:

• Monitor vital signs: Regularly assess for signs of shock or hemorrhage.
• Provide emotional support: Address the emotional impact of pregnancy loss.
• Administer medications: Provide prescribed medications, such as methotrexate, pain management, and Rh immunoglobulin if necessary.
• Prepare for surgery: If surgery is needed, prepare the patient for the procedure and provide postoperative care.

Client Education:

• Signs and symptoms to monitor: Educate the patient on the signs of a ruptured ectopic pregnancy, such as severe abdominal pain, dizziness, and fainting.
• Follow-up care: Emphasize the importance of follow-up appointments to monitor recovery and prevent future complications.
• Contraception advice: Discuss future fertility options and contraceptive use if desired.

Medications:

• Methotrexate: Used to medically manage unruptured ectopic pregnancy by inhibiting the growth of rapidly dividing cells.
• Pain management: Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen.
• Rh Immunoglobulin: If the client is Rh-negative.