A 31-year-old female presents to the emergency room with sudden pain radiating from her mid abdomen to her right shoulder. The patient reports that she is also experiencing light vaginal bleeding. Upon questioning the nurse finds out the patient has an IUD and that she missed her last period. The patient is currently sexually active with multiple partners as well.
The nurse starts an IV and draws blood work. The doctor orders morphine 2 mg IV q4h PRN moderate to severe pain, and an abdominal ultrasound. The nurse administers the morphine per orders and prepares the patient for an ultrasound by giving a prescribed IV fluid bolus of 1 L Normal Saline for bladder filling. The UAP assists the patient to provide a urine sample, which is used for a point-of-care HCG urine pregnancy test – which comes back positive. The UAP and patient report to the RN that there was more bleeding when she went to the bathroom and the patient iis complaining of some upper shoulder pain now.
The nurse notifies the doctor who orders an abdominal ultrasound, which shows a tubal rupture. The patient is rushed to surgery. When the patient returns from surgery, the nurse assesses the patient. Vital signs are stable at this time, the patient is alert and oriented to person, place, time and situation (a little groggy) and the nurse notes no signs or symptoms of distress. While the patient was off the unit, the complete blood count comes back and the hemoglobin is 6.2. The type and screen also result and shows the patient is blood type O and rH factor negative
Debrief: A ruptured ectopic pregnancy would cause internal bleeding, as opposed to external (vaginal) bleeding. The patient bleeds into the abdominal cavity as opposed to out through the uterus and vaginal canal. Ectopic pregnancies will start the same as a normal pregnancy with a missed period and then at around 6 weeks, there is spotting and abdominal pain because the cells have grown within the tube and are getting bigger but the tube does not stretch to accommodate this growth. This causes pain and relief in pain in addition to radiating pain to the shoulders signifies internal bleeding from a tubal rupture. The overall goal is to find the ectopic pregnancy and remove it to save the fallopian tube, but this doesn’t always happen.
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
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