An ectopic pregnancy is when the fertilized egg (zygote) attaches, or implants, and begins to grow in an area other than the uterus. This most often occurs in the fallopian tube, but can be in other areas as well such as the cervix, ovary or abdominal cavity. An embryo cannot grow and survive outside the uterus, and parts like the fallopian tubes are unable to support such a pregnancy and must be treated immediately. Often, a woman may not be aware she is pregnant and symptoms may be vague. Blood test and ultrasound are the best ways to diagnose ectopic pregnancy.
An ectopic pregnancy happens when the egg, traveling from the ovary to the uterus, gets stuck. This may be due to endometriosis, scar tissue from previous abdominal surgeries, inflammation or infection such as chlamydia, use of an IUD, or following IVF treatments. If the pregnancy occurs in the fallopian tube (tubal pregnancy), it may cause the tube to rupture and is considered a medical emergency.
Patient will be free from pain and complications
Ectopic Pregnancy Nursing Care Plan
- Lower abdominal pain
- Amenorrhea, absence of menstrual period
- Vaginal bleeding or spotting
Nursing Interventions and Rationales
- Assess vital signs:
- Blood pressure
- Heart rate
If an ectopic pregnancy occurs in the fallopian tube that ruptures, the patient may go into shock and will have rapid heart rate, rapid breathing and low blood pressure.
- Assess for signs of dehydration; skin turgor, mucous membranes, cap refill
Excessive blood loss and vomiting may cause hypovolemia and dehydration.
- Position patient for comfort and assist with movement as needed
Patient should be positioned lying flat on the bed to reduce movement, stabilize vitals and promote comfort.
- Assess for abdominal pain and tenderness
- Pain may vary, but is usually a sign that an ectopic pregnancy, or fallopian tube, has ruptured.
- Patients will report stabbing or sharp pain in the lower abdomen with fluctuating intensity.
- Monitor blood loss and administer blood products as necessary
Vaginal bleeding may range from spotting to heavier than a normal menstrual cycle
- Monitor intake and output; administer fluids as appropriate
To maintain renal function, especially in the case of shock.
- Administer medications as appropriate and monitor for adverse reactions
- Methotrexate may be given to absorb the pregnancy tissue and save the fallopian tube.
- Anti-nausea and analgesic medications may be given to manage symptoms
- Prepare patient for surgery:
- Maintain NPO status
- Insert indwelling catheter
- Establish and maintain IV access and fluids
If the fallopian tube has ruptured, surgery to remove part or all of the tube may be the best option. Surgery may be performed laparoscopically or a laparotomy may be necessary.
- Provide patient education of ways to prevent future ectopic pregnancies
Educate patient of risk factors and lifestyle changes to avoid future ectopic pregnancies:
- Stop smoking
- Multiple sex partners increase risk of pelvic infections and ectopic pregnancies
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.
For more information, visit www.nursing.com/cornell