Nursing Care Plan (NCP) for Ectopic Pregnancy

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Pathophysiology

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 like 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 that she is pregnant, and symptoms may be vague. Blood tests and ultrasound are the best ways to diagnose.

Etiology

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.

Desired Outcome

The patient will be free from pain and complications

Subjective Data:

  • Amenorrhea, absence of menstrual period 
  • Nausea
  • Dizziness
  • Weakness
  • Lower abdominal pain

Objective Data:

  • Vaginal bleeding or spotting 
  • Tachycardia
  • Tachypnea 
  • Hypotension 
  • If Fallopian tube ruptures:
    • Fainting
    • Hypotension
    • Shoulder pain
    • Rectal pressure

Nursing Interventions and Rationales

Nursing Intervention (ADPIE) Rationale
Assess vital signs:

Blood pressure

Heart rate

Respirations

Temperature

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 Patients 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 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 the 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 tubes 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 the risk of pelvic infections and ectopic pregnancies

Writing a Nursing Care Plan (NCP) for Ectopic Pregnancy

A Nursing Care Plan (NCP) for Ectopic Pregnancy starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088

https://my.clevelandclinic.org/health/diseases/9687-ectopic-pregnancy

https://medlineplus.gov/ectopicpregnancy.html

https://www.plannedparenthood.org/learn/pregnancy/ectopic-pregnancy

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Transcript

Hi everyone today, we’re going to be creating a nursing care plan for ectopic pregnancy. So let’s get started. First, we’re going to be going over the pathophysiology. So an ectopic pregnancy is when the fertilized egg, the 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 such as the cervix, ovary, or abdominal cavity. Some nursing considerations: you want to assess vital signs, signs of dehydration, abdominal discomfort or tenderness, bleeding, administering medications, and preparing the patient for surgery. Some desired outcomes. The patient will be free from pain and complications. 

So we’re going to go ahead and get into the care plan. We’re going to be writing down some subjective data and some objective data. So what are we going to see with these patients? So some subjective data that we’ll see is some nausea and weakness. Some objective data. There’s going to be some vaginal bleeding, tachycardia, and hypotension. There’s an absence of a menstrual cycle. Some dizziness weakness, some lower abdominal pain. If the fallopian tube ruptures, you’ll see a patient that will have fainting, hypotension, shoulder pain, and rectal pressure. 

So interventions, you want to make sure that we’re assessing the vital signs. So we want to make sure we’re checking the blood pressure, the heart rate, respiration, and temperature. If an ectopic pregnancy occurs in the fallopian tube that ruptures, the patient may go into shock and will have a rapid heart rate, rapid breathing, and low blood pressure. Another intervention is we want to assess for signs of dehydration. So you’re going to be checking skin turgor, mucous membranes, or capillary refill. Usually, excessive blood loss and vomiting will cause hypovolemia and dehydration. So we want to give some IV fluids, our isotonic solution, and be able to hydrate and establish good renal function for the patient. We want to make sure we’re positioning the patient for comfort and assisting with movement as needed. So we want to make sure that we have them in a comfortable position. Patients should be positioned, lying flat on the bed to reduce movement, stabilize vitals, and promote comfort. We want to make sure we’re assessing for any sort of abdominal pain and tenderness. So for pain for these patients, pain may vary, but is usually a sign that ectopic pregnancy or the fallopian tube has ruptured. So if they’re having a lot of pain, you want to immediately think about rupture; patients will report stabbing or sharp pain in the lower abdomen with full intensity. Another intervention is we want to make sure we’re monitoring blood loss and administer blood products as necessary. So, how much blood loss? Vaginal bleeding may range from spotting to having heavier than normal menstrual cycles. We want to administer medications as appropriate. One medication we may give these patients is methotrexate. It may be given to absorb the pregnancy tissue and save the fallopian tube. We can also do anti nausea medication and analgesics for the pain. We want to make sure we’re preparing the patient for surgery. You want to maintain NPO status. You want to make sure we’re inserting a Foley catheter. We want to make sure that we have established and maintain an IV access for fluids and or any medications we might be giving them. If the fallopian tube is ruptured, surgery to remove part or all of the tube may be the best option for the patient. Surgery may be performed laparoscopically, or it may be not done laparoscopically. It might be a laparotomy that may be completed for the patient. 

All right, we’re going to move on to the key points. So it is a fertilized egg that attaches or implants and begins to grow in another area other than the uterus. This can be caused by endometriosis, scar tissue, or inflammation. Some subjective or objective data. You’ll see some nausea, weakness, dizziness, lower abdominal pain, vaginal bleeding, or spotting, tachycardia, hypertension. We want to assess their vital signs, signs of dehydration, abdominal pain, and tenderness monitoring for any sort of blood loss. We want to make sure we’re administering medications as needed and prepping the patient for surgery. And there you have a completed care plan. 

You guys did amazing. Hope you guys are having a great day. Go out, be your best self today. And as always happy nursing.

 

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