Ruptured ectopic pregnancy Assessment Answer

The Patient's Presenting Problem and History

The patient named Mrs. Fathima Ahmed, the 34-year-old lady is 7 weeks pregnant. The patient is then bought to ED by ambulance, the patient has complained about severe abdominal pain, slight vaginal bleeding, shoulder pain, and some sort of lightheadedness. The patient is looking, pale, and clammy, and has cold skin. The vital signs of the patient are measured and the recordings are present below: BP of the patient recorded is 75/48 mmHg, the heart rate of the patient recorded is 136 bpm, in addition to it the RR of the patient is 27 breaths per minute, the temperature of the patient recorded is 36-degree celsius. Along with it, the spO2 is 94% and the pain score recorded is 10/10. The history of the patient states that the patient has 2 kids, and both the kids are with the procedure LSCS which is lower segment cesarean section. In addition to it, the patient has a history of ectopic pregnancy and it has been treated medically with methotrexate.

Pathophysiology of the presenting acute condition

The pathophysiology of the condition is due to the damage to the fallopian tube, it is usually due to secondary to inflammation. In addition to it, it also induces tubal dysfunction and which results in the retention of embryo or oocyte. Along with these factors, several local factors also result in this condition and these are: toxic, infectious, hormonal, and immunological, all these factors together lead to the development of inflammation. There is also an upregulation of the pro-inflammatory cytokine followed by tubal damage. This also promotes embryo implantation, angiogenesis, and invasion within the fallopian tube (Rubio et al., 2020). Infection due to Chlamydia trachomatis leads to the production of interleukin 1 by the tubal epithelial cells. It usually occurs due to the vital indicator for embryo implantation within the endometrium. Interleukin 1 plays important role in downstream neutrophil recruitment, this will contribute to fallopian tubal damage. Cilia present affects the frequency in a negative manner and infection and smoking also increase the side effect. Among women hormonal variation is also observed, throughout the menstrual cycle, in addition, it also affects the cilia beat frequency. The implantation of ectopic can occur in the uterine cornea, cervix, ovaries, uterine cornea, and abdominal cavity. Women with tubal ligation or any other post-surgical alteration in the fallopian tube are at higher risk of ectopic pregnancy. This is mainly observed because the native function of the fallopian tube will be altered. In addition to it, the anatomic structure which contains the fetus mainly ruptures at about 6-16 weeks. Due to this rupture, bleeding occurred and this might result in hemorrhagic shoc (Cardall et al., 2022).

Vital signs, patient history, and investigation results

The vital signs of the patient are measured and the recordings are present below: BP of the patient recorded is 75/48 mmHg, the heart rate of the patient recorded is 136 bpm, in addition to it the RR of the patient is 27 breaths per minute, the temperature of the patient recorded is 36 degree Celsius. Along with it, the spO2 is 94% and the pain score recorded is 10/10. All the measurements which are presented do not lie within the normal range hence, steps need to be taken to bring all the vital signs within the normal range. The patient history states that the patient has 2 kids, and both the kids are with the procedure LSCS which is lower segment cesarean section. The investigation of the patient states that the BHCG level recorded initially was 1458, and after 48 hrs it was 1396, at the time of the third reading measured was 1415. The patient adopted medical management, however as the BHCG fluctuated the patient opted for conservative management.

Normal or abnormal using literature support

The brief medical management plan

 The medical management plan needs to be taken care of, ectopic pregnancy is highly common among women and hence they attend the infertility clinic. Along with this, the ATR increases ectopic pregnancy and hence treatment needs to be adopted. One of the famous types of treatment is the use of contraception, one of the most important forms of contraception is progesterone-only contraception and intrauterine contraceptive devices. These treatment options are directly associated with an increase in the incidence of ectopic pregnancy (Nzaumvila et al., 2018).

In several cases it has been observed that regular smoking increases the risk of ectopic pregnancy, hence interventions need to be adopted to control it. Several studies suggest that regular smoking lead to several side effects and these are altered tubal, delay in ovulation, uterine motility, and also altered immunity. The best medication which can be used in the medical management of ectopic pregnancy is methotrexate. It is a folic acid antagonist which affects DNA synthesis. It has been observed that about 90% of un-ruptured none live ectopic pregnancies respond to the methotrexate treatment and after its treatment, no future treatment is required. In addition to it, surgery is also an option. However, surgery treatment is always high, hospital admission is of high rate and also there is risk in surgery (Katler et al., 2018).

In addition to it, the laparoscopic procedure is also present, under these two treatment options are present and these are Salpingostomy and salpingectomy. In these procedures, a small incision is made near the abdomen near to and next to the naval. After this, the doctor uses a thin tube that is equipped with a camera lens and also lights to view the tubal area. In the process of salpingectomy, the ectopic pregnancy is removed and then the tube left is used to heal on its own (Barnhart et al., 2018).

Latest evidence-based nursing management for Ruptured ectopic pregnancy

References

Rubio, X. B., Kresak, J., Zona, M., Beal, S. G., & Ross, J. A. (2020). Educational case: Ectopic pregnancy. Academic Pathology, 7, 2374289520911184. https://doi.org/10.1177/2374289520911184

Cardall, A.K., Jacobson, J.C., Prager, S., Flynn, A.N., & Russo, J. (2022). Medical management of ectopic pregnancy in a family planning clinic: A case series. Contraception, 109, 68–72. https://doi.org/10.1016/j.contraception.2021.11.010

Nzaumvila, D.K., Govender, I., & Ogunbanjo, G.A. (2018). An audit of the management of ectopic pregnancies in a district hospital, Gauteng, South Africa. African Journal of Primary Health Care & Family Medicine, 10(1), e1–e8. https://doi.org/10.4102/phcfm.v10i1.1757

Katler, Q., Pflugner, L., & Martinez, A. (2018). Management of bilateral ectopic pregnancies after ovulation induction using unilateral salpingectomy and methotrexate for the remaining ectopic with subsequent intrauterine pregnancy. Case Reports in Obstetrics and Gynecology, 2018, 7539713. https://doi.org/10.1155/2018/7539713

Barnhart, K.T., Sammel, M.D., Stephenson, M., Robins, J., Hansen, K.R., Youssef, W. A., Santoro, N., Eisenberg, E., Zhang, H., & NICHD Cooperative Reproductive Medicine Network (2018). Optimal treatment for women with a persisting pregnancy of unknown location, a randomized controlled trial: The ACT-or-NOT trial. Contemporary Clinical Trials, 73, 145–151. https://doi.org/10.1016/j.cct.2018.09.009

You Might Also Like:-

Psoriasis Nursing Dissertation Help

The Best Nursing Universities in London 2024