case study ectopic preg
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¾ Because of the high maternal mortalityassociated with undiagnosed ectopicpregnancy until after rupture or tubal
ligation, it is very important for nurses to bealert to sign and symptoms of thiscomplication of pregnancy.
¾ Therefore any woman during her child
bearing years of experience irregular vaginalspotting associated with dull, aching pelvicpain, with or without signs of pregnancy,should be evaluated for a possible ectopicpregnancy.
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� If an ectopic pregnancy is suspected, adetailed history should include question
regarding the type of abdominal pain.The pain caused by an unrupturedectopic pregnancy can be unilateral,cramp like pain related to tubal
distention by the enlarge embryo or fetusat the time of tubal rupture many patientexperience a sudden, sharp, stabbingpain in lower abdomen.
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� Assess for vaginal bleeding, and obtainmenstrual history. Vaginal bleeding is usually
related to the sloughing of the endometriallining related to decreasing progesteroneand estrogen levels and can presents ascontinuous or intermittent vaginal bleeding
in small or large quantities. It is usuallydifferent from the patient·s normal period.Pad counts should be kept determine theamount and type of vaginal bleeding
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� Assess for the presence of any signs ofsyncope.
� When an ectopic pregnancy ruptures or aborts, blood is lost into the peritoneal cavity.
� At this time the patient can experience afeeling of faintness or weakness related tohypovolemia. If the bleeding is not continuous,
the depleted blood volume is restored to near normal 1 or 2 days by hem dilution and thefaint or weak feeling subsides. If bleeding isprofuse, the patient can go into should quickly.
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� To assess the amount of intraperitoneal
blood loss, the patient·s vital signs should
be checked as frequently as thesituation indicates.
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DRUGS ACTION INDICATION ADVERSE
REACTION
NURSING
RESPONSIBILITIES
Generic
Name:PropofolBrand Name:Diprofol
Propofol is a short
acting anesthetic
given IV for the
induction and
maintenance of
general
anesthesia. It is
also used for
sedation in adult
patients
undergoing
surgery in
conjunction with
local or general
anesthesia.
Propofol has no
analgesic activity
and
supplementary
Induction and
maintenance of
General
Anesthesia
Hypotension,
Bradycardia,prematureatrialcontractions,
convulsions,hallucination,
nausea,vomiting, skin
flushing, rash.
*Propofol should be
administered with caution to
patients with hypovolemia.
*record baseline vital signs.
*Monitor clients
postoperative state of
sensorium. Report if client
remains non responsive orconfused for a time.
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DRUGS ACTION INDICATION ADVERSE
REACTION
NURSING
RESPONSIBILITIES
Generic Name:Atracurium Besylate
Brand Name:
Tracrium
Atracuriumbesylate is a
highly selective,
competitive or
nondepolarizing
neuromuscular
blocking agent.
Adjunct to generalanesthesia to
enable tracheal
intubation to be
performed ad to
relax skeletal
muscles duringsurgery or
controlled
ventilation.
Hypotension, skinflushing,
anaphylactic
reactions,
seizures.
*Check
preoperative
and post
operative
urine output.
*Evaluateclient·s
response to
the
anesthetic.
*Continue to
monitor client
for adverse
reactions.
*Maintain a
patent airway
together with
Generic Name:
Succinylcholine
ChlorideBrand Name:
Anectine
ANECTINE
(succinylcholine
chloride) is anultra short-acting
depolarizing-type,
skeletal muscle
relaxant for
intravenous (IV)
administration.
Succinylcholine
chloride is
indicated as anadjunct to general
anesthesia, to
facilitate tracheal
intubation, and to
provide skeletal
muscle relaxationdurin sur er or
respiratory
depression to the
point of apnea;this effect may be
prolonged.
Hypersensitivity
reactions,
including
anaphylaxis, mayoccur in rare
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DRUGS ACTION INDICATION ADVERSE
REACTION
NURSING
RESPONSIBILITIES
GenericName:Thiopental
SodiumBrand Name:Pentothal
Pentothal(Thiopental
Sodium for Injection, USP) is an
ultrashort-acting
depressant of the
central nervous
system which
induces hypnosisand anesthesia,
but not analgesia.It produces
hypnosis within 30to 40 seconds of
intravenousinjection. Recovery
after a small doseis rapid, with some
somnolence and
retrograde
amnesia.
Repeated
intravenous doses
lead to prolonged
anesthesiabecause fatty
Pentothal (Thiopental
Sodium for Injection,
USP) is indicated (1) as
the sole anesthetic agent
for brief (15 minute)
procedures, (2) for
induction of anesthesia
prior to administration of
other anesthetic agents,
(3) to supplement
regional anesthesia, (4)
to provide hypnosis
during balanced
anesthesia with other
agents for analgesia or
muscle relaxation, (5) for
the control of convulsive
states during or following
inhalation anesthesia,
local anesthesia, or
other causes, (6) in
neurosurgical patients
with increased
intracranial pressure, if
adequate ventilation is
provided, and (7) for
narcoanal sis and
respiratorydepression,
myocardial
depression,
cardiac
arrhythmias,
prolongedsomnolence and
recovery,
sneezing,
coughing,
bronchospasm,
laryngospasm andshivering.
Anaphylactic and
anaphylactoid
reactions to
Pentothal
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ASSESSMEN
T
DIAGNOSIS PLANNING INTERVENTIO
N
RATIONALE EVALUATIO
N
-Description
of pain andit·s location
-Monitor v/sand LOC
-Natureand
amount ofvaginal
bleeding
-
Anticipator y, grieving
R/T the lossof
pregnancyand effects
on futurepregnancie
s.
- After
nursinginterventio
n, will beable to
acceptthe loss of
pregnancy.
-Identify
cultural/religious beliefs
that mayimpact sense
of loss.-Ascertain
response offamily/ SO to
client·ssituation.
-Noteemotional
responsessuch as
withdrawal,angrybehaviour,
crying.-
-For the
health careprovider to
identifyhow to talk
about thesituation.
-to assessappropriate
ness offamily tothesituation.
-to identifyhow long
will it taketo acceptthe
situation by
-begins to
accept lossof
pregnancyand
expressesgrief by
verbalizingfeelings
andreactions toloss.
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ASSESSMEN
T
DIAGNOSIS PLANNING INTERVENTIO
N
RATIONALE EVALUATIO
N
-Fluid loss
(e.g.,fever,diarrhea/vomiting,excessive
sweating,surgical
drains)-Limitedintake- Fluid shifts
(e.g.,ascites,
effusions,burns,
sepsis)-
Environmental factors
-
hemorrage
- Risk for
deficientfluidvolume
-
Demonstratebehavioursor lifestyle
changesto prevent
development of fluidvolumedeficit.
-Monitor I/O
-Weightcilent andcomparewith recent
weight hx.Perfrom serial
weights.- noteclient·sLOC/mentati
on.- Encourage
oral intake:-Provide
water andother fluid
needs to aminimum
amount daily
-Limit fluids
-To ensure
accuratepicture offluid status.- to
determinetrends.
- toevaluateability toexpress
needs.
-
Demonstratedbehaviorsto prevent
developmenmt of fluid
volumedeficit.
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� SALPINGECTOMY
¾ Salpingectomy has traditionally been done
via a laparotomy; more recently however,laparoscopic salpingectomies havebecome more common as part of minimallyinvasive surgery. The tube is severed at the
point where it enters the uterus and along itsmesenteric edge with hemostatic control.
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� This is the most common treatment of
ectopic pregnancy. The salpingectomy
is performed by cross-clamping thebroad ligament and removing the whole
tube. This form of surgical management
is most appropriate in the ruptured
ectopic pregnancy where there isconsiderable bleeding.
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� This procedure involves excision of
segment of the Fallopian tube involved
in the ectopic pregnancy. The tubalsegment to be removed is coagulated
(see diagram 16) and cut off with bipolar
forceps (see diagram 17 and 19). The
mesovarium is also coagulated and cutoff in the same manner (see diagram
18).
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� Unilateral salpingo-oophorectomy is the
surgical removal of a fallopian tube and
an ovary. If both sets of fallopian tubesand ovaries are removed, the procedure
is called a bilateral salpingo-
oophorectomy.
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� In a salpingo-oophorectomy, a woman'sreproductive organs are accessed
through an incision in the lower abdomen, or laparoscopically (A). Oncethe area is visualized, a diseasedfallopian tube can be severed from theuterus and removed (B and C). Theovary can also be removed with thetube (D). The remaining structures arestitched (E), and the wound is closed.
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� If performed through an abdominal incision,salpingo-oophorectomy is major surgerythat requires three to six weeks for full
recovery. However, if performedlaparoscopically, the recovery time can bemuch shorter. There may be somediscomfort around the incision for the firstfew days after surgery, but most women are
walking around by the third day. Within amonth or so, patients can gradually resumenormal activities such as driving, exercising,and working.
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� Immediately following the operation, the
patient should avoid sharply flexing the
thighs or the knees. Persistent back painor bloody or scanty urine indicates that a
ureter may have been injured during
surgery.