Ectopic Pregnancy Case Study (30 min)
Included In This Lesson
Study Tools For Ectopic Pregnancy Case Study (30 min)
Outline
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.
What is the first test the nurse should do on this patient?
What should the nurse be concerned about at this time?
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.
What should the nurse be concerned about at this time?
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
Why would the patient have a low hemoglobin with only light vaginal bleeding?
What else should the nurse ensure is administered to this patient?
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.
Ground Zero
Concepts Covered:
- Communication
- Fundamentals of Emergency Nursing
- Intraoperative Nursing
- Documentation and Communication
- Legal and Ethical Issues
- Emergency Care of the Cardiac Patient
- Delegation
- Perioperative Nursing Roles
- Preoperative Nursing
- Community Health Overview
- Prioritization
- Studying
- Factors Influencing Community Health
- Concepts of Population Health
- Understanding Society
- Test Taking Strategies
- Medication Administration
- Adult
- Microbiology
- Cardiac Disorders
- Anxiety Disorders
- Depressive Disorders
- Vascular Disorders
- Nervous System
- Upper GI Disorders
- Central Nervous System Disorders – Brain
- Gastrointestinal Disorders
- Immunological Disorders
- Dosage Calculations
- Circulatory System
- Concepts of Pharmacology
- Hematologic Disorders
- Newborn Care
- Adulthood Growth and Development
- Disorders of Pancreas
- Respiratory Disorders
- Postoperative Nursing
- Pregnancy Risks
- Neurological
- Postpartum Complications
- Substance Abuse Disorders
- Noninfectious Respiratory Disorder
- Bipolar Disorders
- Peripheral Nervous System Disorders
- Learning Pharmacology
- Psychotic Disorders
- Prenatal Concepts
- Tissues and Glands
- Basics of Chemistry
- Gastrointestinal
- Newborn Complications
- Labor Complications
- Fetal Development
- Terminology
- Labor and Delivery
- Postpartum Care
- EENT Disorders
- Infectious Disease Disorders
- Lower GI Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Hematologic Disorders
- Integumentary Disorders
- Cardiovascular Disorders
- Musculoskeletal Disorders
- Endocrine and Metabolic Disorders
- Renal and Urinary Disorders
- Urinary System
- Oncologic Disorders
- Renal Disorders
- Infectious Respiratory Disorder
- Urinary Disorders
- Sexually Transmitted Infections
- EENT Disorders
- Behavior
- Emotions and Motivation
- Growth & Development
- Psychological Disorders
- State of Consciousness
- Health & Stress