Ectopic Pregnancy
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Ectopic Pregnancy Laparascopic View (Image)
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Outline
Overview
- When a fertilized egg (ovum) implants outside of the uterine cavity
- “Ectopic” means out of place
- It could be in multiple different locations, however most are in fallopian tubes
- Fallopian tube, cervix, abdominal cavity
Nursing Points
General
- Patient may have missed period/ presumptive signs of pregnancy, but do not know that it is ectopic without ultrasound or until it ruptures
- This can be an emergency, especially if the fallopian tube has ruptured
Assessment
- Classic signs are pregnancy symptoms (missed period, positive pregnancy test) followed by vaginal spotting and severe abdominal pain
- Signs of ruptured fallopian tube include severe pain on one side, signs of shock, and pain referring to the right shoulder
- Referred pain is due to blood in the abdomen
Therapeutic Management
- Goals are to prevent rupture, bleeding, and shock
- Surgical removal
- Laparoscopic
- Medical
- Methotrexate-inhibits cellular division of the embryo (aborts)
- Fallopian tube may be compromised and need to be removed
- Rh immune globulin if mom is Rh negative
Nursing Concepts
- Reproduction
- Comfort
- Coping
Patient Education
- Report severe pain, especially right shoulder pain
- Report vaginal bleeding
- Ectopic pregnancies cannot survive, the pregnancy will have to be terminated
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ADPIE Related Lessons
Related Nursing Process (ADPIE) Lessons for Ectopic Pregnancy
Transcript
In this lesson I will explain what an ectopic pregnancy is, how it occurs, and your role in caring for a patient with an ectopic pregnancy.
An ectopic pregnancy means a pregnancy that occurs outside of the uterus.So let’s get this straight we are talking about an embryo that attaches outside of the uterus. As you see in this picture these white eggs are showing the embryo in the normal place verses wrong places. This could be in the cervix, abdomen or most commonly in the fallopian tube. This is dangerous because the fallopian tubes are not very big so they are at risk to rupture because the embryonic cells are rapidly dividing causing growth. The patient will more then likely have a missed period and presumptive signs of pregnancy as well as a positive pregnancy test. She will not be aware that it is ectopic until later. This can be an emergency because it is usually not detected until there is a problem. What do I mean by problem? Well we have a fallopian tube and it is a small space. We have rapidly dividing cells in the fallopian tube growing bigger and bigger. Eventually something has to give and it is usually the rupture of the fallopian tube. The hope is that when the pain starts the female will seek medical help and they can preserve the tube and prevent the rupture.
The classic signs of an ectopic pregnancy start with just basic pregnancy symptoms. There is a missed period and a positive pregnancy test. This is followed by vaginal spotting, usually around 5-6 weeks, and severe abdominal pain. Remember it is in the wrong place! If it is not caught in time the fallopian tube could rupture. So what will that look like? This will cause severe pain on one side, the side that ruptured. This patient is bleeding into her abdomen so there will be signs of shock. She also might have referred pain. The referred pain is usually felt in the shoulder and is due to the blood in the abdomen. In this picture you can see the uterus marked with the blue arrows and in the left fallopian tube there is swelling and bleeding. You can see how much bigger the left tube is compared to the right. It really looks at risk to rupturing.
For therapeutic management our main goal is to prevent rupture of the fallopian tube from happening. We want to prevent or minimize bleeding to prevent shock from occurring. Management could include surgical removal. This could be laparoscopic which would not require a large incision or a laparotomy if the doctor needs a larger opening to remove contents or the ruptured tube. Medical management is with Methotrexate. This medication will inhibit cellular division. Remember an embryo is a ball of rapidly dividing cells. This will cause the body to abort the embryo and hopefully save the fallopian tube. It is very important that our management of this patient include rhogam for Rh immune globulin if mom is Rh negative. We need to give her this to protect any future pregnancies from her body attacking them because of the Rh factor.
What education does this patient need? She needs to report any severe pain, especially right shoulder pain. What was that a sign of? Right, a ruptured fallopian tube causing referred pain. Vaginal bleeding should also be reported because vaginal bleeding even spotting could be a sign of a problem such as an ectopic pregnancy. All ectopic pregnancies are not viable. This means they cannot survive so the pregnancy will have to be terminated. This is difficult for the patient to understand so we need to be aware of this and explain why it has to be terminated and what the options are.
Nursing concepts for the patient with ectopic pregnancy are reproduction because she has reproduced, comfort because we need to keep her comfortable during management for her care, and coping because this is a loss. She thought she was pregnancy and now has to cope with the loss.
Let’s look at the key points to bring it all together. Ectopic pregnancies are when the embryo attaches outside so it is not in the right place. The body recognizes that there is a pregnancy so there is a missed period and positive pregnancy test. Usually around 6 weeks the patient will begin to feel pain and experience some spotting. This is because it has started to grow and the body now realizes there is a problem. The pregnancy is not viable. A patient care not deliver an ectopic pregnancy. The goal is to terminate and save the fallopian tube, if that is where the pregnancy is. Termination will be either medically or surgically. Medically will be drugs such as methotrexate because that medication prevents cells from rapidly dividing. Think about it. An embryo is trying to develop there are a bunch of rapidly dividing cells so it will prevent this from occurring and the hope is that the body will terminate and remove on it’s own. Surgical termination will be trying to laparoscopically removing the embryo and trying their best to preserve the fallopian tube.
Make sure you check out the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing.
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Study Plan Lessons
Communicating with Other Nurses
Conflict Management (Patient, Perioperative Team, Family) for Certified Perioperative Nurse (CNOR)
CRNA
Daily Charting
Day in the Life of a Labor Nurse
Day in the Life of a Med-surg Nurse
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05.03 Jaundice for CCRN Review
Abortion in Nursing: Spontaneous, Induced, and Missed
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Addicted Newborn
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Cardiac (Heart) Disease in Pregnancy
Causes of Chorioamnionitis Nursing Mnemonic (Pregnancies Are Very Interesting)
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Certified Nurse Midwife
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Discomforts of Pregnancy
Disseminated Intravascular Coagulation (DIC)
Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Dystocia
Ectopic Pregnancy
Ectopic Pregnancy Case Study (30 min)
Ectopic Pregnancy for Certified Emergency Nursing (CEN)
Emergent Delivery (OB) (30 min)
Emergent Delivery for Certified Emergency Nursing (CEN)
Epidural
Episiotomy – Evaluation of Healing Nursing Mnemonic (REEDA)
Erythroblastosis Fetalis
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Eye Prophylaxis for Newborn (Erythromycin)
Factors That Can Put a Pregnancy at Risk Nursing Mnemonic (RIBCAGE)
Family Planning & Contraception
Family Planning & Signs of Pregnancy – Live Tutoring Archive
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Hepatitis B Vaccine for Newborns
Homocysteine (HCY) Lab Values
Hydatidiform Mole (Molar pregnancy)
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Hydrochlorothiazide (Hydrodiuril) Nursing Considerations
Hyperbilirubinemia (Jaundice)
Hyperemesis Gravidarum
Hyperemesis Gravidarum for Certified Emergency Nursing (CEN)
Hyperglycemia Management Nursing Mnemonic (Dry and Hot – Insulin Shot)
Hypovolemic Shock Case Study (OB sim) (60 min)
Incompetent Cervix
Infections in Pregnancy
Initial Care of the Newborn (APGAR)
Inserting a Foley (Urinary Catheter) – Female
Intra Uterine Device – Potential Problems Nursing Mnemonic (PAINS)
Isotonic Solutions (IV solutions)
Labor Progression Case Study (45 min)
Leopold Maneuvers
Lung Surfactant
Lung Surfactant for Newborns
Magnesium Sulfate
Magnesium Sulfate
Magnesium Sulfate (MgSO4) Nursing Considerations
Magnesium Sulfate in Pregnancy
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Meds for PPH (postpartum hemorrhage)
Menstrual Cycle
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Nursing Care Plan (NCP) for Abruptio Placentae / Placental abruption
Nursing Care Plan (NCP) for Chorioamnionitis
Nursing Care Plan (NCP) for Diabetes Mellitus (DM)
Nursing Care Plan (NCP) for Dystocia
Nursing Care Plan (NCP) for Ectopic Pregnancy
Nursing Care Plan (NCP) for Gestational Diabetes (GDM)
Nursing Care Plan (NCP) for Gestational Hypertension, Preeclampsia, Eclampsia
Nursing Care Plan (NCP) for Hyperemesis Gravidarum
Nursing Care Plan (NCP) for Hypertension (HTN)
Nursing Care Plan (NCP) for Incompetent Cervix
Nursing Care Plan (NCP) for Mastitis
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Nursing Care Plan (NCP) for Meconium Aspiration
Nursing Care Plan (NCP) for Neonatal Jaundice | Hyperbilirubinemia
Nursing Care Plan (NCP) for Newborns
Nursing Care Plan (NCP) for Placenta Previa
Nursing Care Plan (NCP) for Postpartum Hemorrhage (PPH)
Nursing Care Plan (NCP) for Premature Rupture of Membranes (PROM) / Preterm Premature Rupture of Membranes (PPROM)
Nursing Care Plan (NCP) for Preterm Labor / Premature Labor
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Nursing Care Plan (NCP) for Transient Tachypnea of Newborn
Nursing Care Plan for (NCP) Fetal Alcohol Syndrome (FAS)
Nursing Care Plan for Newborn Reflexes
Nursing Case Study for Maternal Newborn
Nutrition Assessments
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OB (Labor) Nurse Report to OB (Postpartum) Nurses
OB Course Introduction
OB Non-Stress Test Results Nursing Mnemonic (NNN)
OB Pharm and What Drugs You HAVE to Know – Live Tutoring Archive
Obstetric Trauma for Certified Emergency Nursing (CEN)
Obstetrical Procedures
Opioid Analgesics in Pregnancy
Oral Birth Control Pills – Serious Complications Nursing Mnemonic (Aches)
Oxytocin (Pitocin) Nursing Considerations
Pediatric Vital Signs (VS)
Physiological Changes
Phytonadione (Vitamin K)
Phytonadione (Vitamin K) for Newborn
Placenta Previa
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Possible Infections During Pregnancy Nursing Mnemonic (TORCH)
Post-Partum Assessment Nursing Mnemonic (BUBBLE)
Postpartum Discomforts
Postpartum Hematoma
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Postpartum Interventions
Postpartum Physiological Maternal Changes
Postpartum Thrombophlebitis
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Preeclampsia, Eclampsia, and HELLP Syndrome for Certified Emergency Nursing (CEN)
Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
Pregnancy Labs
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Preload and Afterload
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Preterm Labor
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Process of Labor
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Prolapsed Umbilical Cord
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Prostaglandins
Prostaglandins in Pregnancy
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Rh Immune Globulin (Rhogam)
Rh Immune Globulin in Pregnancy
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Signs of Pregnancy (Presumptive, Probable, Positive)
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Threatened/Spontaneous Abortion for Certified Emergency Nursing (CEN)
Tips & Advice for Newborns (Neonatal IV Insertion)
Tocolytics
Tocolytics
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Transient Tachypnea of Newborn
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Uterine Stimulants (Oxytocin, Pitocin) Nursing Considerations
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What the Heck is Antepartum Testing? – Live Tutoring Archive
Abdomen (Abdominal) Assessment
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Assessment of a Burn Nursing Mnemonic (SCALD)
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Isolation Precaution Types (PPE)
Isolation Precautions (MRSA, C. Difficile, Meningitis, Pertussis, Tuberculosis, Neutropenia)
Lactulose (Generlac) Nursing Considerations
Leukemia
Levels of Consciousness (LOC)
Levetiracetam (Keppra) Nursing Considerations
Lung Sounds
Marfan Syndrome
Meningitis
Meningitis Assessment Findings Nursing Mnemonic (FAN LIPS)
Meningitis for Certified Emergency Nursing (CEN)
Methylphenidate (Concerta) Nursing Considerations
Mixed (Cardiac) Heart Defects
Mumps
Nephroblastoma
Nephrotic Syndrome
Nephrotic Syndrome Case Study (Peds) (45 min)
Neuro Assessment
NSAIDs
Nursing Care Plan (NCP) for Acute Bronchitis
Nursing Care Plan (NCP) for Appendicitis
Nursing Care Plan (NCP) for Asthma
Nursing Care Plan (NCP) for Asthma / Childhood Asthma
Nursing Care Plan (NCP) for Attention Deficit Hyperactivity Disorder (ADHD)
Nursing Care Plan (NCP) for Bronchiolitis / Respiratory Syncytial Virus (RSV)
Nursing Care Plan (NCP) for Burn Injury (First, Second, Third degree)
Nursing Care Plan (NCP) for Celiac Disease
Nursing Care Plan (NCP) for Cerebral Palsy (CP)
Nursing Care Plan (NCP) for Cleft Lip / Cleft Palate
Nursing Care Plan (NCP) for Clubfoot
Nursing Care Plan (NCP) for Congenital Heart Defects
Nursing Care Plan (NCP) for Constipation / Encopresis
Nursing Care Plan (NCP) for Cystic Fibrosis
Nursing Care Plan (NCP) for Decreased Cardiac Output
Nursing Care Plan (NCP) for Dehydration & Fever
Nursing Care Plan (NCP) for Eczema (Infantile or Childhood) / Atopic Dermatitis
Nursing Care Plan (NCP) for Enuresis / Bedwetting
Nursing Care Plan (NCP) for Epiglottitis
Nursing Care Plan (NCP) for Fluid Volume Deficit
Nursing Care Plan (NCP) for Hemophilia
Nursing Care Plan (NCP) for Hydrocephalus
Nursing Care Plan (NCP) for Impaired Gas Exchange
Nursing Care Plan (NCP) for Imperforate Anus
Nursing Care Plan (NCP) for Impetigo
Nursing Care Plan (NCP) for Infective Conjunctivitis / Pink Eye
Nursing Care Plan (NCP) for Influenza
Nursing Care Plan (NCP) for Intussusception
Nursing Care Plan (NCP) for Marfan Syndrome
Nursing Care Plan (NCP) for Meningitis
Nursing Care Plan (NCP) for Mumps
Nursing Care Plan (NCP) for Neural Tube Defect, Spina Bifida
Nursing Care Plan (NCP) for Omphalocele
Nursing Care Plan (NCP) for Otitis Media / Acute Otitis Media (AOM)
Nursing Care Plan (NCP) for Pediculosis Capitis / Head Lice
Nursing Care Plan (NCP) for Pertussis / Whooping Cough
Nursing Care Plan (NCP) for Phenylketonuria (PKU)
Nursing Care Plan (NCP) for Reye’s Syndrome
Nursing Care Plan (NCP) for Rheumatic Fever
Nursing Care Plan (NCP) for Rubeola – Measles
Nursing Care Plan (NCP) for Scoliosis
Nursing Care Plan (NCP) for Sickle Cell Anemia
Nursing Care Plan (NCP) for Tonsillitis
Nursing Care Plan (NCP) for Varicella / Chickenpox
Nursing Care Plan (NCP) for Vomiting / Diarrhea
Nursing Care Plan for (NCP) Autism Spectrum Disorder
Nursing Case Study for Pediatric Asthma
Obstructive Heart (Cardiac) Defects
Ocular Infections (Conjunctivitis, Iritis) for Certified Emergency Nursing (CEN)
Omphalocele
Opioid Analgesics
Pancrelipase (Pancreaze) Nursing Considerations
Pediatric Bronchiolitis Labs
Pediatric Gastrointestinal Dysfunction – Diarrhea
Pediatric Oncology Basics
Pediatrics Course Introduction
Pediculosis Capitis
Pertussis – Whooping Cough
Phenylketonuria
Phenytoin (Dilantin) Nursing Considerations
Platelets (PLT) Lab Values
Pneumonia
Promotion and Evaluation of Normal Elimination Nursing Mnemonic (POOPER SCOOP)
Pulmonary Function Test
Red Blood Cell (RBC) Lab Values
Respiratory Acidosis (interpretation and nursing interventions)
Reye’s Syndrome
Reyes Syndrome Case Study (Peds) (45 min)
Rheumatic Fever
ROME – ABG (Arterial Blood Gas) Interpretation
Rubeola – Measles
Salmeterol (Serevent) Nursing Considerations
Scoliosis
Selegiline (Eldepyrl) Nursing Considerations
Sickle Cell Anemia
Spina Bifida – Neural Tube Defect (NTD)
Steroids – Side Effects Nursing Mnemonic (6 S’s)
Stoma Care (Colostomy bag)
Strabismus
Sudden Infant Death Syndrome (SIDS)
Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
Thorax and Lungs Assessment
Tonsillitis
Topical Medications
Tracheal Esophageal Fistula – Sign and Symptoms Nursing Mnemonic (The 3 C’s)
Transient Incontinence – Common Causes Nursing Mnemonic (P-DIAPERS)
Treatment of Sickle Cell Nursing Mnemonic (HOP to the hospital)
Umbilical Hernia
Vaccine-Preventable Diseases (Measles, Mumps, Pertussis, Chicken Pox, Diphtheria) for Certified Emergency Nursing (CEN)
Varicella – Chickenpox
Varicella Case Study (Peds) (30 min)
Vitals (VS) and Assessment
Vomiting
White Blood Cell (WBC) Lab Values
X-Ray (Xray)
ADLs (Activity of Daily Living) Nursing Mnemonic (BATTED)
Emotions and Motivation
Growth & Development Theories
Maslow’s Hierarchy of Needs in Nursing
Psychological Disorders
State of Consciousness
Stress and Crisis