NURSING
PROCESS: THE PATIENT WITH AN ECTOPIC PREGNANCY
The
health history includes the menstrual pattern and any (even slight) bleeding
since the last menstrual period. The nurse elicits the patient’s description of
pains and their location. The nurse asks the patient whether any sharp, colicky
pains have occurred. Then the nurse notes whether pain radiates to the shoulder
and neck (possibly caused by rupture and pressure on the diaphragm).
The
nurse monitors vital signs, level of consciousness, and na-ture and amount of vaginal
bleeding. If possible, the nurse as-sesses how the woman is coping with the
loss of a pregnancy.
Based
on the assessment data, the patient’s major nursing diag-noses may include the
following:
· Acute pain related to
the progression of the tubal pregnancy
· Anticipatory grieving
related to the loss of pregnancy and effect on future pregnancies
· Deficient knowledge
related to the treatment and effect on future pregnancies
Based on
the assessment data, major complications may include the following:
· Hemorrhage
· Hemorrhagic shock
The
major goals for the patient may include relief of pain; accep-tance and
resolution of grief and pregnancy loss; increased knowl-edge about ectopic
pregnancy, its treatment, and its outcome; and absence of complications.
The
abdominal pain associated with ectopic pregnancy may be described as cramping
or severe continuous pain. If the patient is to have surgery, preanesthetic
medications may provide pain re-lief. Postoperatively, analgesic agents are
administered liberally;this promotes early ambulation and enables the patient
to cough and take deep breaths.
Patients’
distress levels vary. If the pregnancy is wanted, loss may or may not be
expressed verbally by the patient and her partner. The impact may not be fully
realized until much later. The nurse should be available to listen and provide
support. The patient’s partner, if appropriate, should participate in this
process. Even if the pregnancy was unplanned, a loss has been experienced, and
a grief reaction may follow. Severe and persistent psychological dis-tress may
require referral for psychological counseling.
Potential
complications of ectopic pregnancy are hemorrhage and shock. Careful assessment
is essential to detect the development of these complications. Continuous
monitoring of vital signs, level of consciousness, amount of bleeding, and
intake and output pro-vides information about the possibility of hemorrhage and
the need to prepare for intravenous therapy. Bed rest is indicated. Hematocrit,
hemoglobin, and blood gas levels are monitored to assess hematologic status and
adequacy of tissue perfusion. Sig-nificant deviations in these laboratory
values are reported imme-diately, and the patient is prepared for possible
surgery. Blood component therapy may be required if blood loss has been rapid
and extensive. If hypovolemic shock occurs, the treatment is di-rected toward
re-establishing tissue perfusion and adequate blood volume.
If the
patient has experienced life-threatening hemorrhage and shock, these
complications are addressed and treated before any in-depth teaching can begin.
At this time, the patient’s and the nurse’s attention is focused on the crisis,
not on learning. Therefore, it may be later that the patient begins to ask
questions about what has hap-pened and why certain procedures were performed.
Procedures are explained in terms that a distressed and apprehensive patient
can understand. The patient’s partner is included in teaching and ex-planations
when possible. After the patient recovers from postop-erative discomforts, it
may be more appropriate to address any questions and concerns that the patient
and her partner have, in-cluding the effect of this pregnancy or its treatment
on future preg-nancies. Patients should be advised that ectopic pregnancies may
recur. It is important to review signs and symptoms with the pa-tient and
instruct her to report an abnormal menstrual period promptly. Patient teaching
is based on the needs of the patient and her partner and must take into
consideration their distress and grief. The patient is informed about possible
complications and in-structed to report early signs and symptoms.
Because
of the risk of subsequent ectopic pregnancies, the patient is advised to seek
preconception counseling before considering fu-ture pregnancies and to seek
early prenatal care. Psychological sup-port and counseling may be advisable for
women and their partners to help them deal with the loss of the pregnancy.
Follow-up con-tact enables the nurse to answer questions and clarify
information for the woman and her partner. In addition, it provides an
oppor-tunity to assess their ability to cope with the loss of the pregnancy.
Expected
patient outcomes may include:
1) Experiences relief of
pain
a)
Reports a decrease in pain and discomfort
b)
Ambulates as prescribed; performs coughing and deep
breathing
2) Begins to accept loss of
pregnancy and expresses grief by verbalizing feelings and reactions to loss
3) Verbalizes an
understanding of the causes of ectopic preg-nancy
4) Experiences no
complications
a)
Exhibits no signs of bleeding, hemorrhage, or shock
b)
Has decreased amounts of discharge (on perineal
pad)
c)
Has normal skin color and turgor
d)
Exhibits stable vital signs and adequate urine
output
5) Levels of beta-hCG
return to normal
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