Nursing Care Plan for Ectopic Pregnancy

Pathophysiology

An ectopic pregnancy is when the fertilized egg (zygote) attaches, or implants, and begins to grow in an area other than the uterus. This most often occurs in the fallopian tube, but can be in other areas as well such as the cervix, ovary or abdominal cavity. An embryo cannot grow and survive outside the uterus, and parts like the fallopian tubes are unable to support such a pregnancy and must be treated immediately. Often, a woman may not be aware she is pregnant and symptoms may be vague. Blood test and ultrasound are the best ways to diagnose ectopic pregnancy.

Etiology

An ectopic pregnancy happens when the egg, traveling from the ovary to the uterus, gets stuck. This may be due to endometriosis, scar tissue from previous abdominal surgeries, inflammation or infection such as chlamydia, use of an IUD, or following IVF treatments.  If the pregnancy occurs in the fallopian tube (tubal pregnancy), it may cause the tube to rupture and is considered a medical emergency.

Desired Outcome

Patient will be free from pain and complications

Ectopic Pregnancy Nursing Care Plan

Subjective Data:

  • Lower abdominal pain
  • Weakness
  • Dizziness
  • Nausea
  • Amenorrhea, absence of menstrual period

Objective Data:

  • Vaginal bleeding or spotting
  • Tachycardia
  • Tachypnea
  • Hypotension

Nursing Interventions and Rationales

  1. Assess vital signs:

    • Blood pressure
    • Heart rate
    • Respirations
    • Temperature
  2. If an ectopic pregnancy occurs in the fallopian tube that ruptures, the patient may go into shock and will have rapid heart rate, rapid breathing and low blood pressure.

  3. Assess for signs of dehydration; skin turgor, mucous membranes, cap refill

  4. Excessive blood loss and vomiting may cause hypovolemia and dehydration.

  5. Position patient for comfort and assist with movement as needed

  6. Patient should be positioned lying flat on the bed to reduce movement, stabilize vitals and promote comfort.

  7. Assess for abdominal pain and tenderness

    • Pain may vary, but is usually a sign that an ectopic pregnancy, or fallopian tube, has ruptured.
    • Patients will report stabbing or sharp pain in the lower abdomen with fluctuating intensity.

  8. Monitor blood loss and administer blood products as necessary

  9. Vaginal bleeding may range from spotting to heavier than a normal menstrual cycle

  10. Monitor intake and output; administer fluids as appropriate

  11. To maintain renal function, especially in the case of shock.

  12. Administer medications as appropriate and monitor for adverse reactions

    • Methotrexate may be given to absorb the pregnancy tissue and save the fallopian tube.
    • Anti-nausea and analgesic medications may be given to manage symptoms

  13. Prepare patient for surgery:

    • Maintain NPO status
    • Insert indwelling catheter
    • Establish and maintain IV access and fluids
  14. If the fallopian tube has ruptured, surgery to remove part or all of the tube may be the best option. Surgery may be performed laparoscopically or a laparotomy may be necessary.

  15. Provide patient education of ways to prevent future ectopic pregnancies

  16. Educate patient of risk factors and lifestyle changes to avoid future ectopic pregnancies:

    • Stop smoking
    • Multiple sex partners increase risk of pelvic infections and ectopic pregnancies


References

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