A patient with a suspected ruptured ectopic pregnancy presents with hypotension, tachycardia, and shoulder pain. Which of the following nursing actions is the priority for stabilizing this patient?

B) Initiate intravenous fluid resuscitation to manage hypotension

A) Administer pain medication to alleviate shoulder pain

B) Initiate intravenous fluid resuscitation to manage hypotension

C) Prepare the patient for a possible blood transfusion

D) Obtain a consent form for emergency surgery

A patient with a suspected ruptured ectopic pregnancy presents with hypotension, tachycardia, and referred shoulder pain. Which of the following is the priority nursing intervention?

B) Initiating intravenous fluid resuscitation with normal saline

A) Administering oxygen via nasal cannula to maintain oxygen saturation

B) Initiating intravenous fluid resuscitation with normal saline

C) Preparing the patient for a bedside ultrasound to confirm diagnosis

D) Administering analgesics to manage the patient's shoulder pain

A patient with a suspected ruptured ectopic pregnancy is experiencing hemodynamic instability. Despite fluid resuscitation, her blood pressure remains low, and her heart rate is elevated. What is the most appropriate next step in managing this patient prior to surgery?

C) Prepare for immediate blood transfusion

A) Administer a vasopressor to increase blood pressure

B) Increase the rate of intravenous fluid administration

C) Prepare for immediate blood transfusion

D) Administer a higher concentration of oxygen via non-rebreather mask

In managing a patient with suspected ruptured ectopic pregnancy who is hemodynamically unstable, which nursing intervention is most critical to address first?

D) Establishing and maintaining large-bore intravenous access for fluid resuscitation

A) Administering supplemental oxygen to maintain oxygen saturation above 94%

B) Preparing blood products for potential transfusion to manage blood loss

C) Initiating continuous cardiac monitoring to detect arrhythmias

D) Establishing and maintaining large-bore intravenous access for fluid resuscitation

A patient is in the postoperative period following a salpingectomy due to a ruptured ectopic pregnancy. Her vital signs are stable, but she remains at risk for complications. Which nursing intervention is most critical in the immediate postoperative period to ensure her continued recovery?

C) Monitor urine output closely to assess for adequate kidney perfusion.

A) Encourage early ambulation to prevent deep vein thrombosis.

B) Administer prophylactic antibiotics to prevent infection.

C) Monitor urine output closely to assess for adequate kidney perfusion.

D) Apply sequential compression devices to both legs to improve circulation.

A patient is recovering in the ICU after surgery for a ruptured ectopic pregnancy and has received a blood transfusion. The nurse is monitoring her for complications related to the transfusion. Which of the following signs should the nurse immediately report to the healthcare provider as indicative of a possible transfusion reaction?

A) Elevated temperature and chills

C) Slight bruising at the IV site

D) Decreased urine output and thirst

A patient in the intensive care unit is experiencing increased abdominal pain post-surgery, with guarding on palpation and a pain score of 6 out of 10. Her vital signs are stable, but she has mild hyponatremia and a slightly elevated white blood cell count. What is the most appropriate initial nursing intervention to address her pain while ensuring her safety?

A) Administer a high-dose opioid analgesic to quickly control the pain

C) Increase the oxygen flow rate to improve oxygenation and alleviate pain

D) Provide a fluid bolus to correct the mild hyponatremia before addressing the pain

A postoperative patient in the ICU shows a hemoglobin level of 8.2 g/dL, mild tachycardia, and localized abdominal pain rated as 6 out of 10. Which nursing intervention should take priority in managing this patient's current condition?

C) Reassess the patient's abdominal wound and notify the healthcare provider of the findings.

A) Increase the oxygen flow rate to 4 liters per minute via nasal cannula.

B) Administer the prescribed low-dose opioid for pain management immediately.

C) Reassess the patient's abdominal wound and notify the healthcare provider of the findings.

D) Initiate a blood transfusion to improve the patient's hemoglobin level.

A patient in the intensive care unit is experiencing a downward trend in blood pressure, increased heart rate, and a drop in hemoglobin levels post-surgery, with an ultrasound revealing free fluid in the pelvis. What is the most appropriate initial intervention by the nursing team to address the patient's hemodynamic instability?

B) Increase IV fluid rate to manage potential hypovolemia

A) Administer an immediate blood transfusion

B) Increase IV fluid rate to manage potential hypovolemia

C) Prepare the patient for immediate surgical intervention

D) Increase oxygen flow to improve oxygen saturation

A patient in the ICU is experiencing a downward trend in blood pressure, increased heart rate, and evidence of free fluid in the pelvis post-surgery. Her hemoglobin has dropped to 7.8 g/dL. Which of the following nursing interventions is the most appropriate to address her hemodynamic instability?

B) Administer the ordered blood transfusion to address potential ongoing blood loss.

A) Increase oxygen flow to 4 liters per minute to improve oxygenation.

B) Administer the ordered blood transfusion to address potential ongoing blood loss.

C) Elevate the head of the bed to 45 degrees to reduce abdominal pressure.

D) Restrict fluid intake to prevent fluid overload and potential pulmonary edema.

ectopic pregnancy - Nursing Case Study

Pathophysiology

• Primary mechanism: Ectopic pregnancy occurs when a fertilized ovum implants outside the uterine cavity, most commonly in the fallopian tube, due to disrupted tubal motility or damaged ciliated epithelium. This prevents the embryo from reaching the uterus for proper implantation.

• Secondary mechanism: Tubal damage, often resulting from infections like pelvic inflammatory disease or conditions such as endometriosis, creates adhesions or scarring, further obstructing the normal passage of the fertilized egg and increasing the risk of ectopic implantation.

• Key complication: As the embryo grows in the confined space of the fallopian tube, it can lead to rupture, causing internal bleeding and acute abdominal pain, which can be life-threatening and requires immediate medical intervention.

Patient Profile

Demographics:

28-year-old female, nurse

History:

• Key past medical history: Previous pelvic inflammatory disease

• Current medications: Oral contraceptive pills

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Lower abdominal pain and vaginal bleeding

• Key symptoms: Sharp left lower quadrant pain, dizziness, shoulder pain

• Vital signs: Blood pressure 95/60 mmHg, heart rate 110 bpm, respiratory rate 22 breaths per minute, temperature 99.1°F

Section 1

Change in Patient Status

As the healthcare team continues to monitor the patient, there is a notable change in her condition. The patient's blood pressure drops further to 85/55 mmHg, and her heart rate increases to 120 bpm, indicating a possible hemodynamic instability. The patient is now experiencing increased dizziness and her shoulder pain, a classic sign of referred pain due to diaphragmatic irritation, has intensified. These symptoms suggest that the ectopic pregnancy may have ruptured, leading to significant internal bleeding.

On physical examination, the patient exhibits guarding and rebound tenderness in the lower abdomen, particularly in the left lower quadrant. A focused abdominal ultrasound at the bedside reveals free fluid in the pelvis, consistent with hemoperitoneum. Laboratory results show a decrease in hemoglobin levels to 9.5 g/dL from an earlier value of 12.2 g/dL, indicating acute blood loss. These findings necessitate urgent intervention to stabilize the patient and prevent further deterioration.

The clinical team initiates intravenous fluid resuscitation to manage the patient's hypotension and prepares for possible surgical intervention. An immediate consultation with the on-call obstetrician-gynecologist is arranged to assess the need for an emergency laparoscopic procedure to address the suspected tubal rupture and control the bleeding. This situation underscores the critical nature of rapid decision-making and highlights the importance of identifying and managing ectopic pregnancy complications promptly to prevent severe morbidity or mortality.

Section 2

As the healthcare team implements initial interventions, the patient's condition unfortunately deteriorates. Despite aggressive intravenous fluid resuscitation efforts, her blood pressure remains critically low at 88/54 mmHg, and her heart rate escalates further to 130 bpm. The patient is now visibly pale and diaphoretic, indicating worsening hemodynamic instability. Her oxygen saturation starts to drop to 92% on room air, prompting the team to administer supplemental oxygen via nasal cannula. The patient's increased respiratory rate of 28 breaths per minute reflects her body's attempt to compensate for the decreased oxygen delivery due to ongoing blood loss.

The on-call obstetrician-gynecologist arrives promptly and conducts a thorough reassessment. A repeat bedside ultrasound confirms an increase in the amount of free fluid in the abdomen, reinforcing the suspicion of ongoing intraperitoneal hemorrhage. Given the patient's unstable clinical status and the likelihood of further complications, the decision is made to proceed immediately with an emergency laparoscopic surgery. The surgical team is mobilized, and the patient is prepared for transfer to the operating room, with continuous monitoring of her vital signs and ongoing fluid administration to maintain perfusion.

The urgency of the situation necessitates quick yet careful clinical reasoning; the team discusses the potential need for blood transfusion intraoperatively, considering the patient's dropping hemoglobin levels now at 8.7 g/dL. They also review the patient’s coagulation profile, which remains within normal limits but is closely monitored. The impending surgery represents a critical juncture in the patient's care, aiming to locate and control the source of bleeding and stabilize her hemodynamic status. The coordinated efforts of the multidisciplinary team are crucial in managing this complex case of ectopic pregnancy with rupture, emphasizing the importance of timely intervention to prevent further complications.

Section 3

As the patient is swiftly transferred to the operating room, the team prepares for potential complications and remains vigilant in their monitoring. The anesthesiology team initiates a rapid sequence induction to secure the airway, mindful of the patient's respiratory distress and the need for controlled ventilation to optimize oxygenation. During the induction of anesthesia, the patient's blood pressure drops further to 82/50 mmHg, necessitating the administration of vasopressors to stabilize her hemodynamic status. The surgical team begins the laparoscopic procedure, and it becomes apparent that the ectopic pregnancy has indeed ruptured, causing significant bleeding in the abdominal cavity.

Intraoperatively, the surgeon identifies and addresses the source of bleeding by excising the affected fallopian tube, a procedure known as a salpingectomy. Despite the surgical intervention, the patient's hemoglobin continues to decrease, now at 7.5 g/dL, prompting the team to initiate a blood transfusion to replenish circulating red blood cells and improve oxygen delivery. The coordinated efforts to manage her coagulopathy with fresh frozen plasma and ensure adequate perfusion through crystalloid and colloid solutions are crucial in stabilizing the patient's condition.

As the surgery concludes, and the patient's vital signs begin to stabilize, her blood pressure improves to 100/70 mmHg with a heart rate of 110 bpm. The successful control of hemorrhage and supportive measures in the operating room highlight the importance of timely surgical intervention in ectopic pregnancy with rupture. The patient is transferred to the intensive care unit for close postoperative monitoring, where the healthcare team continues to assess her recovery and address any residual effects of the significant blood loss she endured. The focus now shifts to ensuring her physiological stability, preventing infection, and managing her pain effectively as she begins the path to recovery.

Section 4

As the patient settles into the intensive care unit, the nursing team conducts a thorough initial assessment to establish a baseline for ongoing monitoring. On examination, the patient remains pale but is responsive and oriented, indicating a positive response to the interventions thus far. Her vital signs are more stable, with a blood pressure of 105/72 mmHg and a heart rate of 102 bpm, though she still exhibits mild tachycardia. Her respiratory rate is 22 breaths per minute, and her oxygen saturation is 96% on 2 liters of nasal cannula oxygen, suggesting adequate oxygenation.

Laboratory tests drawn postoperatively reveal a hemoglobin level of 8.2 g/dL, showing a slight improvement post-transfusion, although still below normal. Her white blood cell count is slightly elevated at 12,500/mm³, indicating a potential inflammatory response or early signs of infection. The nursing team, alert to these findings, considers the need for vigilant monitoring and possible prophylactic antibiotics to prevent infection. Additionally, her electrolyte panel shows a mild hyponatremia with a sodium level of 133 mmol/L, which prompts the team to adjust her intravenous fluids accordingly.

Despite the overall stabilization, the patient begins to experience increased abdominal pain, rating it at 6 out of 10 on the pain scale. The pain is more localized to the surgical site, and she exhibits guarding on palpation. This development necessitates an evaluation of pain management strategies to ensure comfort without compromising her hemodynamic stability. The nursing team implements a multimodal analgesia plan, including acetaminophen and a low-dose opioid, while remaining cautious of potential side effects. As she progresses through her recovery, the team remains attentive to these evolving clinical indicators, poised to intervene promptly should any new complications arise.

Section 5

As the patient remains under close observation in the intensive care unit, the nursing team notes a subtle change in her status. Despite the initial stabilization, her blood pressure starts to trend downward, measured at 98/68 mmHg upon reassessment. The heart rate, while initially steady, has increased slightly to 108 bpm, indicating the possibility of hypovolemia or another underlying issue. Her respiratory rate remains elevated at 24 breaths per minute, and although her oxygen saturation is still satisfactory at 95% on 2 liters of oxygen, there is a growing concern for her overall oxygen demand and hemodynamic status.

A follow-up ultrasound is conducted to evaluate the source of her increased abdominal pain and hemodynamic changes. The results reveal the presence of a small amount of free fluid in the pelvis, raising the suspicion of continued bleeding or a hematoma at the surgical site. The nursing team, in collaboration with the attending physician, decides to increase the frequency of vital sign monitoring and re-evaluate her hemoglobin levels. The repeat hemoglobin test comes back at 7.8 g/dL, indicating a drop that suggests ongoing blood loss. This finding prompts the team to consider another blood transfusion and further imaging to assess the need for potential surgical intervention.

In response to these developments, the nursing team strengthens their focus on fluid management and pain control. They adjust her IV fluids to ensure adequate volume resuscitation and continue with the multimodal analgesia approach, carefully balancing the need for effective pain relief with the risk of exacerbating her hemodynamic instability. As they evaluate the effectiveness of these interventions, the team remains vigilant for signs of deterioration, such as increased tachycardia or further drops in blood pressure, which would necessitate immediate escalation of care. Through these proactive measures, they aim to stabilize the patient's condition and prevent further complications, while preparing for potential surgical consultations to address any unresolved issues.