Detail description has been provided in this pdf regarding history collection, physical examination, treatment modalities, investigations and a detail description on Ectopic Pregnancy. causes, clinical manifestations. management, diagnostic evaluation and nursing care plan which is compared between patient and book data.

1. C M PATEL COLLEGE OF NURSING
GANDHINAGAR
SUBJECT: OBSTETRICS AND GYNECOLOGY
NURSING
TOPIC: CASE STUDY ON TUBAL ECTOPIC
PREGNANCY
BATCH: 2022-2024
YEAR: S.Y. MSc. NURSING
SUBMITTED TO: SUBMITTED BY:
Mrs Shalini Nair Rashmi Goswami
Associate Professor Roll No. 04
C.M.P.C.O.N C.M.P.C.O.N
Gandhinagar Gandhinagar
SUBMITTED ON:

3.  BIODATA OF THE CLIENT:
Name: Jyotiben Sagar
Age: 34 year
Sex: Female
Register No.: 126930
Ward: Gynec ward
Bed No.: 09
Doctor’s unit: Dr Komal
Admission date: 02/02/24
Education: 8th
pass
Occupation: Housewife
Address: Gandhinagar
Nationality: Indian
Marital status: Married
LMP: 19/12/23
EDD: 26/08/24
Obstetric score: G4P3L3A0
Diagnosis: Ectopic Pregnancy
Surgery: Laparotomy with left Salpingectomy
 PRESENT HISTORY:
Medical and Surgical history:
Medical: Mrs Jagrutiben was having ectopic pregnancy.
Surgical: Mrs Jagrutiben Sagar had undergone laparotomy with left
salpingectomy on 03/02/24.

4. Past obstetrical history:
Sr.
no
Year Full
term
Pre
term
Abortion Type of
delivery
Baby Remark
Sex Alive Still
birth
Weight
1. 2004 Yes - - FTND M Yes - 2.7kg -
2. 2006 Yes - - FTND M Yes - 3kg -
3. 2007 Yes - - FTND F Yes - 2.5 -
 PRESENT OBSTETRICAL HISTORY:
First trimester Second trimester Third trimester
LMP:19/12/2023
Pregnancy diagnosed by
UPT.
Positive after 6 week of
LMP
Referred from PHC and
diagnosed with Ectopic
Pregnancy.
No h/o fever, rashes,
excessive vomiting,
bleeding etc.
-------- --------
 CHIEF COMPLAINS:
Mrs Jagrutiben having Abdominal pain h/o ruptured ectopic
 FAMILY HISTORY:
Sr.
no.
Name of
the
family
member
Relationship
with the
patient
Age Sex Education Occupation Health
Status
1. Mr
Maheshbhai
Husband 35yr M 12th
passed Farmer Healthy
2. Mr Sumit Son 19yr M BSc Student Healthy
3. Mr Shailesh Son 17yr M 12th
std Student Healthy
4. Ms.Renuka Daughter 16yr F 11th
std Student Healthy

5.  SOCIOECONOMIC HISTORY:
She belongs to a Nuclear family having 4 members. She is a
housewife & her husband is an earning person in her family.
Monthly income are 30,000/- . There is no history of any disease
like TB, HTN, DM & hereditary disease, twin pregnancy in her
family.
 MENSTRUAL HISTORY:
Age of Menarche: 12 year
Cycle: 30 days
Duration: 5 days
Regular/Irregular: Regular
 MARITAL STATUS:
Type of marriage: Non consanguineous
Duration of marriage: 13 years
 PRESENT PREGNANCY:
Date of admission: 02/02/2024
Height: 156 cm
Weight: 42 kg
LMP: 19/12/23
 HEAD TO TOE EXAMINATION:
 Head: Hairs were rough,
No skull injury and infection,
No any scar present
 Face: Face was looking anxious
 Eyes: Conjunctiva normal,
Eyelids are normal
Vision was normal
 Ear: No any discharge from the ear
Hearing acuity was normal
 Nose: No any nasal deviation
No any discharge from the nose
 Mouth: Lip was cracked

6. No gums bleeding
No any tooth decay
 Neck: Normal ROM
No Lymphadenopathy
No thyroid abnormality
 Chest:
Inspection – Breast were symmetrical
Primary areola was present
Nipple was erect
Palpation – No lump was found
 Abdomen:
Inspection – Striae Albicans was seen
Scar: Present
Palpation – Tenderness present
 Back: No Lordosis and no Kyphosis
 Extremities: Normal ROM
 Genital: Catherization is done
 VITAL SIGNS:
Parameters Patient value Normal range
Temperature 98 F 96.8-98.6 F
Pulse 82 beats/min 70-90 beats/min
Respiration 16 breaths/min 16-24 breaths/min
Blood pressure 146/82 mmHg 120/80 mmHg

7.  INVESTIGATIONS:
Sr.
No.
Name of
investigations
Patient value Normal value
1 Blood count:
 RBC
 WBC
 Platelet count
4.46x10/cmm
12100/cmm
298000/cmm
4.2-5.4/cmm
4000-12500/cmm
150000-
450000/cmm
2. RBC indices:
 Haemoglobin
 Haematocrit
 MCV
 MCH
 MCHC
11.08g/dL
25.60%
81.80fl
26.20pg
32g/dL
12-14g/dL
37-47%
80-99fl
27-31pg
32-36g/dL
3. Serum Electrolytes:
 Serum Sodium
 Serum
Potassium
135mEq/L
4.04mEq/L
120-160mEq/L
2.8-6.2mEq/L
4. Blood group B positive
5. Blood sugar 89.10g/dL 70-160g/dL
6. HBsAg Negative

8.  TREATMENT:
Sr.
No.
Name of the
drug
Dose Route Frequency Action
1. Inj
Metronidazole
100ml IV TDS Antimicrobial
2. Inj Ondansetron 1 Amp IV TDS Antiemetic
3. Inj Pantop 40mg IV BD Proton pump
inhibitor
4. Inj Tranexa 1 Amp IV TDS Antifibrinolytic
5. Inj
Cefosulbactum
2g IV BD Antibiotic
6. Inj Gentamicin 240mg IV OD Antibiotic
7. Tab 1A IV SOS Antiemetic
8. Inj Tramadol 1A IV SOS Opiate analgesic
9. Tab Nifedipine 20mg Oral BD Calcium channel
blocker

9.  ANATOMY & PHYSIOLOGY:
Fallopian Tube
The uterine tubes are paired structures, measuring about 10 cm and are situated
in the medial three-fourth of the upper free margin of the broad ligament.
Each tube has got two openings, one communicating with the lateral angle of
the uterine cavity called uterine opening and measures 1 mm in diameter, the
other is on the lateral end of the tube, called pelvic opening or abdominal
ostium and measures about 2 mm in diameter.
PARTS: There are four parts. From medial to lateral are-
1. Intramural or interstitial lying in the uterine wall and measures 1.25 cm in
length and 1 mm in diameter
2. Isthmus-almost straight and measures about 3-4 cm in length and 2 mm in
diameter
3. Ampulla -tortuous part and measures about 5 cm in length which ends in
4. Wide Infundibulum measuring about 1.25 cm long with a maximum
diameter of 6mm.
The abdominal ostium is surrounded by a number of radiating fimbriae (20-
25%), one of these is longer the rest and is attached to the outer pole of the
ovary called ovarian fimbria.
STRUCTURES It consists of 3 layers-
1) Serous consists of peritonnum on all sides except along the line of
attachment of mesosalpinx .
2) Muscular-arranged in two layers outer longitudinal and inner circular.

10. 3) Mucous membrane has three different cell types and is thrown into
longitudinal folds. The epithelium rests on a delicate vascular reticulum
of connective tissue Mucous membrane is lined by
i. Columnar ciliated epithelial cells that are most predominant near the
ovarian end of the tube. These cells compose 25% of the mucosal cells
ii. Secretory columnar cells are present at the isthmic segment and compose
60% of epithelial cells
iii. Peg cells are found in between the above two cells. They are the variant
of secretory cells
FUNCTIONS: The important functions of the tubes are:
i. Transport of the gametes
ii. To facilitate fertilization and survival of zygote through its secretion
BLOOD SUPPLY: Arterial supply is from the uterine and ovarian
Venous drainage is through the Pampiniform plexus into the
ovarian veins.
LYMPHATICS: The lymphatics run along the ovarian vessels to Paraaortic
nodes.
NERVE SUPPLY: The nerve supply is derived from the uterine and ovarian
nerves. The tube is very much sensitive to handling.
DEVELOPMENT: The tube is developed from the upper vertical part of the
corresponding Mullerian duct at about 6-10th week.

11.  DISEASE CONDITION:
Ectopic Pregnancy
Definition:
An ectopic pregnancy is one in which the fertilized ovum is implanted
and develops outside the normal endometrial cavity.
Sites of Implantation:
Tubal pregnancy
A tubal pregnancy the most common type of ectopic
pregnancy happens when a fertilized egg gets stuck on its way to the
uterus, often because the Fallopian tube is damaged by inflammation
or is misshapen. Hormonal imbalances or abnormal development of
the fertilized egg also might play a role.

12. Etiology:
In Book In Patient
In majority, causes are not known
Possible causes are:
 Salpingitis and PID
 Contraception failure such as
IUD, Sterilization operation, use
of Progestin only pill etc.
 Tubal surgery
 Intrapelvic adhesion following
pelvic surgery
 ART such as IVF
 Others such as
- Previous ectopic pregnancy
- Developmental defect
Idiopathic (causes are not known)
Signs and Symptoms:
1. Acute
In Book In Patient
Persistent unilateral uneasiness Absent
Abdominal Pain Present
Appearance of vaginal bleeding Present
Vomiting and fainting attack Absent
Pallor skin and becomes cold Absent
Lower abdomen becomes tense and
tender, no mass is felt
Present
Extreme tenderness on fornix Absent
2. Unruptured
In Book In Patient
Continuous uneasiness on one side of
the flank/ colicky pain
Not occurs because it ruptured
Presence of delayed period
3. Sub-acute
In Book In Patient
Amenorrhea Amenorrhea
Lower abdominal pain Not occur
Vaginal bleeding is more dark

13. Diagnosis:
In Book In Patient
Blood examination such as Hb, Grouping &
Rh typing, Total WBC count, Differential
count.
Done
Culdocentesis Not done
Urinary hCG test Done
USG Done
Laparoscopy Not done
Complications:
In Book In Patient
Rupture Present
Internal bleeding Present
Maternal death Absent
Management:
In acute cases:
In Book In Patient
Hospitalization Done
Ringer’s solution is started Started
Blood transfusion Given
Laparotomy with Salpingectomy,
Oophrectomy, sub-total hysterectomy
Laparotomy with left Salpingectomy done
In sub-acute or chronic cases:
In Book In Patient
Hospitalization Management done according to acute type
Laparotomy
In unruptured cases:
In Book In Patient
Drugs such as Methotrexate, Prostaglandin
are given for salpingocentesis
Management done according to acute type
Linear salpingectomy

14.  NURSING PROCESS:
List of nursing Diagnosis
1. Acute abdominal pain related to ruptured ectopic as
evidenced by verbalization of pain.
2. Risk for deficient fluid volume related to bleeding from a
ruptured ectopic pregnancy.
3. Deficient knowledge related to unfamiliarity with
information resources as evidenced by inaccurate follow
up of instructions.
4. Powerlessness related to early loss of pregnancy as
evidenced by fainting.
5. Anxiety related to fear of prognosis as evidenced by
restlessness.

15. Assessment Diagnosis Expected
outcome
Intervention Rationale Evaluation
Subjective
data:
Client says
that “I am
having pain”.
Objective
data:
Verbalization
of pain.
Acute
abdominal pain
related to
ruptured
ectopic as
evidenced by
verbalization of
pain.
The client
will get
relieve from
pain.
- Assess blood
pressure and
pulse every
one hour.
- Assess for
signs of
dehydration,
skin turgor.
- Position
patient with
comfort and
assist with
movement as
needed.
- Monitor
intake and
output.
- Maintain
NPO status
insert
catheter &
maintain IV.
- The patient may go
into shock and will
have rapid heart rate,
rapid breathing and
low BP.
- Excessive blood loss
and vomiting may
cause hypovolemia
and dehydration.
- Patients should be
positioned lying flat
on the bed to reduce
movement, stabilize
vitals, and promote
comfort.
- To maintain renal
function.
- Helps in a surgery.
Surgery has
performed.

16. Assessment Diagnosis Expected
outcome
Intervention Rationale Evaluation
Subjective
data:
------
Objective
data:
--------
Risk for
deficient fluid
volume related
to bleeding
from a ruptured
ectopic
pregnancy.
The client
must
maintain
adequate
fluid volume
at a
functional
level.
- Assess the
clients vital
signs and
closely
monitoring
BP and pulse
rate.
- Monitor
intake and
output.
- Ensure that
the patient is
comfortable
with her
position..
- Monitor the
patient’s pain
status.
- To obtain baseline
data.
- To maintain adequate
renal function..
- This attitude will
relieve her
symptoms.
- To obtain baseline
data
-------

17. Assessment Diagnosis Expected
outcome
Intervention Rationale Evaluation
Subjective
data:
Client says
that” please
provide me
with the
necessary
information”
Objective
data:
Inaccurate
follow up of
instruction.
Deficient
knowledge
related to
unfamiliarity
with
information
resources as
evidenced by
inaccurate
follow up of
instructions.
The client
verbalizes
understanding
of the disease
process and
appropriate
treatment
plan.
- Assess the
client’s
knowledge of
the disease
process.
- Provide
information
about
signs/sympto
ms indicating
worsening of
the condition.
- Inform the
client about
her health
status and
result of tests.
- Reinforce the
importance of
adhering to
treatment
regimens.
- Establishes a
database and
provides information.
- Helps ensure that the
client seeks timely
treatment and may
prevent
complications.
Instruct the client to
report headache.
- When the client
understands the
consequences of
inadequate
intervention and is
motivated to achieve
health.
- Lack of engagement
in the treatment plan
will result for failure
of therapy.
The client is
able to
follow
instructions
and has got
little
knowledge
about her
condition.

19.  HEALTH EDUCATION:
 Activity: (Do’s and Don’ts)
 Rest for a week after the surgery.
 Avoid doing heavy exercise.
 Avoid sexual intercourse about a week.
 Don’t lift anything heavier to prevent straining of incisions.
 Walk as often as you can.
 Other home care activity:
 Continue with the coughing and deep breathing exercises.
 To prevent constipation
- Eat fruits, vegetables and whole grains.
- Drink 6 to 8 glasses of water everyday.
 Wash your incision with mild soap and water. Pat it dry. Don’t
use oils, powders, or lotions on incision.
 Shower as normal.
 Follow up care:
 Make a follow up appointment.

20.  PROGRESS NOTES:
Day:-1
My client Jagrutiben was admitted in civil hospital Gandhinagar with complains
of abdominal pain, and history of ectopic rupture. She was taken for emergency
laparotomy with left salpingectomy.
During time of admission her vital sign was:
Vital signs Patient value Normal value
Temperature 98 F 98.6 F
Pulse 76bpm 70-90bpm
Respiration 18bpm 18-24bpm
Blood pressure 150/95mmHg 120/80mmHg
Day 2:
Jagrutiben was feeling fatigue and was having abdominal pain.
Advise to rest and sleep.
Vital signs were recorded
Vital signs Patient value Normal value
Temperature 98 F 98.6 F
Pulse 72bpm 70-90bpm
Respiration 16bpm 18-24bpm
Blood pressure 135/100mmHg 120/80mmHg
Same medicine was continued on the second day.
Day 3:
On 3rd day, her health improved much better.
She was fully co-operative in all the procedures.
Advise her for ambulation.
The same medications were continued on the third day.
Following vital sign recorded on 3rd day.
Vital signs Patient value Normal value
Temperature 98 F 98.6 F
Pulse 80bpm 70-90bpm
Respiration 22bpm 18-24bpm
Blood pressure 150/90mmHg 120/80mmHg

21.  SUMMARY
 My Patient came with complain of abdominal pain and ruptured
ectopic.
 Patient is 4th
gravid women.
 On admission she is having abdominal pain and came with the
history of ruptured ectopic so she is taken for emergency
laparotomy and left Salpingectomy.
 After providing 4 days care with health education to her she is
maintaining stable vital parameters, so doctors gave discharge to
my client.

22.  CONCLUSION:
During my clinical posting in civil hospital in antenatal ward, I got
chance to provide care to, Mrs Jagrutiben with diagnosis of Ectopic
pregnancy by this study I learn in detail about Ectopic definition,
causes and its management. I thank my client for her cooperation and
my clinical coordinator for her valuable guidance.

23.  BIBLIOGRAPHY
 Basvanthappa B.T : “TEXT BOOK OF MIDWIFERY AND
REPRODUCTIVE HEALTH NURSING”; 1st
edition 2006,
Jaypee brother publication, New Delhi.
 Dutta D.C : “TEXT BOOK OF OBTETRICS” ; 7th
Edition , 2004;
New central book agency publication, Calcutta. Page no: 177 -185
 Jacob Anamma : “A COMPREHENSIVE TEXT BOOK OF
MIDWIFEREEY”;1st
edition 2005; Jaypee brother medical
publication; New Delhi,
 Kumari Neelam; (2010); 1st
edition; “MIDWIFERY AND
GYNAECOLOGICAL NURSING”; S.vikas and company;
Jalandhar city
 Myles: “ TEXT BOOK OF MIDWIVES” ; 14th
edition,2003
Elsevier publisher, Philadelphia.
 Rao Kamini “TEXT BOOK OF MIDWIFERY AND OBSTETRICS
FOR NURSES”; First edition, 2011, Elsevier publisher,
Philadelphia
 REFERENCES
 https://medicoapps.org/ectopic-pregnancy-4/
 https://www.scribd.com/document/401805305/Case-Presentation-
on-Ectopic-Pregnancy-New
 https://www.saintlukeskc.org/health-library/after-laparoscopic-
treatment-ectopic-
pregnancy#:~:text=Don't%20lift%20anything%20heavier,longer
%20taking%20prescription%20pain%20medicine.