Ward Class

An Online Resource Site For Student Nurses

Welcome

Ward Class is an online resource for student nurses. Created with the aim of helping student nurses cope with the demands of nursing school and clinicals, it offers free downloads, notes, sample NCPs, sample drug studies, study aids, news and updates, and practical tips to its users.

Site Announcement

The December 2012 PRC Nursing Board Exam Result is already available here at Ward Class and at Pinoy R.N.




Another Batch of Nursing Downloads

For today's blog entry, I am pleased to announce that WARD CLASS has another batch of nursing downloads.

This 4-part compilation is useful for those who are about to have an RD (return demonstration) on vital signs- taking sometime soon. Aside from the step-by-step implementation guide, do not forget to take note of the special considerations per procedure. You just might learn something you totally missed out on during your clinical instructor's lecture demonstration.

Furthermore, the files, all in PDF format, are as follows:

Vital Signs Assessment: Blood Pressure
Vital Signs Assessment: Body Temperature
Vital Signs Assessment: Heart Rate
Vital Signs Assessment: Respiratory Rate

This 4-part compilation is useful for those who are about to have an RD (return demonstration) on vital signs- taking sometime soon. Aside from the step-by-step implementation guide, do not forget to take note of the special considerations per procedure. You just might learn something you totally missed out on during your clinical instructor's lecture demonstration.

As I always say, I hope you find these downloads helpful. And please, please put them to good use.

27,765 Passed the June 2008 Nurse Licensure Examination

Congratulations, new nurses!

The wait is OVER. The much-awaited June 2008 Nurse Licensure Examination Results are officially out!

As promised, Ward Class and Pinoy R.N. brings you the results of the June 2008 Nursing Board Exams.

To download the June 2008 NLE Results, click any of the links below:

June 2008 Nurse Licensure Examination Results (PDF)

June 2008 Nurse Licensure Examination Results (backup)

Both files are in PDF format so you will be needing Adobe Reader to open the files. Click here to download and install a copy of Adobe Reader.

For more news and updates on the June 2008 Nursing Board Exam Results, visit Pinoy R.N.

Sample NCP for Diabetes Insipidus

Here's a sample NCP for Diabetes Insipidus-- a disorder of the pituitary gland characterized by intense thirst and the excretion of large amounts of urine. While Diabetes Insipidus is an endocrine disorder, it is NOT to be confused with Diabetes Mellitus, an endocrine disorder which affects the pancreas.

Before you view or download this sample NCP for Diabetes Insipidus, I would like to emphasize the following points:
  • Fluid Volume Deficit is a priority nursing diagnosis for clients with Diabetes Insipidus.
  • Always take into consideration the age of your client when making your nursing care plan. For this NCP on Diabetes Insipidus, I had a 9-y.o. child in mind so during planning and outcome evaluation, I made sure that the criteria I used (e.g. I/O, vital signs) are appropriate for my client's age.
  • An individualized nursing care plan is a well-constructed nursing care plan. When making an actual NCP for a patient during clinicals, your criteria for outcome evaluation and your nursing interventions should be based on the assessment you performed on your client. If you will be using care plan constructors or reference books on NCP-making , make sure to exclude suggested outcome criteria and/or nursing interventions that are inappropriate for your client's condition.

Understanding Crisis Intervention

A crisis is any serious interruption in the functioning of an individual, family or group. A problem may sometimes be so serious that the client's usual problem-solving mechanisms fail. During a crisis, the client is in a state of emotional turmoil and this temporary state of high anxiety may disrupt overall functioning.

There are three types of crisis and they are as follows:
  • situational crisis--> refers to extraordinarily stressful life events such as loss of loved ones, loss of investment, or losing one's home to a fire.
  • maturational crisis--> refers to events that are normal processes of growth and development, examples are adolescence, birth of first child, and retirement.
  • adventitious crisis--> refers to extremely stressful events that are catastrophic, unplanned, and accidental e.g. war, hurricanes, terrorist attacks, rape (note: some reference books do not include adventitious crisis and so rape is listed under situational crisis)
Most crises are short in duration lasting 24- 36 hours, are self-limiting, and usually do not last longer than 6 weeks (note: usually asked during boards). During this critical period, however, the client experiences feelings of anxiety, guilt, shame, anger, and helplessness and may manifest self-destructive and dangerous behavior (usually 3 days after the life-changing event).

To help the client cope with a very stressful crisis situation, mental health practitioners utilize crisis intervention. Crisis intervention is an active but temporary entry into the client's life to support the client, help client resolve existing crisis, restore the client to precrisis level of functioning, and to facilitate the client's attainment of a higher level of functioning.

During crisis intervention, a nurse must have the ability to make the necessary assessment of the client's emotional and physical needs while providing emotional support and gaining the client's coopration. The roles of the psychiatric and mental health nurse includes assessment of the severity of the crisis (with safety in mind) and client's perception of the problem, determination of and enlisting available situational supports, exploration of previous coping behaviors and helping the client acquire more effective adaptive behaviors, and providing encouragement while working with the client during the crisis intervention process.

Related Downloads:
Crisis and Crisis Intervention Quick Facts (NEW)
Phases of Crisis (NEW)


FYI: Revised PRC OR/DR Forms

Through Memorandum No. 3, series of 2008, the PRC Board of Nursing released the Amended Guidelines in Processing Applications to the Nurse Licensure Examinations. The new guidelines shall be used starting this November 2008 Nurse Licensure Examinations.



Having read the nine-page memorandum, the following salient points were noted:
  • the Amended Guidelines shall be made effective for nursing graduates of October 2008, 2009, and 2010.
  • the revised OR/DR forms shall only be applied to the incoming Nursing students in Levels I and II only of Academic Year 2008-2009 onwards until their graduation and until new issuances are released by the Board of Nursing.
  • the revised OR/DR forms shall bear the nursing school's logo
  • a CHED recognition certificate will be required for all NEW schools and programs including State Universities and Colleges (SUCs) and Local Universities and Colleges (LUCs)--> so make sure your nursing school/ college of nursing is recognized by CHED!
  • the summary of RLE exhibits should indicate that you completed 2,142 RLE hours as certified by your College Dean
  • for major operations, students can have a maximum of 2 similar cases and 2 students may assist a complicated major surgery--> the keyword is complicated
  • for minor operations, students can have a maximum of 2 similar cases and only 1 student can assist a minor surgery and a major surgery cannot be used as a substitute for a minor O.R. procedure
  • major and minor scrubs classification shall follow Philhealth Classification such that procedures with 31 RVUs and above are considered major cases--> logically, procedures with RVUs of 30 and below are considered minor ones. In cases of discrepancies between the Philhealth and Hospital Classification, the hospital classification shall prevail (note: remember that your O.R. Exhibit Forms will be concurred by the hospital's Chief Nurse so there is no point in arguing with her and giving her a copy of the Philhealth Classification of Procedures if the hospital classifies your major scrub as a minor scrub.Tee-hee!)
  • diagnostic procedures are not to be included in determining major or minor scrubs
  • deliveries in the community are to be supervised by a clinical instructor with a Master’s Degree in Nursing or Allied Medical or Health-Related Sciences
  • The Delivery Room and Initial Cord Care requirements of Registered Midwives who are nursing graduates applying for the Nurse Licensure Examination are waived provided they submit a photocopy of their updated PRC Identification Card--> for nursing graduates who have completed midwifery courses but have not practiced and/or are “under board” beyond five (5) years from date of midwifery graduation, a supervised case of one (1) actually handled delivery and cord care shall be required for the Nurse Licensure Examination properly documented and reported through the required Delivery and/or Initial Cord Care Forms (what luck!)
  • nursing faculty - including supervising clinical instructors- should at least have 1 year of clinical practice in a specialized field and be a holder of a master's degree in nursing, education, or other allied medical health sciences connferred by an institution duly-recognized by the government
  • Entries made in the Summary of Related Learning Experiences, Operating Room / Delivery Room / Initial Cord Care Record of Cases shall be the sole responsibility and accountability of the dean of the college of nursing-> absolutely no designates are allowed so it is prudent that you check if your college dean meets PRC BON or CHED's requirements (e.g. clinical practice, education, memberships to PNA and ADCPN)
In retrospect, things would have been easier for me if I got hold of a copy of PRC's guidelines on processing applications to the Nurse Licensure Examinations when I was completing my documents a couple of years ago. I remember the hours of wait outside my school's nursing faculty lounge each time I had something to ask my Level IV Coordinator regarding the data needed in my exhibit forms. Not to mention the sheets of paper wasted in reprinting all the exhibit forms because of data entry errors due to lack information on how to properly accomplish the said forms.

Still, that very "excruciating" experience is all behind me now so in the hopes of making the whole NLE application process a tad easier for nursing graduates, check out this entry's batch of very useful downloads. Make sure to read the last page of the file bearing the revised PRC OR/DR forms.


Related Downloads:
Revised PRC OR/DR Forms s. 2008 (NEW)
PRC BON Amended Guidelines in Processing Applications to the NLE (NEW)
Philhealth Classification of Procedures (NEW)


June 2008 Nurse Licensure Examination Results Out on July 20?

Hon. Marco Antonio C. Sto. Tomas of the Board of Nursing is said to have announced that the June 2008 Nursing Board Exam results may be released within the last week of July. With emphasis on the may be, that is.

Considering that no exact date of release has been given and that previous nursing board exam results weren't released exactly as predicted by "reliable" sources, let us just treat this matter with a healthy dose of skepticism.

If the June 2008 NLE results will be released on July 20 (said to be the earliest possible release date), well and good. If not, then those who took the nurse licensure exams last June will have more time to psyche themselves up in preparing for the much-awaited nursing board exam results.

And since we understand how anxious our June 2008 Nurse Licensure Examination hopefuls are, Ward Class and Pinoy R.N. would like to give these very simple and yet helpful tips on dealing with the agony of waiting for the nursing board exam results. Here goes:
  • Drag yourself out of bed. Avoid lingering in bed as this will only aggravate your anxiety. It is also important for you to get under the early morning sun even for a few minutes each day. Take deep, cleansing breaths and perform simple stretches to invigorate you.
  • Watch what you eat. Eating healthy, balanced meals spaced out during the day will help curb your anxiety. A protein breakfast is also essential to sustain your energy levels as the day progresses. Your daily diet should also have healthy amounts of fruits and vegetables for normal elimination patterns. Furthermore, cut back on fatty and oily food to prevent sluggishness and mood swings. Sugar intake must also be in moderation as it can aggravate anxiety and irritability.
  • Get hydrated. Drink more than 8 full glasses of water on a daily basis. Go easy on caffeine as it can only aggravate your nervousness. It is also advisable to avoid drinking coffee and other caffeinated drinks after 4 p.m. for a good night's rest.
  • Sleep well. It is important for you to get plenty of rest and sleep to reduce anxiety and mood swings. If you are used to staying up late at night, a massage, warm bath, and a glass of warm milk or decaffeinated chamomile tea will help your body relax. Switching to dimmer lighting at bedtime will also promote sleep.
  • Identify support systems. Having a solid support system will help you deal with a stressful situation. It is very natural for you to seek out family members and friends especially during these very stressful times. You have been busy before the board exams so you might want to spend more time with friends and family to strengthen relationships and gain emotional support.
  • Ventilate your feelings. Always, in very stressful situations, it is important to ventilate your feelings in a healthy manner. Feelings of anxiety should be communicated to support persons as pent-up emotions will only aggravate anxiety and stress. Engaging in sports will also help release tension.
  • Try out new things. This is probably the best time for you to visit places you've never been to, try out different cuisines, take up a new hobby, or just do something you haven't had a chance to do because you were so busy preparing for the nursing board exams. These activities will not only help you reduce anxiety but will contribute to your personal growth as well.
  • Be optimistic -- and realistic. While waiting for the results, be optimistic and hope for favorable outcomes. Fretting about the exams now and wallowing in depression won't change your scores and it certainly isn't good for your psychological health so you might as well assume a positive outlook these coming days. And when the results come out and things didn't turn out the way you expected them to, well, there is definitely light at the end of the tunnel. I know people who didn't make it the first time but are now going through an all-time high in their respective nursing careers.
And lastly, as Lyle of Pinoy R.N. aptly wrote in one of his previous entries, if you are a spiritual person, pray. Acknowledging that there is, in fact, a Supreme Being who is bigger than any occasion, turning point, milestone, victory, success, or setback in this life will help comfort you through this long and agonizing wait for the June 2008 Nurse Licensure Examination results.

Having said that, our best wishes - and congratulations- from CyNurse of Ward Class and Lyle of Pinoy R.N.


Note: If you want a copy of the June 2008 Nurse Licensure Examination results, submit your email address to our mailing list.

Acute Biologic Crisis: Shock


  • a serious abnormal physiologic state characterized by an imbalance between the amount of circulating blood volume and the size of the vascular bed resulting in insufficient blood flow to the tissues
  • a life-threatening medical emergency and is considered one of the most common causes of death for critically-ill patients
  • body's response to shock:
  1. hyerventilation leading to respiratory alkalosis
  2. vasoconstriction--> shunts blood to heart and brain
  3. intracellular to intracellular fluid shifts
  4. tissue anoxia--> anaerobic metabolism--> increased capillary permeability and lactic acid build-up-->metabolic acidosis
  5. impaired organ function: renal failure and ARDS (adult respiratory distress syndrome)
  • types of shock (note: think C-H-A-N-S)
  1. cardiogenic--> failure of heart to pump properly
  2. hypovolemic--> decreased circualting blood volume
  3. anaphylactic shock--> massive dilatation caused by an allergic reaction leading to release of histamine and related substances
  4. neurogenic shock--> failure of arteriolar resistance, leading to massive dilatation and pooling of the blood
  5. septic shock--> lethal drop in blood pressure as a consequence of bacteremia
Assessment Findings
  • skin--> cool, pale, and moist for cardiogenic and hypovolemic shock; warm, dry , and pink in septic and neurogenic shock
  • tachycardia
  • weak and thready pulse
  • blood pressure: normal during early stages but will drop in late stages
  • rapid, shallow respirations--> due to tissue anoxia and increase in CO2 levels
  • restlessness and apprehension--> may progress to coma
  • decreased urinary output due to impaired circulation to the kidneys
  • decreased temperature (except in septic shock)
Medical Management
  1. fluid replacement using crystalloid solutions (Ringer's lactate, normal saline), colloid solutions (albumin, plasmanate, dextran) and/or blood products ( whole blood, packed RBC, fresh frozen plasma)
  2. drugs such as dopamine, dobutamine, isoproterenol, norepinephrine, sodium nitroprusside, corticosteroids and antibiotics (for septic shock)
Nursing Management
  1. maintain patent airway
  2. administer oxygen as ordered
  3. resuscitate as necessary
  4. continuously monitor : VS,respiratory status, CVP, ECG, ABG, CBC, electrolytes, BUN, creatinine, urine output, and other parameters as indicated
  5. administer fluid and blood replacement as ordered
  6. administer medications as ordered
  7. elevate extremities to 45 deg.--> promotes venous return to the heart (avoid trendelenburg position as it increases respiratory impairment)
  8. if narcotics will be administered for pain, use cautiously via IV and in small doses only--> incomplete absorption due to vasoconstriction may lead to overdose when circulation improves
  9. promote rest and maintain a quiet, warm environment
  10. provide psychological support for client and family
Prognosis

Prognosis depends on the underlying cause and the extent of complications. Hypovolemic, anaphylactic, and neurogenic shock repond well to therapy. Septic shock has a mortality rate of 30% to 50%. Cardiogenic shock has the poorest prognosis.

Prevention

Shock can be prevented by minimizing factors that favor a specific type of schock. Treatment goals include re-establishing perfusion to the organs by restoring and maintaining the blood circulating volume, ensuring oxygenation and blood pressure are adequate, achieving and maintaining effective cardiac function, and preventing further complications.

Related Downloads:
Classification of Shock (NEW)
Medications Used to Treat Shock (NEW)


Erik Erikson and his Developmental Stages

Erik Erikson was a developmental psychologist and psychoanalyst known for his Stages of Psychosocial Development and for coining the term identity crisis. His theory on the psychosocial development of man- covering eight stages throughout the lifespan- is one of the theoretical bases for mental health nursing.

Dubbed as the Psychosocial Model, Erik Erikson's theory on personality postulates that although an individual has inborn traits, personality also develops from psychologic and social influences. Other characteristics are acquired and learned as he or she goes through the eight (8) developmental stages from infancy to late adulthood. Each stage has an accompanying developmental task which is marked by conflict and the resolution of the conflict prepares the individual for the next stage. To be fully developed, according to Erikson, every human being has to successfully go through each developmental stage.

Successful resolution of the conflict in each developmental stage results in favorable outcomes. For example, in the 4th developmental stage, if the conflict of Industry vs Inferiority is resolved by the school-aged child, the favorable outcome is that the child becomes creative and develops sense of competency. The favorable outcomes with the corresponding developmental stage in which they may be acquired are:
  1. Trust vs Mistrust--> individual learns to trust self and others
  2. Autonomy vs Shame and Doubt--> individual learns self-control
  3. Initiative vs Guilt--> individual learns to influence the environment and evaluate own behavior
  4. Industry vs Inferiority--> individual develops sense of competency
  5. Identity vs Role Confusion--> individual develops a sense of self and is able to prepare or plan for adult roles
  6. Intimacy vs Isolation--> individual develops intimate relationships with another and is able to show commitment to career
  7. Generativity vs Stagnation--> individual becomes productive and is able to show concern and interest for others
  8. Integrity vs Despair--> individual is able to sustain relationships and finds meaning in his or her life; has come to accept the reality of death
Although born in Frankfurt, Erik Erikson migrated to the United States with his wife and became the first child psychoanalayst in Boston. He was a well-known clinician and held esteemed positions at the Massachusetts General Hospital, Harvard Medical School and Psychological Clinic, Yale University, and University of California at Berkeley.

In 1994, twenty-four years after his retirement, Erik Homburger Erikson died in Massachusetts at the age of 92.

Related Download:
Erikson's Psychosocial Stages of Development (NEW)

Avoiding Medication Errors

The increasing number of reported cases of medication errors is a perennial concern in hospitals. Considering that the reported number of cases add up to millions each year, I can just imagine the magnitude of this problem if we take into account those cases that remain undocumented as they happen in consumers' homes each day.

There are a number of sources of medication errors as mistakes can happen during any phase of drug therapy. For example, physicians may prescribe an inappropriate drug for the client's condition or may write orders illegibly. Nurses may fail to follow the '5 rights' of drug administration. Pharmacists may erroneously label drug containers. Clients may fail to use a correctly prescribed drug appropriately. Simply put, medication errors can happen during prescribing, dispensing, or administration.

Often during clinicals, nursing students have to provide health teachings on a client's medication regimen so as to reduce the incidence and severity of medication errors. And since Ward Class and Pinoy R.N. recognizes the importance of client teachings in achieving the goals of drug therapy, a 3-part client teaching guide on safe and effective medication use will be included in the Nursing Downloads section of this site.

On a side note, I have completed the following drug studies a day or two ago: esomeprazole magnesium, amlodipine, ibuprofen, and captopril. Pardon the choice of drugs as I honestly did these drug studies for my personal consumption ( I don't think student nurses need much help on drug studies anyway). Not that I am hypertensive or experiencing symptoms of GERD but as the ONLY nurse in the family, I have to keep track of medications family members are currently taking. But... I have to own up to ibuprofen, though. Just check out the drug studies, if you please.

Related Downloads:
Health Teaching Guide: Prescription Medications (NEW)
Health Teaching Guide: OTC Medications (NEW)
Health Teaching Guide: Herbal and Dietary Supplements (NEW)

Drug Study Downloads:
Esomeprazole magnesium
Amlodipine
Ibuprofen
Captopril


Freud and his Psychoanalytic Theory of Development

Sigmund Freud's psychoanalytic theory of development is one of the theoretical bases for mental health nursing. Sigmund Freud, an Austrian physician who founded the psychoanalytic school of psychology, is famous for his topographic model of the mind, structural elements of personality, and psychosexual stages of development. He is also known for his definition of libido (sexual desire) as the primary motivational energy, free association technique, and his theory of transference in therapeutic relationships.

Freud's psychoanalytic model work on the assumption that genetically determined drives for sex and aggression produce energy and that human behavior is determined by past experiences and responses. Furthermore, in this model, all behavior has meaning and can be understood and clients are capable of changing behavior when made aware of reasons behind the change.

According to Freud's theory of personality, an individual's personality is composed of three structural elements: the id, ego, and superego. The id, the component of personality present from birth, is driven by the pleasure principle and strives for the immediate gratification of desires. The ego, on the other hand, is the component of personality that operates on the reality principle. It controls instinctual drives and mediates between the id and superego. It uses defense mechanisms to protect the self. The last component of personality to develop is the superego. This develops as an individual incorporates restrictions from parents and authority figures to guide behaviors, thoughts, and feelings. It is also the aspect of personality that is responsible for an individual's sense of right and wrong. Furthermore, the superego is divided into two parts, the ego ideal and the conscience.

Another important aspect of the psychoanalytic model is Freud's topographic model of the mind. Freud's topographic model deals with levels of awareness and is divided into the preconscious, conscious, and unconscious mind. The preconscious mind is not within the conscious mind but can be brought to conscious awareness through word linkage. The conscious mind consists of all content and memories immediately available and within conscious awareness. The unconscious mind consists of knowledge that cannot be brought into awareness without interventions such as psychoanalysis, hypnotism, or drugs.

Sigmund Freud is also the proponent of the psychosexual stages of development. According to Freud, an individual goes through five (5) stages of development: oral stage, anal stage, phallic stage, latency stage, and genital stage. An individual has to complete the stages successfully in order to have a healthy personality. If a stage is not complete successfully, fixation occurs. For example, if an individual is neglected by the primary caregiver during the oral stage, he may become a smoker or an alcoholic as an adult.

Freud died in London at the ripe age of 83. Although generally considered controversial and debatable, his work continues to influence psychology and other disciplines and has created huge impact in the study of personality, human development, and mental health.

Related Downloads:
Freud's Psychosexual Stages (NEW)
Freud's Elements of Personality and Topographic Model of the Mind (NEW)


An Overview of Pychiatric-Mental Health Nursing

Psychiatric or mental health nursing is defined as a specialty of nursing that focuses on the identification of mental health isuues, prevention of mental health problems, and the care of people with psychiatric disorders or mental distress. Nurses who specialize in this area are given special trainings enabling them to utilize different therapeutic models, build therapeutic relationships, effectively deal with challenging clients, and administer psychiatric medication.

Psychiatric or mental health nursing utilizes different models in patient care. The more popular models used in patient care are the Medical-Biological Model, Behavioral Model, Community Mental Health Model, Freud's Psychoanalytic Model, Erikson's Psychosocial Model, Maslow's Human Motivation/Need Model, Sullivan's Interpersonal Model, and Hildegard Peplau's Nurse-Client Relationship Model.

While a client with mental disorder or distress may receive a variety of therapeutic interventions, the emphasis of psychiatric or mental health nursing is on the development of a therapeutic relationship between the nurse and the client. Meaning, in addition to psychocial interventions and the administration of psychotropic medications and other forms of therapy, the nurse and the client has to work together in a positive and collaborative manner so that the client may achieve the goals of therapy.

As with any field of nursing, psychiatric or mental health nursing necessitates the development and utilization of nursing care plans, provision of direct nursing care, administration of medications and treatment strategies as ordered, and educating the client and family members regarding the patient's disorder and needs. It also involves crisis intervention, counseling, and case management.

Psychiatric or mental health nurses work with patients in a variety of settings. They may work in psychiatric hospitals, private mental health institutions, community mental health programmes, and private clinics. With advanced education, they may teach, conduct research, and serve as nursing administrators. They may also receive additional trainings in child-adolescent mental health nursing, geriatric-psychiatric nursing, forensics, or substance-abuse.

Related Downloads:
Erikson's Psychosocial Stages of Development (NEW)
Review Notes in Psychiatric Nursing (NEW)



New Nursing Downloads

In cooperation with Pinoy R.N., Ward Class is posting 4 new entries to its growing list of Nursing Downloads. The files, all in PDF format, are as follows:

10 Medicinal Plants (Herbal Meds) Approved by DOH
Therapeutic Diets
Blood Transfusion Reactions
Dehydration Assessment


Honestly, I am a little envious because I did not have a lot of resources when I was in nursing school. Life as a nursing student would have been easier if I had these handy cram-sheets in tow during clinicals and lectures.


And so, knowing first-hand how demanding nursing school can be, I hope you do find these compilations useful and hopefully put 'em to good use.

Complications of Pregnancy: Ectopic Pregnancy

possible sites of implantation in an ectopic pregnancy
  • any gestation occurring outside the uterine cavity (the fertilized egg implants somewhere else)
  • usually occurs in one of the fallopian tubes (called tubal pregnancy) as the fertilized egg gets stuck on its way to the uterus, but may occur in the abdomen, ovary, or cervix
  • an ectopic pregnancy does not proceed normally as the site cannot accommodate the growing tissue; in undetected tubal pregnancies, the fallopian tube ruptures usually before the 12th week of pregnancy
  • risk factors include a history of a previous ectopic pregnancy, PID, salpingitis, endometriosis, gonorrhea, chlamydia, and structural fallopian tube defects (misshapen, scarred tubes); also includes use of medications that stimulate ovulation, use of birth control methods such as pills, IUD, and tubal ligation
Assessment Findings
  • vaginal bleeding-->may lead to shock if severe
  • lower abdominal pain, may be one-sided
  • abdominal cramping, localized to one side if the pelvis
  • signs of fallopian tube rupture: sharp, stabbing pelvic pain which may radiate to the abdomen and neck, dizziness, lightheadedness
  • low hemoglobin and hematocrit
  • rising WBC
  • low HCG titers than is expected in normal pregnancies
Medical Management
  • administration of methotrexate--> to stop cell growth and dissolve existing cells
Surgical Management
  • laparoscopic surgery--> performed if the patient does not respond to methotrexate and the fallopian tube has not ruptured; the ectopic tissue is removed and the fallopian tube is repaired
  • laparotomy--> for ectopic pregnancies causing heavy bleeding and/or ruptured ectopic pregnancies; typical includes removal of the ruptured fallopian tube
Nursing Management
  1. provide care for the preoperative or postoperative client
  2. monitor for shock, if bleeding is severe
  3. provide psychological support for grieving client-->also allow client to express concerns regarding future pregnancies
Prognosis

Treatment for ectopic pregnancy may lead to infertility or removal of reproductive organs. Even with treatment, there is a 10% chance for the condition to recur in future pregnancies. If left untreated, an ectopic pregnancy may lead to life-threatening bleeding but with early detection and treatment, maternal mortality is reduced to 0.05%.

Prevention

An ectopic pregnancy cannot be prevented but risk factors may be reduced by limiting the number of sexual partners and by having protected sexual encounters to prevent STDs and pelvic inflammatory diseases.