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Ectopic PregnancyPrepared by:Adrillano, E.J Nocos, SharmBernales, J.P Peria, PaoloCenteno, Lily Romero, CharmEbron, Don Silay , Anne
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Introduction
The BSN students were given theopportunity to have a hospital exposureat Ospital ng Cabuyao; and on thatday found a commendable case
reasonable to be presented for casestudy. The patient, to be mentioned inthis paper as Patient X, housewife,G2P1 (T1-P0-A0-L1), was one of the patients admitted to the EmergencyRoom. She was 34 years of age. HerLMP is July 30, 2012. She wasadmitted due to ectopic pregnancy.
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An ectopic pregnancy occurs when the baby starts todevelop outside the womb (uterus). The most common site for anectopic pregnancy is within one of the tubes through which the eggpasses from the ovary to the uterus (fallopian tube). However, in rarecases, ectopic pregnancies can occur in the ovary, stomach area, orcervix. Ectopic Pregnancy occurs in about 1 in 250 pregnanciesamounting to approximately 70 000 cases annually, 5,833 per month,1,346 per week, 191 per day, 7 per hour. In the Philippines,unpublished reports have estimated the incidence to be just about 22,
194 each year.An ectopic pregnancy is commonly referred to as a tubal
pregnancy because 95 percent occur in a fallopian tube. An ectopicpregnancy needs to be treated immediately to avoid fallopian tubedamage or life threatening blood loss. When identified early, ectopicpregnancies are treatable with medication that stops the pregnancy.If the pregnancy is further along, laparoscopy is usually performedto remove the ectopic tissue and repair the fallopian tube. Currently,laparotomy is the preferred technique when the patient ishemodynamically unstable, the surgeon has not been trained inlaparoscopy, physical facilities and supplies to perform laparoscopic
surgery are lacking or technical barriers to laparoscopy are present.
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Currently, laparotomy is the preferred techniquewhen the patient is hemodynamically unstable, the surgeonhas not been trained in laparoscopy, physical facilities andsupplies to perform laparoscopic surgery are lacking ortechnical barriers to laparoscopy are present.
If the ectopic pregnancy has ruptured or bleedingpersists, salpingectomy is a very common option. Thisprocedure involves excision of segment of the Fallopian
tube involved in the ectopic pregnancy. The tubal segment tobe removed is coagulated and cut off with bipolarforceps.The group chose J.S. as their subject primarilybecause her case posed as a very intricate case requiringdue understanding and knowledge. The group recognizestheir partial knowledge about ectopic pregnancy and thesurgical procedures involved in such condition, thus makingthis case a good avenue to broaden the proponentsknowledge about the disease and the surgical proceduresinvolved.
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The first warning signs of an ectopic pregnancyare often pain or vaginal bleeding. You might feelpain in your pelvis, abdomen, or, in extreme cases,even your shoulder or neck (if blood from aruptured ectopic pregnancy builds up and irritatescertain nerves). Most women describe the pain assharp and stabbing. It may concentrate on oneside of the pelvis and come and go or vary inintensity.Any of the following additional symptoms canalso suggest an ectopic pregnancy:vaginal spottingdizziness or fainting (caused by blood loss)low blood pressure (also caused by blood loss)lower back pain
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AbstractThis is a case of a patient who has been diagnosed with EctopicPregnancy. The patient was complaining from pain in right lowerquadrant of her abdomen. In an ectopic pregnancy, a fertilized egghas implanted outside the uterus. The egg settles in the fallopiantubes in more than 95% of ectopic pregnancies. This is why
ectopic pregnancies are commonly called "tubal pregnancies." Theegg can also implant in the ovary, abdomen, or the cervix, so youmay see these referred to as cervical or abdominal pregnancies.
None of these areas has as much space or nurturing tissue as auterus for a pregnancy to develop. As the fetus grows, it willeventually burst the organ that contains it. This can cause severe
bleeding and endanger the mother's life. A classical ectopicpregnancy does not develop into a live birth. Ectopic pregnancy canbe difficult to diagnose because symptoms often mirror those of anormal early pregnancy. These can include missed periods, breasttenderness, nausea, vomiting, or frequent urination.
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Patients Profile: Name: Patient X Address: Nia Road Sala, Cabuyao,
LagunaBirthdate: March.18,2012Age: 34Birthplace: Mindanao
Religion: Roman Catholic
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Nationality: FilipinoCivil Status: Single
Admission: Aug. 23,2012
Time: 12:15 amDischarge: Aug. 28, 2012Time: 8:00pmFinal Diagnosis: Tubal pregnancy, rightcompletely ruptured G2P1 (1001) right partialsalpingectomy
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Nursing Assessment
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Review of Reproductive SystemGynecologicalGravida\ paraObstruction
LMP(frequency,duration)Age of menarchyMenopauseDysmenorrhea
ContraceptionDischargeItchinessDysparunia
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HematologicalAnemiaBleeding
BruisingMalignancyTransfusion
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Physical ExaminationSkin-Pale skinChest- SCE no retractionHeart- AP no murmur nrrrAbdomen- flabby soft (+) hypogastrictendernessPelvic Exam- (+) wriggling tenderness
EyesPale palpebral conjuctiva
Nose(-) NAD
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Assessment findings :
Amenorrhea
Abnormal menses (after fallopian tubeimplantation)Slight vaginal bleeding
Unilateral pelvic pain over the massIf fallopian tube ruptures, sharp lowerabdominal pain, possibly radiating to theshoulders and neck.Possible extreme pain when cervix is movedand adnexa palpated.Boggy and tender urine
Possible enlargement of adnexa
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Chest- SCE no retractionHeart- AP no murmur nrrr
Abdomen- flabby soft (+) hypogastrictendernessPelvic Exam- (+) wriggling tenderness
EyesPale palpebral conjuctiva
Nose(-) NAD
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Drug Study
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DRUGNAME
ACTION ANDTHERAPEUTICEFFEC
T
CONTRAINDICATION
ADVERSEEFFECT
NURSING IMPLICATION
CEFAZOLINSODIUMCLASSIFIC
ATION: ANTIBIOTIC, FIRSTGENERATION
CEPHALO-SPORINROUTE,DOSAGE,FREQUENCY AND
ADMINISTR ATION:-ADULT:IV/IM250mg-2gQ8
SEMISYTHETIC,FIRSTGENER
ATIONCEPHALOSPORIN C
WITHLIMITED ACTIVITY
AGIANSTGRAM-NEGATIVEORGANISMS
HYPERSENSITIVITYTO
ANYCEPHALOSPORIN
ANDRELATED
ANTIBIOTICS
BODY: ANAPHYLAXIS,FEVER,EOSINOPHILIA,SUPERINFECTIONS,
SEIZURE,GI:DIARRHEA,
ANOREXIA, ABDOMINAL CRAMPSSKIN:MACULOPAPULARRASH,URTICARIA
-DETERMINE HISTORY OF HYPERSENSITIVITY TOCEPHALOSPORINS, PENICILINS, AND OTHER DRUGSBEFORE THERAPY IS INITIATED-LAB TEST: PERFORM CULTURE AND SENSITIVITYTESTING PRIOR TO AND DURING THERAPY. THERAPYMAY BE INITIALED PENDING RESULTS-MONITOR I & O RATES AND PATTERNS, BE ALERT TOCHANGES IN BUN, SERUM CREATINIRE
-PROMT ATTENTION SHOULD BE GIVEN ONSET SIGNSOF HYPERSENSITIVITYPROMPTLY REPORT THE ONSET OF DIARRHEA,PSEUDOMEMBRANOUS COLITIS, A POTENTIALLY LIFETHREATENNG CONDITION, STARTS WITH DIARRHEA
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DRUG ACTIONANDTHERAPEUTICEFFECT
CONTRAINDICATIONS
ADVERSE EFFECT NURSING IMPLICATION
TRAMA
DOLCLASSIFICATION:
ANALGESIC,NARCOTICROUTE,
DOSAGE,FREQUENCY
AND ADMINISTRATION:POIMMEDI
ATERELEASE:25mgDAILY,TITRATED UPTODOSEOF
CENTRAL
LY ACTINGOPIATERECEPTOR
AGONISTTHATINHIBITSTHE
UPTAKEOFNOREPINEPHRINE
ANDSEROTONIN,SUGGESTINGBOTHOPIOID-LIKEEFECTS,BUTCAUSELESSRESPIRATORYDEPRESSION THAN
HYPERSE
NSITIVITYTOTRAMADOL OROTHEROPIOID
ANALGESICS,SEVERE
RESPIRATORYDEPRESSION,SEVEREOR ACUTE
ASTHMAS,PATIENSON MAOINHIBITORS,SUBSTANCE ABUSE,
ALCOHOLINTOXICATION,LACTATION,CHILDRENYOUNGER
CNS:
DROWSINESS, DIZZINESS,VERTIGO, FATIGUE, HEADACHE,SOMNOLENCE,RESTLESSNESS, EUPHORIA,CONFUSION, ANXIETYCOORDINATION DISTURBANCE,SLEEP DISTURBANCES,SEIZURESCV:
PALPITATION, VASO-DILATIONGI:NAUSEA, CONSTIPATION,VOMITING, XEROSTOMIA,DYSPEPSIA, DIARRHEA,
ABDOMINAL PAIN, ANOREXIA,FLATULENCEBODY:SWEATING, ANAPHYLACTICRAECTION, WITHDRAWALSYDROME w/ ABRUPTDISCONTINUATIONSKIN:RASHSPECIAL SENSES:VISUAL DISTURBANCESUROGENITAL:URINARYRETENTION/FREQUENCY,MENOPAUSAL SYMPTOMS
-ASSESS FOR LEVEL OF
PAIN RELIEF AND ADMINISTER PRN DOSE ASNEEDED BUT NOT TOEXCEED THERECOMEMDED TOTALDAILY DOSE-MONITOR VITAL SIGNS
AND ASSESS FORORTHOSTATIC
HYPOTESION OR SIGNS OFCNS DEPRESSION-WITHHOLD DRUG ANDNOTIFY PHYSICIAN IF S/SOF HYPERSENSITIVITYOCCUR-ASSESS BOWEL ANDBLADDER FUNCTION;REPORT URINARYFREQEUNCY ORRETENTION-USE SEIZUREPRECAUTIONS FORPATIENTS WHO HAVE AHISTORY OF SEIZURES ORWHO ARE CURRENTLYUSING DRUGS THATLOWER THE SEIZURETHRESHOLD-MONITOR AMBULATION
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DRUG ACTION ANDTHERAPEUTIC EFFECT
CONTRAINDICATIONS
ADVERSE EFFECT NURSINGIMPLICATION
DieclofenacClassification:Nonsteroidalanalgesic,anti-inflammator y drugRoute,dose, frequencyandadministrati
on:adult-apply onepatch tomostpainful areaB.I.D.
Diclofenaccompetitivelyinhibits bothcyclooxygenaseisoenzyme, COX-1and COX-2, bybloking arachidonicacid conversion toother chemicals,thus leading to itsanalgesic,antipyreticand anti-inflammatory effect.It appear to be a
potent inhibitor of cyclooxygenase,thereby decreasing thesynthesis of prostaglandin
Hypersensitivitytodiclofenac,NSAIDS, or salicylate;patients inwhomasthma,urthicaria,angioedema,brochospasm,severerhinitis,historyof bleeding;hepatic
porhpyria;shockor other sensitivityreaction ispresipitated byaspirin or other NSAIDS, postoperative
CABG pain.
CNS : Dizziness, headache,drowsinessSpecial senses: TinnitusSkin: Rash, pruritusG I: Dyspepsia, nausea,vomting, abdominal pain,cramps, constipation,diarrhea, indigestion,abdominal distention,flatulence, peptic ulcer, liver enzyme,transaminases,increased liver test abnormalitiesCV : Fluid retention,
hypertention, CHF.RESPIRATORY : AsthmaBODY AS A WHOLE : Back,leg, or joint pain.ENDOCRINE : hyperglycemiaHEMATOLOGIC : prolongedbleeding time; inhibits plateletaggregation
-observe and reportsigns of beeding-Monitor bloodpressure for hypertension andblood sugar for hyperglycemia-Monitor diabeticsclosely for loss of diabetic control-monitor for increased serumsodium andpotassium in
patient receivingpotassuim sparingdiuretics- Monitor for S&Sof CHF, includingweight gain greater than 1kg-monitor for signs
and symptoms of GI irritation and
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DRUG ACTION ANDTHERAPEUTICEFFECT
CONTRAINDICATION
ADVERSEEFFECT
NURSINGIMPLICATION
OMEPRAZOLECLASSIFICATION: PROTONPUMPINHIBITOR,
ANTISECRETORYROUTE, DOSE,FREQUENCY
AND ADMINISTRATION:PO 20-40mgONCE ADAYFOR 4-5WEEKS
AN ANTISECRETORYCOMPOUNDTHAT IS AGASTRIC ACIDPUMPINHIBITOR.SUPPRESSES
GASTRIC ACIDSECRETIONBY INHIBITINGTHE H+, K+,
ATPaseENZYMESYSTEM ACIDIN THEPARIETALCELLS.SUPPRESSESGASTRIC ACIDSECRETIONRELIEVINGGASTROINTES
TINALDISTRESS AND
LONG TERMUSE FORGASTROESOPHAGEALREFLUXDISEASE,DOUDENALULCERS,PROTON
PUMPINHIBITORS,HYPERACTIVITY, BLEEDING,LACTATION,USE OFZEGERID INMETABLOLIC
ALKALOSIS,HYPOGLYCEMI
A, VOMITING
CNS:HEADACHE,DIZZINESS,FATIGUEGI:DIARRHEA,
ABDOMINALPAIN, NAUSEA,MILD
TRANSIENTINCREASES INLIVERFUNCTIONTESTSUROGENITAL:HEMATURIA,PROTEINURIASKIN:RASH
-LAB TESTS:MONITORURINALYSISFORHEMATURIA
ANDPROTEINURIA,PERIODICLFTS w/
PROLONGEDUSE-REPORT ANYCHANGES INURINARYELIMINATIONSUCH AS PAIN
ANDDISCOMFORT
ASSOCIATEDw/ URINATION-REPORTSEVEREDIARRHEA,DRUG MAY
NEED TO BEDISCONTINUE
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DRUG ACTIONANFTHERAPEUTICEFFECT
CONTRAINDICATION
ADVERSE EFFECTS NURSINGIMPLICATION
FERROUSSULFATE
CLASSIFICATION:IRONPREPARATIONROUTE,DOSAGE,FREQUENCY AND
ADMINISTRATION:POSULFATE750-
1500mgPER DAYIN 1-3DIVIDEDDOSES
STANDARD IRONPREPARATIONTHATCORRECTSERYTHROPOIETIC
ABNORM ALITIESINDUCEDBY IRONDEFICIENCY BUTDOESNOTSTIMULA
TEERYTHROPOIESIS
PEPTICULCER,REGIONALENTERITIS,ULCERATIVECOLITIS,HEMILYTIC
ANEMIAS,HEMOCHROMATOSIS,HEMOSIDEROSIS,PATIENTSRECEIVINGREAPETEDTRANSFUSIONS,PYRIDOXINE
-RESPONSIVE ANEMIA,CIRRHOSISOF LIVER
GI:NAUSEA, HEARTBURN,
ANOREXIA, CONSTIPATION,DIARRHEA, EPIGASTRIC PAIN,
ABDOMINAL DISTRESS, BLACKSTOOLSSPECIAL SENSES:YELLOW-BROWNDISCOLORATION OF EYES ANDTEETHLARGE CHRONIC DOSES ININFANTS:RICKETSMASSIVE OVERDOSAGE:LETHARGY, DROWSINESS,NAUSEA, VOMITING,
ABDOMINAL PAIN, DIARRHEA,LOCAL CORROSION OF
STOMACH ANF SMALLINTESTINE, PALLOR ORCYANOSIS, METABOLIC
ACIDOSIS, SHOCK,CARDIOVASCULAR COLLAPSE,CONVULSION, LIVERNECROSIS, RENAL FAILURE,DEATH
-LAB TEST: MONITORHIGH Hgb ANDRETICULOCYTEVALUES DURINGTHERAPY.INVESIGATE THE
ABSENCE OFSATISFACTORYRESPONSE AFTER 3WEEKS OF DRUGTREATMENT-CONTNUE IRONTHERAPY FOR 2-3MONTHS AFTER THEHEMOGLOBIN LEVELHAS RETURNED TONORMAL-MONITOR BOWEL
MOVEMENTS ASCONSTIPATION IS ACOMMON ADVERSEEFFECT
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DRUG ACTION ANDTHERAPEUTIC EFFECT
CONTRAINDICATION
ADVERSE EFFECT NURSINGIMPLICATIONS
CEFUROX
IMESODIUMCLASSIFICATION:
ANTIBIOTIC,SECONDGENERATIONCEPHALOSPORINROUTE,DOSAGE,FREQUENCY AND
ADMINISTRATION:
ADULT:PO 250-500mgQ12IV/IM 750-1.5g Q6-8
SEMISYNTH
ETICSECONDGENERATIONCEPHALOSPORIN BETA-LACTAM
ANTIBIOTIC.PREFERENTIALLY BINDSTO ONE ORMORE OFTHEPENICILINBONDING
PROTEINSLOCATEDON CELLWALLS OFSUSCEPTIBLEORGANISMS, THUSKILLING THEBACTERIUM
HYPERSE
NSITIVITYTOCEPHALOSPORINS
ANDRELATED
ANTIBIOTICS; VIRALINFECTIONS
BODY:
THROMBOPHLEBITIS,PAIN, BURNING,CELLULITIS,SUPERINFECTIONS,POSITIVE COOMBS
TESTGI:DIARRHEA, NAUSEA,
ANTIBIOTIC ASSOCIATEDCOLITISSKIN:RASH, PRURITUS,URTICARIAUROGENITAL:
INCREASED SERUMCREATININE ANDBUN, DECREASEDCRAETININECLEARANCE
-DETERMINE
HISTORY OFHYPERSENSITIVITY REACTIONS TOCEPHALOSPORINS, AND HISTORYOF ALLERGIES,PARTICULARLY TODRUGS, BEFORETHERAPY ISINITIATED-LAB TESTS:PERFORMCULTURE ANDSENSITIVITYTESTS BEFORE
INITIATION OFTHERAPY.THERAPY MAY BEINSTITUTEDPENDING TESTRESULTS.MONITORPERIODICALLYBUN ANDCREATININE
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DRUG ACTION ANDTHERAPEUTICEFFECT
CONTRAINDICATION
ADVERSEEFFECT
NURSINGIMPLICATION
FLANAXFORTE
CLASSIFICATION:
Analgesics, Antipyretics &MuscleRelaxants/
Analgesics,Non-Narcotic/Non-Steroidal
Anti-InflammatoryDrugs (NSAIDs)ROUTE,DOSAGE,
FREQEUNCY AND ADMINISTRATION:PO Non-Rx:Flanax 275mg;Rx: FlanaxForte BID
Relief of mild tomoderately
severe pain withor withoutaccompaniedinflammation.Relief of painassociated withpost-partumcramping anddysmenorrhea.
Hypersensitivity. Active peptic
ulcer. Children
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DRUG ACTION AND CONT ADVERSE NURSING IMPLICATION
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THERAPEUTICEFFECT
RAINDICATION
EFFECT
D5LRS(DEXTROSE 5% INLACTATEDRINGERS
SOLUTION)
CLASSIFICATION:HYPERTONIC,NON-
PYROGENIC,PARENTERALFLUID,ELECTROLYTE,NUTRIENTREPLENISHER
ROUTE,DOSAGE,FREQUENCY
AND ADMINISTRATION:IV SINGLEDOSE OF 500-
1000mL @ 30gtts/min OR AS
HYPERTONICSOLUTIONS
ARE THOSETHAT HAVE ANEFFECTIVEOSMOLARITYGREATERTHAN THEBODY FLUIDS.THIS PULLS
THE FLUIDINTO THEVASCULAR BYOSMOSISRESULTING IN
AN INCREASEVASCULARVOLUME. ITRAISESINTRAVASCULAR OSMOTICPRESSURE
ANDPROVIDESFLUID,
ELECTROLYTES AND
HYPERSENSITIVITY TO
ANYOFTHECOMPONENTS
The mostfrequently
reportedside effectsfor patientstaking D5Lrs are:hypotension,pneumoniarespiratorysyncytialviral,hypernatraemia. Theyare followedby: acute
respiratorydistresssyndrome,pneumonitis, bloodbilirubinincreased.
-DO NOT ADMINISTERUNLESS SOLUTION ISCLEAR AND CONTAINERIS UNDAMAGED-CAUTION MUST BEEXERCISED IN THE
ADMINISTRATION OFPARENTERAL FLUIDS,ESPECIALLY THOSECONTAINING SODIUM
IONS TO PATIENTSRECEIVINGCORTICOSTEROIDS ORCORTICOTROPHIN-SOLUTION CONTAINING
ACETATE SHOULD BEUSED WITH CAUTION ASEXCESS ADMINISTRATIONMAY RESULT INMETABOLIC ALKALOSIS-SOLUTION COINTAINGDEXTROSE SHOULD BEUSED WITH CAUTION INPATIENTS WITH KNOWNCUBCLINICAL OR OVERT
DIABETES MELLITUS
A t Di i i f Pl i I i R i l l i
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Assessment Diagnosis inference Planning Intervention Rationale evaluation
Subjective:Masakit angtiyan ko (
My tummyhurts) asverbalized
by patient .Objective: Facial mask of pain. Guarding
behavior
Acute painrelated todistention
or ruptureof fallopiantube
Ectopic pregnancy isgestation
locatedoutsidethe uterine
cavity.The
fertilizedovumimplantsoutside
of the uterus,usually in
the fallopiantube .
After 8 hoursof nursinginterventions,the patientwill berelievedor controlledIndependent:
Monitor maternal vitalsigns.
Monitor for presenceand amountof vaginal
bleeding.Monitor for increaseand pain andabdominaldistentionand rigidity.Monitor complete blood
count(CBC)
To determine
presence
of hypotension andtachycardiacaused byruptureor hemorrhage.
After 8hoursof nursinginterventions
, the patientwas relievedor controlled
Assessment Diagnosis inference Planning Intervention Rationale Evaluation
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PredisposingfactorsIncludeAdhesions
of the tube,salpingitis,congenitalanddevelopmentalanomaliesof the
fallopian tube, previousectopic
pregnancy,use of anintrauterinedevice for
more than2years,multipleinducedabortions,menstrualreflux , anddecreasedtuba lmotility
Providecomfortmeasure like
back rubs,
deep breathing.Instruct inrelaxation or visualizationexercises.Provideddiversionalactivities
Collaborative:
Administer analgesics asindicated
Tofurther assessthe presentsituationindicatinghemorrhageProvidecomfortmeasure like
back rubs, deep breathing.Instruct in
relaxation or visualizationexercises. Diversionalactivities aidsin refocusingattention andenhancingcoping withlimitations. To maintainacceptablelevel of pain