Upload
vistanaya-ocha
View
42
Download
6
Tags:
Embed Size (px)
Citation preview
The presentation
Nursing care
Ectopic Pregnancy
Our Team Work
ROSMINAHRUSLYRESKI
OUTLINE
Background
Anatomy physiology reproductive organs
Definition
Etiology
Risk Factors
Signs and Sympton
Patofisiology
Complication
Supporting investigation
Management / treatment
Nursing Care
Background
Ectopic pregnancy is an abnormal location of the implantation of a fertilized egg cell, where the location of the products of conception grow and develop are not on the endometrial cavity of the uterus.
These abnormalities can cause many complications in pregnancy one of which is the Ectopic Pregnancy Impaired
By The Centers for Disease Control and Prevention in the United States the incidence of ectopic pregnancy ranges from 1-2% of all pregnancies and is a major cause of death Mothers common in the first trimester of pregnancy.
In Indonesia, particularly West Java at Dr dr. Hasan Sadikin period in 2011 found 103 cases with the most common location on the tube that is 82 cases
Anatomy physiology reproductive organs inner female genitalia
Ovarium
fallopian tube
Uterus
Vagina
Definition
Ectopic pregnancy is a pregnancy where implantation / nidasi / fruit attachment pregnancy outside the normal place, ie outside the uterine cavity.
While known as ruptured ectopic pregnancy is an ectopic pregnancy who experienced abortion rupture in the tube wall.
Etiology
Most of the causes are not well known. Each pregnancy is known to egg growth ampulla tuba section, and on the way to the uterus then obstacles when they dituba fallopian nidasi.
According Trijatmo Rachimhadhi in his book describes some of the factors associated with ectopic pregnancy causes impaired :
Cont ...
Factor in the lumen of the tube.Factors tuba lumen wallFactors beyond the walls of the
tube lumenOther factors
factors associated with ectopic pregnancy causes impaired
Mechanical factors
Functional Factor
Improving the acceptance of tubal mucosa of the fertilized ovum.
Other things like; KET history and the history of previous induced abortion
location of ectopic pregnancy
Cont ...
Risk Factors
a.Endosalpingitis.
b. Diverticula.
c. Tumor pressing on the tube.
d. Previous surgery, such as tubal ligation or resection.
e. Ovum transfer.
f. Konginital defects of the reproductive tract.
g. Ectopic endometrial implants in the fallopian mucosa.
h. Sexually transmitted infection in the tubes.
i. Intrauterine devices.
j. Smoking.
k. Hormonal contraception.
(Williams & Wilkins, 2011).
Signs and Symtompspregnancy has not been disturbed
a little pain in the lower abdomen that is not how ignored. On vaginal examination, uterus enlarged and flabby, even though the amount may not be according to gestational age. Tuba containing products of conception because they flabby hard palpable on bimanual examination
Interrupted tubal pregnancy symptoms are very different from bleeding a lot to arrived in the abdominal cavity until there are no obvious symptoms make diagnosis difficult
Cont ..
Pain is the main complaint on ruptured ectopic pregnancy. At tubal rupture lower abdominal pain occurs suddenly - arrived and strong intensity accompanied by hemorrhage that caused the mother fainted and went into shock.
Beeding pervaginaAmenore
Ruptured Etopic Pregnancy
gastrointestinal complaints
Tenderness of the abdomen and pelvis.
Amenore.
Vaginal spotting or bleeding
Changes uterus
Blood pressure and pulse
Hipovolemi
Temperature
Pelvic masses
Pelvic Hematokel
Patofisiology
In normal pregnancy, the process of fertilization (meeting the egg by the sperm) occurs in the fallopian then the fertilized egg cell is driven and implantation in the uterine endometrial cavity.
Ectopic pregnancy can be caused, among other factors inside the tube and outside the tube, so that the result of conception obstructed or can not enter the uterine cavity, so that the fertilized egg grows and implants (stuck) in some places the female reproductive organ cells in the uterine cavity, among others in the fallopian tubes (fallopian tubes) cervical canal (cervix), ovary (ovarian), and the abdominal cavity. Most occur in the fallopian tube (90%). (Mitayani, 2009).
Complication
Ectopic pregnancy complications can occur secondary to late diagnosis error, or management of approach.
Failure diagnosis quickly and accurately may result in tubal or uterine rupture, depending on the location of the pregnancy, and this can cause massive bleeding, shock, DIC and death.
Complications arising from the surgery include bleeding, infection, damage to surrounding organs (intestines, bladder, ureter, and large blood vessels). In addition there are also complications related to anesthesia action.
Supporting investigation
Complete blood count
HCG-B levels decreased
Toucher vaginal
Ultrasonografi
Kuldosintesi
Oksitosin Test
Foto Rontgen
Histerosalpingografi
ECG
Management / treatment
Surgical :
- 1. Tubektomi
- 2. Laparatomi
- 3. Laparoskopi
- 4. Blood Tanfusi
Nursing :
1. Collaboration with the medical team in drug delivery
2. Implementation of chemotherapy
3. Create a calm and comfortable atmosphere to reduce pain and anxiety.
4. Post-action counseling and self care during home
Nursing Care
1. Assessment2. Phisical Assessment3. Diagnosa 4. Intervention
Diagnosa 1. Ineffective tissue perfusion gastrointestinal associated
with defisit hemoglobin, as a result of more bleeding
in the uterus.
2. Deficit fluid volume associated with the rupture at the site of
implantation, Bleeding
3.Pain associated with a ruptured fallopian tube, intraperitoneal
hemorrhage
4.The weakness relates to the amount of blood that comes out
when bleeding
5. Grieving associated with fetal death
6. Anxiety associated with the process will be done surgery
7. Lack of knowledge related to lack of understanding or do not
know the sources of information.
Cont ...
POST OP :
1. Acute pain associated with skin
diskontinuitas tissue secondary to
laparotomy
2.The risk of wound infection associated with
the operation and installation of equipment
maintenance
For Intervention
Please Check your Nanda’s Book
Ok ... Any Question ?????