University of La Salette Inc.

Bachelor Street, Dubinan East,

Santiago City, Isabela, Philippines

Ectopic Pregnancy: Post-Operative Case

A Case Study
Presented to the College of Nursing, Public Health and Midwifery

Case presented by:

John Michael T. Pascua
Arian Jade T. Atluna
Joyce Ann V. Bretania
Princess Nazarene Joy P. Cafirma
Hanna Rhyjean M. De Vera
Frances A. Parcasio
Jasmin N. Prieto
Paula Angela Maria S. Soriano
Roselle Jane T. Ugot
BSN-2A

Case presented to:

Erella T. Palo, RN, MSN

Clinical Instructor
I. CASE DESCRIPTION
Ectopic pregnancy is when a fertilized egg grows outside of a woman's uterus, somewhere else in her
belly, this is also known as extrauterine pregnancy. It can result in life-threatening bleeding and requires
immediate medical attention. The egg implants in the fallopian tube in more than 90% of cases. A tubal
pregnancy is what it's termed.
It is impossible to rescue an ectopic pregnancy. It will not become a typical pregnancy. If the egg
continues to grow in the fallopian tube, it has the potential to rupture or break the tube, resulting in severe
bleeding that might be fatal. If you have an ectopic pregnancy, you'll need to get treatment right once to
stop it from becoming hazardous.
Damage to the fallopian tubes is a common cause of ectopic pregnancy. A fertilized egg may have
difficulty traveling through a damaged tube, resulting in the egg implanting and growing in the tube. The
following factors increase your chances of fallopian tube injury and an ectopic pregnancy:
• Tobacco use
• Inflammation of the pelvis (PID)
• Scar tissue in or around the fallopian tubes can be caused by endometriosis
• Exposure to chemical DES

Some medical procedures can raise your chances of having an ectopic pregnancy. These are some of
them:
• The fallopian tubes or the pelvic area may be operated on
• Treatments for infertility, such as in vitro fertilization

An ectopic pregnancy usually has the same symptoms as a normal pregnancy in the first few weeks, such
as missed periods, exhaustion, nausea, and aching breasts. The following are the main symptoms of an
ectopic pregnancy:
• Pelvic or belly pain
• Vaginal bleeding

To diagnose ectopic pregnancy, the tests that may be done include:

 Pelvic exam – to check the size of your uterus and feel for growths or tenderness in your
belly.
 A blood test that checks the level of the pregnancy hormone (hCG).
 An ultrasound for a reliable visualization of an extra-uterine gestation
Ectopic pregnancy can be treated with the use of medication, laparoscopic surgery or abdominal surgery.
An early ectopic pregnancy without unstable bleeding is most often treated with a medication called
methotrexate that stops cell growth and dissolves existing cells. There are also surgical procedures such a
salpingostomy and salpingectomy. They are two laparoscopic surgeries used to treat some ectopic
pregnancies.

II. ANATOMY AND PHYSIOLOGY

Specific Structures of The Uterus

The uterus is divided into 3 main parts: the fundus, body, and cervix.

1. Fundus of uterus (Fundus uteri)
- The section of a hollow organ that is directly across from, or farthest away from, the aperture.
The fundus may be at the top or bottom of the organ, depending on the organ.
- The uppermost part where a fertilized embryo will develop into a baby.
2. Body of uterus (Corpus uteri)
- The major section of the uterus, which begins right underneath the fallopian tubes and continues
downward until the uterine walls and cavity begin to narrow
- From the fundus to the isthmus, it gradually narrows.
3. Cervix
- Serves as a fascinating gatekeeper, stopping germs from the vaginal canal from entering the
uterus and allowing sperm to reach the Fallopian tubes. It's also necessary for keeping the
pregnancy alive in the uterus until labor begins.

Specific Structures of The Fallopian Tube

1. Ampulla
- This segment is 5–8 cm long on average. Fertilization and early embryo development take place
in this highly ciliated section of the oviduct. Ectopic implantation most commonly occurs in the
ampulla (ectopic pregnancy).
2. Isthmus
- A tiny area that connects the ampulla and infundibulum to the uterus, measuring about 2 cm (0.8
inch) in length. Hegar's sign refers to the fact that it becomes more compressible during
pregnancy.
3. Infundibulum
- It is the wide distal (outermost) section of each fallopian tube that gathers and conducts the
discharged eggs. Fimbriae end points stretch over the ovary, contracting near to the ovary's
surface during ovulation to guide the liberated egg.
4. Fimbriae
 - Small, fingerlike extensions at the end of the fallopian tubes, through which eggs migrate from
the ovaries to the uterus, are known as fimbriae tubae. The ovary is attached to the fimbriae.

Normal Implantation vs. Ectopic Pregnancy

Normal Implantation of The Fertilized Egg

The sperm and egg combine to form a zygote in one of the fallopian tubes during fertilization. The zygote
then travels through the fallopian tube and transforms into a morula. The morula develops into a
blastocyst once it enters the uterus. Following that, the blastocyst burrows into the uterine lining, a
process known as implantation. During the secretory phase of the cycle, implantation takes place in the
functional layer of the endometrium in the superior and posterior borders of the uterine body (corpus
uteri). The blastocyst's normal implantation zone in the uterine cavity's superior and posterior walls.
Ectopic Pregnancy
When a fertilized egg implants and grows outside the main cavity of the uterus, it is called an ectopic
pregnancy. The most common site of an ectopic pregnancy is the fallopian tube, which transports eggs
from the ovaries to the uterus. The fertilized egg attaches (or implants) somewhere other than the uterus
in an ectopic pregnancy, most commonly in the fallopian tube. (It's for this reason that it's sometimes
referred to as a tubal pregnancy.) The egg can implant in the ovary, cervix, or belly in rare situations.
III. NURSING HISTORY
A. Demographic Data

Name: Mrs. Y
Age: 31
Address: Malvar, Santiago City, Isabela
Sex: Female
Religion: Roman Catholic
Birthdate: February 17, 1990
Civil status: Married
Height: 5’2
Weight: 46 kg
Date of admission: June 05, 2021
Time of admission: 10:30 am
Chief complaint: Pain in surgical site, complaints of fever with chills
Admitting diagnosis: S/P salpingostomy related to ectopic pregnancy
Admitting physician: Dr. dela Cruz
Initial vital signs:
 T: 38.1ºc
 RR: 18 cpm
 PR: 101 bpm
 BP:120/90 mmHg
B. Obstetrical History

Ob Scoring: G2 P0 (0-0-2-0)
Date Weeks of Type of Wt. of Sex of Place of Doctor/Birth Remarks
Gestation Delivery Baby Baby Delivery attendant
G1 4 weeks - - - - - - Therapeutic
2020 abortion
G2 6 weeks - - - - - - Salpingostomy
2021 performed

C. Past Health History

The patient stated that she had a history of ectopic pregnancy on her first pregnancy. It was managed with
the use of Methotrexate as it was detected early. She admitted using intrauterine device before marriage.
The patient also stated that she occasionally smokes, one to two cigarettes a day, to relieve her stress. She
was never hospitalized since the diagnosis of her first ectopic pregnancy.

D. History of Present Illness

10 days ago, Mrs. Y was admitted with a suspected ectopic pregnancy with complaints of the usual
pregnancy signs and symptoms such as missed period, nausea, and vomiting. Sharp abdominal pain was
also reported. Her HCG blood test confirmed that the patient was pregnant. She also had an ultrasound
testing that confirmed ectopic pregnancy and she was ordered for salpingostomy. CBC was taken. IVF
was given. 24 hours later, she underwent salpingostomy and was discharged after 2 days.

2 days prior to readmission, she complained of nausea, high fever with chills. She also reported pain and
warmth feeling on the surgical site.

E. Familial History

The patient stated that they do not have history of cancer, cardiovascular disease or diabetes. She also
stated that they do not have any hereditary diseases.

E.1. Gordon’s Functional Pattern

1. Health Perception/ Health Management

Before During
The patient stated that she is health-conscious. Patient became anxious and doubled her
Even minimal signs and symptoms will make health-consciousness due to present condition.
her want to be checked. She started to be an
occasional smoker at the age of 28.

2. Nutritional- Metabolic

Before During
The patient verbalized that she has a good Patient eats the same kinds of food, but with
 appetite and has no restricted diet, that she can an increase in fruits, vegetables, and whole
eat whatever she wants. She enjoys eating grains, as directed. She is also prohibited from
fruits. She occasionally smokes. She weighed smoking. She has a weight of 46 kg and still
48 kg and has a normal BMI of 19.2. has a normal BMI of 18.5.

3. Elimination

Before During
The patient has stated that she urinates at least She is able to urinate but with mild pain. She
5x a day or when she feels like urinating. She stated that she feels terrified to defecate as of
also stated that she urinates more frequently now.
when she became pregnant. She also reported
that she defecates 1-2x a day.

4. Activity- Exercise

Before During
The patient verbalized that she likes waking She is on bed rest.
up early for walking as an exercise. She
enjoys reading books and magazines on her
free time.

5. Cognitive- Perceptual

Before During
The patient verbalized that Tagalog and No changes.
English are their most used languages at
home. She also stated that she can understand
minimal Ilocano. She is literate and well-
understood by others.

6. Sleep- Rest

Before During
The patient stated that she has a normal Patient complained of disturbed sleep due to
 sleeping pattern. She falls asleep easily and the pain she is feeling. She only sleeps for a
can sleep for 8-10 hours. When she got short period of time and does not feel rested.
pregnant, her sleep becomes disturbed when
she feels an urge to pee every midnight. She
verbalized that she feels rested when sleeping.

7. Self-Perception/ Self-Concept

Before During
The patient stated that she is happy and Patient is anxious about the possible
contented with her life. She is family-oriented happenings.
and loves to socialize with her small group of
friends. Although, she wants to have a baby
the soonest.

8. Role-Relationship

Before During
Patient stated that she has a good relationship She stated that there are no changes with the
with her husband, parents, relatives, and relationship with her husband, parents,
friends. relatives, and friends.

9. Sexuality- Reproductive

 Patient is female.
 Menarche: 13 years old
 First sexual intercourse: 20 years old
 Patient is 31 years old.
 Patient is sexually-active.

10. Coping- Stress Tolerance

Before During
Patient verbalized that she usually talks to her The patient stated that there have been a lot of
 husband or parents when feeling stressed. She changes that happened, which increases her
also smokes to release the stress. anxiety and stress. Furthermore, she stated
that she believes she can adjust to it. She does
not smoke as it was prohibited.

11. Value- Belief

Before During
Patient stated that she is Roman Catholic. She Patient verbalized that there are no certain
frequently attends the mass. She believes that practices that can affect her present situation.
having a baby is a blessing from above. She thinks that whatever is happening, it is
still a blessing. She prays every night for
faster recovery and less complications in the
future.

IV. PHYSICAL ASSESSMENT

General Condition: 06.05.2021. Patient is lying on the bed, hooked on an IVF of PLRS, regulated at 42
gtts/min. She is conscious and coherent, guarding behavior is observed, 5’2 in height, 46 kg, with a pain
scale of 7/10 and the vital signs of:
 T: 38.1ºc
 RR: 17 cpm
 PR: 100 bpm
 BP:120/90 mmHg

Areas Methods Findings Interpretation

1. Head
- Head is round and appropriate to Normal
body size
Inspection and
Hair, scalp, face - Smooth and no lesions. Normal
palpation

- Presence of oily scalp Poor Hygiene

due to bed rest

Eyes Inspection
- Eyes are symmetrical Normal

- Pupils are equal, round, reactive to Normal

light and accommodation
 - Ears are equal in size, clean, smooth Normal
and no lesions present.
Ears and hearing Inspection
- Ear piercing present

- No swelling in mucus membrane Normal

Nose Inspection

- Complete dentition with slight tartar Smoker

on the front tooth from nicotine

- Tongue is pink, moist and moderate Normal

Inspection and
Mouth size
palpation
- Color and consistency of tissues Normal
along cheek and gums are even

2. Neck
- Normal neck movement, trachea is in Normal
midline, landmark is position midline

Inspection, - No bruises, no swelling and no Normal

palpation and tenderness present.
auscultate
- No Lymph nodes palpated Normal

- Thyroid gland is 4cm and non-tender Normal

3. Upper - Skin color is dark brown, presence of Normal

extremities tattoo

Inspection and - Clear skin and no lesions Normal

Skin and
nails palpation
- 2 sec capillary refill Normal

- Nails are short Normal

Muscle
strength and Inspection - Can grip firmly Normal
tone
4. Chest and
back - No lesions, tenderness or swelling
Skin and Inspection and Normal
back palpation - No pain
 - No adventitious sounds (RR is 17
cycles per minute) Normal
Auscultation and
Lungs
Inspection
- Chest expands symmetrically and no
retraction occurs Normal

- Audible heart sounds (PR is 100 Normal

Heart Auscultation
beats per minute)

- No rashes, no swelling and no signs Normal

Breast and Inspection and of infection
axillary palpation Normal
- No lymph nodes noted

5. Abdomen - Tenderness
Normal in post-
- Pain (in lower abdomen) operative
Inspection,
salpingostomy
auscultation,
- (+) swelling and redness in surgical
percussion and
site
palpation
- (+) dehiscence Abnormal

6. External genitalia - Unremarkable Not examined

Inspection

7. Anus Inspection - Unremarkable Not examined

8. Lower
extremities - 2 secs capillary refill Normal
Skin and Inspection and
palpation - Short nails Normal
nails
- Pinkish nail beds Normal

Walking,
Not examined:
balance and Inspection - N/A
on bed rest
joint
Popliteal,
posterior Palpation - Normal popliteal, posterior tibial, Normal
tibial, dorsalis pedis pulses
dorsalis
pedis
pulses
V. LABORATORY DIAGNOSIS

LABORATORY DEPARTMENT
Hematology Report

PATIENT NAME: Mrs. Y DATE: 06/06/2021

DATE OF BIRTH: February 17, 1990 AGE: 31 years old
PHYSICIAN: Dr. dela Cruz
GENDER: Female

PARAMETER RESULT UNIT REF. RANGE INTERPRETATION

White cell count 15 10^9 L 5.0-10.0 high
Hematocrit 40.7 % 37.0-47.0 normal
Hemoglobin 13.3 g/L 11.0-15.0 normal
Red cell count 3.7 10^12/L 3.50-5.00 normal
Differential count

Neutrophils 73.2 % 50.0-70.0 high

Lymphocytes 19.5 % 20.0-40.0 slightly decreased
Monocytes 9.0 % 3.0-12.0 normal
Eosinophils 1.0 % 0.5-5.0 normal
Basophils 0.3 % 0.0-1.0 normal
Blood indices
MCV 100 FL 80-100 normal
MCH 31.8 pg 27.0-34.0 normal
MCHC 32.5 g/dL 32.0-36.0 normal
Platelet count 198 10^9/L 150-450 normal

Narcissa Basilio, RMT Juana Batongbakal, RMT

Medical Technologist Pathologist
 RADIOLOGY DEPARTMENT
Ultrasound Report

 No anatomic or functional abnormalities exist. The organs are normal in size, shape, contour,
position. The internal structures of organs and nearby tissues are within normal limits.
 Uterus is normal in size measuring 7.7 cm x 4.3 cm x 3.9 cm (LWT)
 Uterine parenchyma is unremarkable. No definite focal mass lesion.
 Endometrial stripe is not thickened and measures approximately 0.4 cm. The cervix is closed
measuring 2.0 cm x 2.7 cm (LW). No cervical mass noted.
 The left ovary is not unusual and measures 1.8 cm x 2.4 cm (LWT). Right ovary measures 2.4 cm
x 2.0 cm (LW).

 Right fallopian tube is normal.

 Left fallopian tube is slightly swollen. (S/P: Salpingostomy, May 2021)

 IMPRESSION: NORMAL UTERUS AND LEFT OVARY. MINIMAL PELVIC FLUID. S/P
SALPINGOSTOMY, LEFT. NO OTHER ABNORMALITIES SEEN.
 VI. PATHOPHYSIOLOGY

RISK FACTORS
\
 Previous Ectopic pregnancy
 Use of IUD (Intrauterine device)
 Tobacco use/ smoking
 Previous infection such as salpingitis or pelvic inflammatory disease. 
 Scars from Tubal surgery
 Uterine tumors
 Congenital malformation

Anatomic distortion, presence of scar and obstruction of the fallopian tube.

Zygote cannot travel through the length of the tube. It stays on that constricted part and implantation
takes place at that area.

The Tubal pregnancy Ovarian ectopic pregnancy Abdominal ectopic Cesarean scar ectopic
and cervical ectopic pregnancy pregnancy
pregnancy (relatively rare
conditions.)

Ruptures after about 6 to 16 weeks.

Bleeding

Scant Vaginal
Bleeding
PERITONEAL IRRITATION OF
IRRITATION THE DIAPHRAGM/
Most of the blood goes to abdominal
PHRENIC NERVE
cavity.

RIGID
ABDOMEN
Decrease blood volume that can lead SHOULDER
to HYPOVOLEMIC SHOCK PAIN

CULLEN SIGN
 VII. NURSING CARE PLAN
A. Infection

Assessment Diagnosis Planning Interventions Rationale Evaluation

Subjective: Infection Short-term goal: 1. Monitor vital signs To monitor the condition of Short-term
“Nilalagnat secondary the patient goal:
po ako” as to post- After 30 minutes
verbalized by operative to 1 hour of 2. Maintain strict To prevent the spread of After 30
the patient salpingosto nursing aseptic techniques. infection minutes of
my as intervention, the Especially for nursing
Objective: evidenced patient will be dressing changes, intervention,
 Unusual by able to stabilize wound care, and the patient’s
odor increased body intravenous therapy. body
coming body temperature temperature
from the temperature within the 3. Educate clients and To help the patient in case normalized
surgical and normal range of SO about appropriate the patient needs assistance from 38.1ºC to
site elevated 36.1˚C to methods for cleaning, 37.2˚C.
 Redness white blood 37.2˚C. disinfecting, and
and cells. sterilizing items Goal met.
swelling Long-term goal:
 Surgical 4. Encourage intake of To give the patient more
site is After 5 to 7 days protein rich and energy and extra nutrition
warm to of nursing calorie rich foods for faster recovery
touch intervention, the
 Elevated patient will be 5. Encourage increase To stay hydrated
WBC: 15 free from the fluid intake
x109 L infection unless
possibly contraindicated
evidenced by a
V/S: lowered or 6. Provide emotional To improve healing
T: 38.1ºC normal WBC of support to the patient process
RR: 18cpm at least 4.5 to
PR: 105 bpm 11.0 × 109/L. 7. Encourage patient to To know if the effects of
BP:120/90 report untoward medications are effective
mmHg effects of antibiotics. or not.

INDEPENDENT:

8. Administer To alleviate fever and pain

paracetamol for fever
and pain due to
infection as
prescribed

Antibiotics for infection

9. Administer
antibiotics for
 infection as
prescribed
B. Pain

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Acute Pain After 20 to 30 1. Determine how After 30

“Halos ilang araw related to minutes of the client is minutes of
palang po ang tissue trauma nursing managing pain nursing
nakalipas ng mag secondary to intervention Necessary for intervention
undergo ako ng salpingostomy the client’s 2. Establish treatment of the the client
salpingostomy at procedure as pain will be collaborative underlying cause. reported a
ngayon po evidence by lessened from approach for pain lessened
nakakaranas ako dehiscence 7 to at least based on client’s pain of 3/10,
ng sakit sa may and guarding 3/10, will understanding. feeling of
bandang site ng behaviors. report a comfort and
surgery.” feeling of relaxation,
comfort and 3. Administer and
Pain scale of 7 relaxation, and analgesic, as To maintain maintained
out of 10 maintain indicated, to acceptable level of stable vital
stable vital maximum dosage if pain signs.
Objective: signs. needed. To
maintain acceptable V/S
 (+) dehiscence
level of pain T: 37.2˚C
 Facial grimace
RR: 16 cpm
 Guarding PR: 100
behavior in the bpm
surgical site. INDEPENDENT: BP:120/90
 Restlessness mmHg
1. Instruct client to Unrelieved pain can
 With limitation
report any create other
of movement Goal met.
improvement in problems such as
 Cold and anger, anxiety,
clammy skin pain experience.
immobility,
respiratory
V/S problems, and delay
T: 38.1˚C in healing.
RR: 18 cpm
PR: 105 bpm
BP:120/90
mmsHg 2. Encourage Only the client can
verbalization of judge the level and
feelings about distress of pain; pain
the pain. management should
be a team approach
that includes the
client.

3. Encourage and Deep breathing for

assist client to relaxation is easy to
 do deep learn and contributes
breathing to pain relief and/or
exercises. reduction by
reducing muscle
4. Provide tension and anxiety.
psychological
support/motivati If the client is ill,
on. ascertain the
motivation for
returning to an
optimal level of
5. Encourage wellness.
adequate periods
of rest and sleep, To promote
including circulation and
uninterrupted prevent excessive
periods of tissue pressure.
sufficient
duration,
meeting comfort
needs, limiting/
avoiding use of
caffeine/ alcohol
and medications
affecting REM
sleep. Encourage
quiet, restful
atmosphere.

6. Teach the client

and significant
others about the It may be possible to
non- teach clients a
pharmacologic combination of these
ways, such as techniques to
cold compress, maximize their
to lessen pain. opportunities for
self-control over
manifestations of
pain.
C. Anxiety

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: “hindi Anxiety After 30 1. Assess patient's Serves as a baseline After 30

ko kaya ikamatay related to minutes to 1 level of anxiety. data to compare minutes of
‘tong infection na alteration in hour of following nursing
‘to?” post- nursing assessments. intervention,
surgical intervention, the patient
Objective: infection patient will 2. Monitor V/S. Changes in vital signs appeared
 Verbal secondary appear are signs of anxiety. relaxed and
complaints to lack of relaxed and reported a
of anxiety knowledge report 3. Establish Good rapport will reduced
 Poor eye about the anxiety is rapport. establish a basis for level of
contact disease reduced to a comfort in anxiety
 Difficulty process. manageable communicating (mild).
concentrating level from anxious feelings.
 Worried- moderate to V/S:
looking mild. 4. Speak with To gain control of the RR: 16 cpm
patient in a calm situation and increase PR: 100
V/S: manner. the patient’s feeling bpm
RR: 18 cpm of security. BP:120/90
PR: 105 bpm mmHg
BP:120/90 5. Provide accurate Helps client to
mmHg information identify what is Goal met.
about the signs reality based.
and symptoms Providing answers
of infection and and information
its management. regarding the disease
process can alleviate
patient’s anxiety.

6. Encourage to Presence of
seek assistance significant others
and interaction reinforces feelings of
with the security for the
significant patient.
others.

7. Assist patient in Anxiety-reduction

developing strategies enhances
anxiety- patient's sense of
reducing skills personal mastery and
(relaxation, confidence.
deep breathing,
positive
 visualization,
and others).
VIII. DRUG STUDY

Consider
Contrain
& Route
Classific
Name of

dication

Nursing
Dosage

Action

ations
drugs

Paracetamol ation
Analgesic  1-amp Acetaminophe This drug is - Do not
(acetaminophen q4˚for 2 n is indicated contraindicated exceed the
) days IV for the to patients who recommended
 For management of are allergic or dosage.
discharge mild to hypersensitive
: 500 mg moderate pain, to - Avoid
PO 1 tab the acetaminophen.
taking any
PRN management of Use this drug
other
moderate to cautiously with
severe pain impaired medication
with adjunctive hepatic containing
opioid function, paracetamol.
analgesics, and chronic
the reduction alcoholism,
of fever. pregnancy,
lactation.
Mupirocin Anti-  2% cream Mupirocin Hypersensitivit - Notify
infective to be exerts its y to any of its physician of
applied on antimicrobial components and severe or
the activity by for ophthalmic prolonged
cleansed reversibly use symptoms. If
suture site inhibiting applied
BID for 5 isoleucyl-
topically to
days transfer RNA,
skin lesions,
thereby
inhibiting monitor any
bacterial new or
protein and increased skin
RNA synthesis reactions,
which usually including
results in localized
bacterial death. pain, burning,
itching, or
stinging.

- Make sure
to apply on
clean area

- Discontinue
if a sensitivity
 reaction or
chemical
irritation
occur.
Cephalexin Antibiotic;  500 mg For treatment Hypersensitivit - Check for
First- PO q12hr or prevention y to allergies,
generation of infections cephalosporins including if
cephalospori caused by and related allergic to
n susceptible antibiotics; penicillin
organisms. pregnancy.
- Take
without
regard to
food; if GI
distress, take
with food

- Patient
should be
instructed to
monitor for
rash and signs
of
superinfectio
n and report
to the
prescribing
provider.

- Patient must
be instructed
to complete
the course of
antibiotic
therapy.

IX. DISCHARGE PLANNING

SELF-CARE AND ACTIVITY

 Advice patient not to smoke. Smoking increases the risk for ectopic pregnancy.
 After your laparoscopy you may be tired and irritable. Use this time for rest and quiet activities.
 It will take time to heal, but you should feel better each day.
 Get plenty of rest, you may feel tired as usual.
 Avoid lifting heavy objects.
  Advice the grieving mother and her partner to talk to family members, friends, or counsellor that
may help them to cope up with their loss.

DIET

 On your first day at home, have light liquids and foods such as apple juice, ginger ale, ice pops,
soup, crackers, and toast to help prevent stomach upset.
 By the second day after surgery, you should be able to return to your regular diet.
 Since most prescription pain medications cause constipation, it’s important to drink plenty of
water, eat foods that contain fiber such as fruits and vegetables, and stay active.

WOUND CARE

 You’ll have bandages over the small incisions. Remove the bandage 2 days after your surgery.
 Wear light clothing to avoid irritating the surgical site.
 You may have black and blue areas around the incisions.
 Your stitches don’t need to be removed. They will dissolve within 2–6 weeks.

HYGIENE

 Wash the area daily with warm, soapy water and pat it dry. Don't use hydrogen peroxide or
alcohol, which can slow healing. You may cover the area with a bandage or band-aid if it weeps
or rubs against clothing. Change the bandage or band aid every day.

MEDICATIONS

 Take prescribed medications as ordered:

 Paracetamol: Paracetamol 500 mg 1 tab PRN
 Antibiotics: Cephalexin 500 mg PO q12hr
 Mupirocin 2% cream to be applied on the cleansed suture site BID for 5 days
PROBLEMS TO REPORT

 Call the healthcare provider if you experience.

 Severe vaginal bleeding or Heavy bleeding
 Dizziness or lightheadedness
 Fever
 Severe pain that doesn’t get better with pain medicine.
 Redness, swelling or pus at the incision sites.
 Vaginal discharge that smells bad.
 And if you are not getting better as expected.

FOLLOW-UP

 You need to have a follow-up and be checked in 2–6 weeks after surgery to make sure that you’re
healing well.