Ectopic Pregnancy Nursing Diagnosis and Nursing Care Plan

Ectopic pregnancy is a medical condition wherein the zygote fails to attach to the uterus and will either be on the fallopian tubes, the cervix, or any other part of the female reproductive system.

Due to the nature of placement, the embryo cannot fully mature and this will eventually lead to death.

In a healthy pregnancy, the fertilized egg attaches to the inner uterine wall. Without timely diagnosis, ectopic pregnancy poses a great threat to the mother’s life.  

Signs and Symptoms of Ectopic Pregnancy

50% of patients present with all 3 symptoms of the classic triad of ectopic pregnancy and they are:

1. Abdominal pain 
2. Amenorrhea
3. Vaginal bleeding

Other associated clinical signs and symptoms common to early pregnancy that can be found in ectopic pregnancy are:

1. Nausea and vomiting
2. Breast fullness
3. Fatigue
4. Heavy cramping
5. Shoulder pain – may be suggestive of peritoneal inflammation
6. Dizziness or weakness
7. Flu-like symptoms 
8. Syncope
9. Painful fetal movements (for advanced abdominal pregnancy)

The following are clinical manifestations that would warrant emergency surgical management and they are:

1. Abdominal rigidity
2. Involuntary guarding
3. Severe tenderness
4. Evidence of severe low blood pressure (Hypovolemic shock) – orthostatic blood pressure changes, tachycardia

Causes and Risk Factors of Ectopic Pregnancy

A tubal pregnancy, wherein the implantation happens at the fallopian tubes, is considered the most common type of ectopic pregnancy.

This occurs when the fallopian tubes are damaged or erratic in shape. Imbalances in hormones and abnormal development of the zygote may also play a role in ectopic pregnancy.

The following are proven to increase the risk for its development:

1. Previous ectopic pregnancy. Scarring of the structures brought about by previous ectopic pregnancies contributes to future episodes.
2. Inflammation or infection. Pelvic inflammatory disease (PID) brought about by infections like chlamydia and gonorrhea alters the normal structures by blocking the passage of the fertilized egg
3. Fertility treatments. Artificial induction of ovulation through injectable gonadotropin therapy has been linked to a 4-fold increased risk, therefore suggesting that multiple egg cells and high hormone levels plays a major role in ectopic pregnancy.
4. Tubal surgery. Alterations and scarring of the structures contribute to the improper implantation of the fertilized egg
5. Choice of birth control. Use of progestin-only oral contraceptives or progestin-only implants (IUD) may put a woman at risk for ectopic pregnancy.
6. Smoking. Studies have shown that an elevated risk of 1.6 to 3.5 times is more common for smokers than non-smokers to develop ectopic pregnancies.

Complications of Ectopic Pregnancy

Complications of ectopic pregnancy can be due to incorrect or late diagnosis, or faulty treatment regimen.

Failure to address the diagnosis of ectopic pregnancy correctly and promptly will result to rupture depending on the implantation site, therefore leading to massive bleeding, shock, disseminated intravascular coagulopathy (DIC), and death.

Diagnosis of Ectopic Pregnancy

• Physical examination – a pelvic examination may show these findings:
• Uterus is slightly soft and enlarged
• Uterine or cervical motion tenderness – suggestive of peritoneal inflammation
• Upon palpation, an adnexal mass may be assessed. However, this mass is usually difficult to differentiate from the ipsilateral ovary.

• Serum B-HCG levels – serum Beta Human Chorionic Gonadotropin (B-HCG) levels are elevated, but not as much as with normal pregnancy. This test is necessary to differentiate between normal and abnormal pregnancies. This is also crucial to monitor the therapeutic effect of treatment once therapy is initiated. An elevated serum B-HCG level and the absence of uterine pregnancy is highly suggestive of an ectopic pregnancy or abortion.
• Progesterone levels – They are helpful in aiding with diagnosis as progesterone is:
  • Not gestational age dependent
  • Remaining relatively constant during the first trimester of normal and ectopic pregnancy
  • Independent and not correlated with B-HCG levels
  • If initially abnormal, progesterone levels do not return to reference range

• Ultrasonography – used as the most important tool for diagnosing extra-uterine pregnancy. It involves the utilization of sound waves in assessing the intra uterine and abdominal structures.
• Laparoscopy –used as the gold standard in diagnosing ectopic pregnancy for patients who are in pain or hemodynamically unstable.

Treatment for Ectopic Pregnancy

Treatment management for unruptured ectopic pregnancy involves medical and surgical therapies and they are:

1. Antimetabolite therapy/ Folic acid antagonist. In antimetabolite therapy, the patient is given a single dose or multiple sessions of chemotherapeutic agent through the intramuscular route.  The effectiveness of this regimen to trophoblastic has been well established due to its original indication for use against hydatidiform moles and choriocarcinomas.
2. Salpingostomy and Salpingectomy. Salpingostomy is the surgical removal of the unruptured ectopic pregnancy from the fallopian tube utilizing laparoscopic technique. Salpingectomy is the surgical resection of the unruptured ectopic pregnancy and the involved fallopian tube through laparoscopy.

Medications. Other supportive medical treatments for the management of ectopic pregnancy are:

• Folic acid analogs – used with Antimetabolite therapy to limit its nephrotoxic and hepatotoxic effects while allowing its action against trophoblastic tissue.
• Vitamin D – used to correct depressed folic acid levels brought about by antimetabolite treatment
• Vasopressors – used to minimize bleeding during surgery by acting on the alpha1 and beta1 receptors, thereby stimulating vasoconstriction

Nursing Diagnosis for Ectopic Pregnancy

Nursing Care Plan for Ectopic Pregnancy 1

Nursing Diagnosis: Deficient Fluid Volume related to active blood loss secondary to ectopic pregnancy, as evidenced by an average blood pressure level of 85/50, body weakness, decreased urinary output, and pale, clammy skin

Desired Outcome: The patient will re-establish a functional body fluid volume and a balanced input and output status.

Nursing Intervention for Ectopic Pregnancy	Rationale
Assess vital signs, conduct physical examination, and commence daily weight monitoring.	Edema, headaches, low blood pressure, and pain are associated with the patient’s blood loss. Fluid retention may be evident if the patient has an unexplained weight gain.
Start input and output monitoring.	To monitor circulatory blood volume. To ensure that the patient has adequate oral hydration or if there is a need to commence IV hydration therapy.
Speak to the patient and family about the need for hospitalization for the treatment of serious hemorrhage and the need for surgery.	To treat the vaginal bleeding and deficient fluid volume related to ectopic pregnancy in the appropriate setting.
Prepare the patient for the surgical intervention for ectopic pregnancy. Place the patient on a nothing by mouth (NBM or NPO) status.	Salpingostomy is the surgical removal of the unruptured ectopic pregnancy from the fallopian tube utilizing laparoscopic technique. Salpingectomy is the surgical resection of the unruptured ectopic pregnancy and the involved fallopian tube through laparoscopy.  Placing the patient on “Nothing By Mouth” (NBM or NPO) is necessary to prepare the patient for emergent delivery.
Prepare for blood transfusion as required.	To increase blood volume.
Encourage the patient to have a low salt intake.	Consuming salt between 2 to 4 g per day is ideal as a very low salt intake may increase dehydration.

Nursing Care Plan for Ectopic Pregnancy 2

Nursing Diagnosis: Risk for Maternal Injury

Desired Outcome: The patient will maintain safety and participate in measures that will protect self during the treatment.

Nursing Intervention for Ectopic Pregnancy	Rationale
Assess the patient’s mental status.	Ectopic pregnancy may cause the patient to have low mood, depression, or negative emotional state, which puts her at risk for maternal injury.
Monitor the patient’s level of consciousness using AVPU.  Heavy vaginal bleeding may result to hypotension and lower level of consciousness. Using AVPU scale (i.e.  Alert, Voice, Pain stimuli, or Unresponsive/unconscious) can help determine the urgency of surgical treatment and increased risk for maternal injury.
Prepare the patient for immediate surgical intervention for the removal of the ectopic pregnancy.	Ectopic pregnancy is the leading cause of maternal death during the first trimester due to internal bleeding, therefore an urgent surgery to remove it is needed.
Place the patient in complete bed rest if there is evidence of severe bleeding.	To reduce pain and keep the patient safe

Nursing Care Plan for Ectopic Pregnancy 3

Nursing Diagnosis: Acute Pain related to ectopic pregnancy as evidenced by pain score of 10 out of 10, verbalization of abdominal pain, abdominal rigidity, and restlessness

Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness.

Nursing Intervention for Ectopic Pregnancy	Rationale
Administer prescribed pain medications.	To alleviate the symptoms of acute abdominal pain.
Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.	To monitor effectiveness of medical treatment for the relief of abdominal pain. The time of monitoring of vital signs may depend on the peak time of the drug administered.
Elevate the head of the bed and position the patient in semi Fowler’s.	To increase the oxygen level by allowing optimal lung expansion.
Place the patient in complete bed rest during severe episodes of pain. Perform non-pharmacological pain relief methods such as relaxation techniques such as deep breathing exercises, guided imagery, and provision of distractions such as TV or radio.	To provide optimal comfort to the patient.
Prepare the patient for surgery.	Salpingostomy is the surgical removal of the unruptured ectopic pregnancy from the fallopian tube utilizing laparoscopic technique. Salpingectomy is the surgical resection of the unruptured ectopic pregnancy and the involved fallopian tube through laparoscopy.
Post-surgery, advise the patient to: Have no strenuous activity for a few weeks.Apply support on the abdomen when coughing, laughing, or moving by placing a pillow over the abdominal areaInform the healthcare team if the pain medications are not working	To reduce post-surgical pain and allow full recovery and healing.

Nursing Care Plan for Ectopic Pregnancy 4

Risk for Bleeding

Nursing Diagnosis: Risk for Bleeding related to active blood loss secondary to ectopic pregnancy.

Desired Outcomes:

• The patient will have stable fetal heartbeats and normal vital signs.
• The patient will experience less or no vaginal spotting or bleeding.
• The patient will practice self-precaution to prevent more bleeding.

Nursing Intervention for Ectopic Pregnancy	Rationale
Evaluate the patient’s productive history.	Establishing gestational dates and determining whether the pregnancy location is known can be done by reviewing the menstrual history and, if applicable, prior ultrasound.
Evaluate maternal vital signs.	Every 15 minutes, check the patient’s heart rate, breathing, and blood pressure; when needed, use a pulse oximeter and an automated blood pressure cuff. Baseline information on how mothers react to blood loss is provided through this. As the heart tries to make up for the lower blood volume and the respiratory system speeds up the gas exchange to better oxygenate the RBCs, the heart rate and respiratory rate will begin to rise with severe blood loss.
Position the patient so that they are comfortable and help them move when necessary.	Patients should be positioned flat on the bed to minimize movement, stabilize vitals, and enhance comfort.
Keep an eye out for any of the following symptoms: severe abdomen discomfort, vaginal spotting, severe lower-quarter pain, and vaginal bleeding.	Before the rupture happens, it’s important to recognize any warning signs and symptoms. It would be challenging to first detect them because the majority of ectopic pregnancies do not exhibit any odd signs and symptoms at the point of implantation.
Plan out the patient’s rest and activity times.	If a threatened abortion involves a living fetus and probable bleeding, the patient may refrain from the intense activity for 24 to 48 hours to stop it. Since blood pools in the vagina, complete bed rest is typically not necessary even if it may seem to reduce vaginal bleeding. When the patient begins to move again, the vaginal blood collection will drain and bleeding will resume.
Monitor input and output.	To track the volume of blood in circulation. To determine whether the patient is receiving appropriate oral hydration or whether IV hydration therapy has to be started.
Get the patient ready for the surgical procedure to remove the ectopic pregnancy. Put the patient on a nothing by mouth status.	Due to internal bleeding, ectopic pregnancy is the leading factor of maternal death during the first trimester. Therefore, it requires immediate surgery to be removed. Using a laparoscopic method, an unruptured ectopic pregnancy is surgically removed from the fallopian tube by a salpingostomy. Salpingectomy is the surgical removal of the affected fallopian tube and the unruptured ectopic pregnancy using laparoscopy. For the patient to be ready for urgent delivery, they must be put on nothing by mouth.
If necessary, get ready for a blood transfusion	To increase blood flow.
Give medications as prescribed and keep an eye out for any negative reactions.	To treat symptoms, antiemetic, and analgesic drugs may be administered. Other medications may be used to absorb the pregnant tissue and preserve the fallopian tube.
Give the patient information on how to prevent ectopic pregnancies in the future.	Advise the patient about risk factors and lifestyle adjustments that can be made to prevent ectopic pregnancies in the future. Quit smoking. Pelvic infections and ectopic pregnancies are more likely in those who have multiple sexual partners.
11. Examine the patient’s vital signs and pain characteristics at least 30 minutes following medication administration.	To assess the efficacy of medical treatment for pain alleviation. The timing of vital signs monitoring may be influenced by the peak time a medicine is administered.
12. Provide anxiety-relief education to patients and their families.	Describe the situation and the anticipated result. Early diagnosis and immediate treatment, such as laparotomy to ligate bleeding vessels and repair or remove the damaged fallopian tube, improve the prognosis for mothers.

Nursing Care Plan for Ectopic Pregnancy 5

Anticipatory Grieving

Nursing Diagnosis: Anticipatory Grieving related to loss of pregnancy secondary to ectopic pregnancy as evidenced by distress, changes in communication patterns, and changes in quality of sleep.

Desired Outcomes:

• The patient and her partner will share their grief over the loss of their pregnancy.
• The patient and her partner will employ effective coping mechanisms to get through sorrow.
• The patient will verbalize a desire to move through the established stages of mourning in her own pace.

Nursing Intervention for Ectopic Pregnancy	Rationale
Recognize signs of grief, such as astonishment, denial, wrath, and despair.	The patient, her partner, or her family may go through a spectrum of emotional responses to the bereavement and its real and possible effects on life. These phases are fluid, and the patient’s progress through them changes with time. It’s common for excruciating pain to take the place of shock after it starts to subside. Even though this mourning reaction is agonizing, it’s crucial that bereaved parents feel all of their suffering. Negative coping techniques may result from the grieving process when the sorrow of prenatal loss is avoided.
Determine whether there is a communication gap, emotional lability, or a lack of inquiries.	The initial reaction to losing a pregnancy is shock. Following a miscarriage, some patients suppress their emotions out of a desire to move on as quickly as possible.
Take note of the lack of interest in life, disturbed sleep, suicidal ideation, and despair.	Weeks, months, or even years may pass during a depression. This stage of mourning can last for a protracted period of time and include feelings of sadness, isolation, loneliness, emptiness, despair, and self-reflection. It is at this point that the bereaved parents understand the full significance of their loss.
Encourage grief expression by offering privacy, eliminating time constraints, and enabling support individuals of choice to visit.	These interventions support the patient and the family in expressing their grief and starting the process of resolving it. Grief is a personal experience, and people respond to it in different ways. Support could be given effect by acknowledging the patient’s and family’s emotions and encouraging expression.
Use the stages of grieving to guide nursing interventions.	Understanding the typical stages of grief can help a nurse determine whether a family member is experiencing normal grief or dysfunctional grief. Stages allow the nurse to better understand the patient’s behavior; for instance, blaming others is a common grief process and isn’t always intended for the nurse or other health practitioners. As a result, the nurse can comfort the patient that their sensations are normal without making them seem less intense.
Communicate with the patient’s family in an open and honest manner.	The family’s ability to communicate their grief is the initial step in resolving their issues, thus being present, empathetic, and encouraging open communication is key. The family may also be directed to neighborhood organizations or interdisciplinary medical teams as necessary.
Give the patient’s family clear, factual information about the diagnosis and treatment.	When offering emotional support, be honest with the patient’s family and avoid making any fictitious assurances. The patient may first become unaware of her environment and goings-on, and her capacity for sustained concentration may be diminished. The family’s frustration and sadness may be exacerbated by their lack of knowledge.
Accept expressions of anger and despair. Instead of arguing, demonstrate compassion for the patient.	The treatment provided to patients following a pregnancy loss differs, parents expect the healthcare professionals to be sensitive to their requirements and compassionate to their pain. They seek emotional reassurance. However, callousness and indifference, which are frequently unintended, can make the mourning parents’ already trying situation even more difficult. Warm words of kindness and touch have the ability to have long-lasting healing benefits.
Help the patient to take charge wherever it is possible by helping them set up care routines, nutritional preferences, entertainment activities, and so on.	Encouragement of patient participation lessens a feeling of helplessness while also giving the patient a sense of control and responsibility. If surgery has involved removing the fallopian tube, the patient who experienced an ectopic pregnancy may also experience issues with a weakened sense of self-image and a sense of helplessness.
Whenever necessary, inform the patient and partner regarding the benefits of psychotherapy.	In order to move past their grief and make peace with their unpleasant sentiments and memories, individuals who have recently lost a loved one can benefit from psychotherapy. In order to manage the symptoms of anxiety and depression, therapy may also help patients use techniques including relaxation, pleasant activities, and questioning negative beliefs. From clinical experience, couples therapy, interpersonal therapy, and cognitive behavioral therapy are effective treatments for this demographic. Both mourning parents should be included in therapy, and they should maintain communication throughout.

Nursing Care Plan for Ectopic Pregnancy

Fear/Anxiety

Nursing Diagnosis: Fear/Anxiety related to the potential for death for oneself or a fetus secondary to ectopic pregnancy as evidenced by verbal expression of particular issues in words, heightened anxiety, and sympathetic activation

Desired Outcomes:

• The patient will talk about her anxieties for herself, her unborn child, and future pregnancies while distinguishing between healthy and harmful fears.
• The patient will communicate precise information about the circumstance verbally.
• The customer will demonstrate good resource management and problem-solving skills.
• The patient will express or report reduced fear and/or fear-related behaviors.

Nursing Intervention for Ectopic Pregnancy	Rationale
Observe the patient’s or couple’s nonverbal and verbal reactions.	This reveals the level of fear that the patient or couple is feeling. Most expectant mothers believe their baby is alive up until the point an ultrasound reveals that their fetus no longer has a heartbeat. Due to worries that they may never be able to carry a kid to full term, they may want assistance embracing the reality of the situation and counseling before starting a future pregnancy.
Check the fetal heart sounds together with the patient and her partner.	No matter how the patient may appear to others, she most likely is under a lot of emotional strain. The patient can’t help but worry that the next time she bleeds, either she, the baby, or both of them will die. It is beneficial to hear the fetal heart sounds and be comforted that they are within a healthy range. It is also beneficial to have a supportive person with whom she can discuss her worries about the child and herself.
Inform the patient and her partner about the circumstances.	This reveals details about how each person is responding to the current situation. Make sure the patient is aware that, in the event of an incomplete or impending abortion, the pregnancy has already been lost and that the operations being performed are being done to keep her safe from bleeding and infection, not to stop the pregnancy.
Encourage the patient and partner to share their feelings and concerns at a suitable moment.	Following a miscarriage, some patient suppress their emotions out of a desire to move on as quickly as possible. If it helps them deal with their rage or sadness about losing the pregnancy, short-term repression in this manner may be beneficial. Be careful, though, so the patient doesn’t expose herself to bleeding by denying the memory of her medication at the same time as the event.
Be attentive to the patient’s issues.	This encourages a feeling of authority over the circumstance and gives the patient the chance to create their solutions. The nurse pays attention to the patient and expresses sympathy for both her and her partner’s grief. They frequently lament what may have been even if the pregnancy wasn’t anticipated or intended. They may experience deeper and more prolonged grief and distress than they or other people anticipate.
Define to the patient the processes and the meaning of any symptoms.	Fear can be lessened and a sense of control over the circumstance can be enhanced with knowledge. After having an abortion, most patients adjust well, especially if they were given accurate and comprehensive knowledge about what to anticipate both during and after the surgery.
Provide accurate and truthful answers to the patient’s inquiries.	The patient will be better able to handle the situation if they are informed. Written material enables evaluation in the future because the patient’s level of anxiousness may prevent them from being able to process knowledge. Sincere responses help others learn more and can lessen fear.
Make every effort to engage the patient in the planning and delivery of care.	The fear can diminish if there is something you can do to help manage the circumstance. If surgery has involved removing a fallopian tube, a patient who has an ectopic pregnancy may also experience issues with a lowered feeling of self-worth and a sense of helplessness.

More Ectopic Pregnancy Nursing Diagnosis

• Risk for Shock
• Powerlessness related to early loss of pregnancy

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

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