异位妊娠护理双语课件

A case for example,Miss Wang,25,complained about delayed menstruation for 10 days, have had vaginal bleeding for 5 days. A great sharp pain occurred in her abdomen this morning when she was lifting something heavy. Then she felt dizzy and cold . Her HCG test of urine was positive. And the B-mode ultrasona- graphy suggested some fluids was in the abdominal cavity and a mass was on the lateral oviduct. So what happened to her?,Aims and demands,1. To master the definition of ectopic pregnancy and its typical clinical manifestation. 2. To know well about the pathology of ectopic pregnancy and the main nursing interventions. 3. To know about the main treatments for ectopic pregnancy and its diagnostic tests.,Ectopic pregnancy,Definition,Ectopic Pregnancy is an implantation of a fertilized ovum(受精卵) in an area outside the uterine cavity,Abstract,According to the locations 1.Tubal Pregnancy (the most common, make up 95%) 2.Ovarian Pregnancy 3.Cervical Pregnancy 4.Abdominal Pregnancy,Tubal Pregnancy,According to the locations, they are classified into four types: 1.Ampullar壶腹部tubal pregnancy (78%) 2.Isthmic（峡部） tubal pregnancy 3.Fimbriated tubal pregnancy 4.Interstitial（间质） tubal pregnancy,Etiology,Any condition that narrows the tube or brings about some constrictions within it may cause a tubal pregnancy 1.An infection or inflammation of the fallopian tube. Or pelvic inflammatory diseases involving the tube. 2.Developmental abnormalities 3.Others,Pathology,1.Tubal abortion Common in ampullary tubal pregnancy. 2.Tubal rupture Common in isthmic tubal pregnancy,Pathology,3.Abdominal pregnancy. rare to see 4. Uterine changes. an increase in size endometrium（子宫内膜） is converted to deciduas vaginal bleeding,Clinical manifestation,1.Symptoms: The most common symptoms are amenorrhea(停经), lower abdominal and pelvic pain and vaginal bleeding. amenorrhea vaginal bleeding pelvic/abdominal pain shock and syncope (晕厥),Clinical manifestation,2. Signs General condition Vital signs（生命体征）: blood pressure will fall, pulse would rise and shock may present. Abdominal examination abdominal mass in the lateral oviduct（附件） abdomen becomes rigid from peritoneal irritation. Pelvic examination pain of movement of the cervix fullness in cul-de-sac（直肠子宫陷凹） on vaginal examination,Diagnostic tests,1.Culdocentesis （后穹窿穿刺） The blood aspirated does not clot . The result is positive.,Diagnostic tests,2. Test of human chorionic gonadotropin (HCG) This is the key test, however, is whether the woman is pregnant. 3. Ultrasonography （超声检查） To determine whether or not a pregnancy is inside the uterine cavity 4. Curettage（刮宫） None of an embryo or a fetus is identified but deciduas 5. Laparoscopy.(内窥镜) A characteristic bluish swelling within the tube,Management,1.Operation salpingectomy （输卵管切除术） or salpingotomy （输卵管切开术）.,Management,2. Medical management Methotrexate （氨甲喋呤） It is a folic acid antagonist（叶酸拮抗剂） that interferes with DNA synthesis（合成）,Nursing assessment,1.Nursing history histories of the pregnancy, abdominal surgeries , infections of the fallopian tube 2.Symptoms and signs the typical symptoms signs: fullness in the cul-de-sac. Pain of the cervix. 3.Psychic reactions anxious, sad, misery and etc. 4. The diagnostic tests,Nursing diagnosis,Risk of the hypovolemic shock related to the bleeding. Fluid volume deficit related to the bleeding from rupture The anticipatory grieving related to the loss of pregnancy. Pain related to tubal rupture, the intra-abdominal bleeding. Knowledge deficit related to lack of information about treatment and possible complications.,Nursing plans,The intra-abdominal bleeding will be released and the shock will be treated in time. The fluid volume will be normal again after the timely treatments. The pain will be controlled in time. The patient will discuss the impact of the loss on her and her family, progressing appropriately through the grieving process.,Nursing interventions,For the ones received the medical or the conservative treatments. 1.Explain the importance of keeping in bed. 2. We should suggest the patients eat more vegetables and fruits in order to help for defecation. 3.Do not let the patient go outside of the ward alone. 4. Explain the therapeutical effect and the side-effects of the medicine.,Nursing interventions,For the ones who need surgeries especially for the intra-abdominal bleed