Primary Nursing Diagnosis

Anticipatory grieving related to the loss of a pregnancy OUTCOMES. Coping; Family coping; Grief resolution

INTERVENTIONS. Grief work facilitation; Perinatal death; Active listening; Presence

U PLANNING AND IMPLEMENTATION Collaborative

MEDICAL. Medical management of a tubal pregnancy depends on the patient's condition, gestational age and size, whether the tube has ruptured. If the tube is intact, the gestation is less than 6 weeks, and the fertilized mass is less than 3.5 cm in diameter, methotrexate, a chemothera-peutic agent that inhibits cell division, may be ordered. The patient must also be committed to coming in for follow-up appointments, as this is critical to maternal well-being and assessing the effectiveness of treatment. Human chorionic gonadotropin (hCG) levels and fetal cardiac activity are monitored with methotrexate therapy; success of treatment is based on these two assessments (hCG should decrease 15% by day 4 and fetal cardiac activity should cease by day 7). If the tube is damaged or ruptured, surgical management is indicated immediately.

SURGICAL. Laparoscopic laser surgery is usually performed, but if the tube has already ruptured, a laparotomy may be indicated. A salpingectomy (removal of the tube), salpingostomy (incision and evacuation of tubal contents), salpingotomy (incision and closure of the tube), or segmental resection and anastomosis can be performed. The goal is to salvage the tube, especially in women who desire future pregnancy.

Postoperative care includes monitoring vital signs and observing for other signs of shock. Monitor the fluid intake and output as well, and note the color and amount of vaginal bleeding. Observe the incision for any signs and symptoms of infection. Administer analgesics and assess the patient's level of pain relief from the medication.

Pharmacologic Highlights

Medication or

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