A pregnant woman is rushed to the hospital with vaginal bleeding, rapid thready pulse, rapid respirations, and falling blood pressure. After inserting a needle through the postvaginal fornix the doctor confirmed a ruptured ectopic pregnancy. The nurse immediate action prior to surgery is to:

Explanation

•Once an ectopic pregnancy ruptures, it is an emergency situation and the woman’s condition must be evaluated quickly. Keep in mind that the amount of blood evident is a poor estimate of the actual blood loss.

•To keep blood to vital organs, immediately position the patient in the trendelenburg position with the feet higher than the head.

•After positioning the patient, intravenous fluids are administered using a large gauge catheter to restore intravascular volume. Blood can be administered through this same line as necessary.

•Although the therapy for a ruptured ectopic pregnancy is laparoscopy to ligate the bleeding vessels and to remove or repair the damaged fallopian tube, obtaining surgical consent is not top priority of the nurse. The physician should inform the patient and significant others of the diagnosis and its treatment options.

•If an ectopic pregnancy can be diagnosed by a routine sonogram before the tube has ruptured, it can be treated medically by oral methotrexate, followed by leucovorin. Methotrexate attacks and destroys fast growing cells.

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