A pregnant woman is rushed to the hospital with vaginal bleeding, rapid thready pulse, and falling blood pressure. She is distressed and crying. After inserting a needle through the postvaginal fornix, the doctor confirmed a ruptured ectopic pregnancy. The nurse's immediate action prior to surgery is to
• 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.
• Use the A-B-C Framework to answer this question. This patient is crying and does not have evidence of a compromised airway but is hemorrhaging, so your initial intervention should address the bleeding.
• To keep blood to the 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.
• Incorrect: 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 the top priority of the nurse. In an emergency, the physician can write an order for surgery due to medical necessity and surgery can proceed without the consent.
• Incorrect: 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.
• Incorrect: Administering oxygen should be done, but only after the patient has been put in Trendelenburg and has her IV started to ensure fluid management. In reality, another nurse would probably be on hand to help apply oxygen while this happens, but the first priority is circulation.