Family Nurse Practitioner in Outpatient Environment Crucial Patient Interview Questions
When did you first notice the abdominal pain?
When did you first notice a lack of menstrual periods?
When did you first notice vaginal bleeding? What was the duration?
Have you previously had an ectopic pregnancy?
Have you ever had a fallopian tube disorder?
Do you have a history of fallopian tube anomalies or gynecological surgeries?
Have you ever suffered from pelvic inflammatory disease, fibroids, or endometriosis? How long have you been using IUDs?
What is the number of sex partners you have?
A patient with the condition's clinical findings
Bleeding in the cervix
Amenorrhea
Tenderness in the abdomen, palpable adnexal mass
Enlarged uterus (Du, Fan, Chen, Lyu & Kuang, 2016).
Ectopic pregnancy is confirmed by imaging and laboratory studies as well as physical examination. The clinical findings include;
• Postive beta HcG test result above 15-00 IU/L (Du, Fan, Chen, Lyu & Kuang, 2016).
• Positive ultrasounds
• Positive laparoscopy (Gordon, 2014).
Diagnostic studies
The diagnostic studies are ordered for the physician to have identification of the specific condition to create a holistic treatment plan. The study identifies the specific area of weakness and the diseases. The ordered studies may include imaging and radiology.
Diagnosis
The primary diagnosis for the patient includes physical examination of the symptoms and medical history to identify the probable condition. The examination identifies the risk factors for the condition. Differential diagnosis includes checking and measuring the β-HCG levels based on the symptoms identified in the physical examination (Gordon, 2014). When the levels are above 1500IU/L, there is a high probability of the physicians suspecting ectopic pregnancy (Du, Fan, Chen, Lyu & Kuang, 2016). β-HCG levels above the discriminatory zone can indicate an ectopic pregnancy and the level measured in primary diagnosis performance of transvaginal ultrasound to confirm the case and rule out other conditions. A diagnostic laparoscopy is also conducted as a final confirmatory test for ectopic pregnancy as it visualizes the pelvic and abdominal organs (Du, Fan, Chen, Lyu & Kuang, 2016).
Management Plan
The management plan for the patient incorporates pharmacological and non-pharmacological interventions. Methotrexate can be useful for the unruptured ectopic pregnancy through single dose IM injections (Gordon, 2014). The management plan should also incorporate surgical treatment by utilizing laparotomy.
Patient education should be giving precaution against sexual intercourse, anti-inflammatory drugs, folic acid vitamins and alcoholic beverages while using methotrexate (Gordon, 2014). Medical monitoring of the patient and follow-up is done especially to the patients that have undergone surgeries. Besides, regular monitoring of the β-HCG levels is recommended until the treatment is complete (Gordon, 2014).
References
Du, T., Fan, Y., Chen, Q., Lyu, Q., & Kuang, Y. (2016). Recurrence risk of ectopic pregnancy is not increased for patients with previous ectopic pregnancy compared with those without previous ectopic pregnancy in frozen blastocyst transfer cycles: a study based on more than 30,000 cycles. Fertility And Sterility, 106(3), e24-e25. http://dx.doi.org/10.1016/j.fertnstert.2016.07.082
Gordon, C. (2014). Ectopic pregnancy. [Place of publication not identified]: Adhurst Publishing.
