A 28-year-old at 7 weeks gestation by LMP presents with sudden right lower quadrant pain, syncope, BP 88/56, HR 124, and a serum hCG of 4200 with no intrauterine pregnancy on bedside US. Which interventions should the nurse anticipate? Select all that apply.
Select All That Apply
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Explanation
Ruptured ectopic with hemodynamic instability requires SURGICAL management (laparoscopic salpingostomy or salpingectomy) with two large-bore IVs, blood products on standby, urinary catheter for resuscitation monitoring. Rh-negative clients receive anti-D immunoglobulin. Methotrexate is for STABLE unruptured ectopic with hCG under 5000, no fetal cardiac activity, mass under 3.5 cm — NOT for ruptured/unstable. Time to surgical control is the most important determinant of survival.
Risk factors: prior PID, prior ectopic, IUD in place at conception, tubal surgery, IVF. Consider ectopic in any reproductive-age female with abdominal pain plus positive hCG.
Free fluid on FAST. History of PID and prior tubal surgery. Hb 9.4.
ectopic pregnancy — Pregnancy implanting outside the uterine cavity; tubal most common.
methotrexate — Folate antagonist used for medical management of stable, unruptured ectopic.
Rho(D) immune globulin — Prevents Rh isoimmunization in Rh-negative pregnant clients exposed to Rh-positive blood.